I think that when we are talking about crisis care we need to recognise that a big part of problem is the care that people experience prior to their crisis because maybe then some crises can be prevented and people can go through less distress rather than ending up at the point where emergency services are required and hospital admissions are needed.
Firstly, I feel that GPs need more training in mental illness so that they can better understand patients who present with mental health concerns. Often people don’t want to go to their GP about their mental health difficulties when they first appear and so when they do make an appointment it is usually out of desperation. We all know how hard it can be to get a GP appointment these days, my surgery has a 6 week wait for an appointment at present. If someone walks into their GP surgery and says that they are struggling with mental health related symptoms then this must be taken seriously. I had been living in remission of my illnesses for almost a year when a huge relapse hit me and I had to go to a new GP surgery, I was drastically underweight and thinking of taking my life and my GP told me to book an appointment in a month and if I was still struggling he would make a referral then. I was in general hospital the next evening on drips and oxygen. Often it takes a lot of guts for a patient to turn up to an appointment and admit to a professional that they are unwell, GPs must realise that and act immediately on what the person is saying whether that be making a referral to a counsellor, the community mental health team or discussing medication. Help needs to be offered. Four weeks is a long time to be unwell and/or suicidal with no support.
The next problem with ‘pre-crisis care’ is the assessment process at community mental health teams. People may have waited weeks, or even months, for their assessment with the CMHT. I have known several people who have clung onto that assessment for dear life. It has been their glimmer of hope but at the assessment they have been told that they will be discharged back to the care of the GP and if things escalate then their GP should re-refer them. I think this is unacceptable and often leaves people feeling very hopeless and like there is no help for them. When I first moved to Wales I had an assessment with the mental health team before my notes had been sent over. I explained my history, my current struggles but was told that primary care (my GP) was appropriate for me and when I received the letter with a summary of the assessment it said that they felt the relocation to Wales was my primary difficulty. This was despite me explaining my history of anorexia nervosa, depression, avoidant personality disorder and previous inpatient admissions. I feel that they are under so much pressure practically and financially that they are using all the excuses they can to turn people away but this is life threatening. I fought hard and ended up with some support and then when I ended up detained under the Mental Health Act I finally got the help I needed. It’s just a shame that things were allowed to get to that point. Unwell, vulnerable patients should not have to fight for help when they are fighting for their lives. When depression is leaving you housebound and/or you are having psychotic episodes how are you meant to push your GP and mental health services to help you?
Next, I come to waiting lists. Where I live there is a two and a half year wait to see a psychiatrist if you are a non-urgent case…I imagine after two and a half years of an untreated mental illness the patient will be an urgent case! If the patient isn’t an urgent case then they are going to need more treatment to get well than they originally required, two and a half years of being ill is a long time! There is a 9 month wait to see a psychologist, the eating disorder specialist…people can die from their eating disorder in that time. I was in treatment for my eating disorder when the funding changed and as I lived on the county border it meant that my treatment had to go to the other county. I was discharged mid-treatment and put on the waiting list for the other county. I ended up waiting 18 months and spent that time in and out of inpatient care meaning that I lost my place at college. I was in recovery and doing well but being placed on that long waiting list made me unwell, cost me a lot in terms of life and by the time treatment came around I was so ingrained in anorexia that I couldn’t engage with the therapy.
This brings me on to therapy limits. When I began the therapy mentioned above my BMI was classed as ‘severe anorexia’ and the treatment team gave me 20 sessions. 20 weeks…that was it. I couldn’t even gain the weight I needed to reach a healthy BMI in that time and they wouldn’t start the therapy until my weight was healthy due to cognitive function. It was never going to work. How can you put a time limit on someone’s recovery? Everyone is different, someone might be back on track in 6 weeks, someone else might take 2 years. You cannot expect someone who has been unwell for 17 years to get better in 20 weeks.
I have reached crisis point several times, I have experienced personally how appalling pre-crisis care can be, or pre-hospital should I say. It shouldn’t take for a person to need a lengthy hospitalisation for them to receive the help they need. Some of my admissions could have been preventable, as could my detentions under the Mental Health Act. It’s quite scary to think that I have been admitted to hospital 7 times and only two of those times was I admitted without the police detaining me under S136 first. That’s 5 admissions where the NHS ignored my pleas for help, brushed me off and I ended up in a life threatening situation.
- I had spent weeks speaking to my GP and CMHT and was told to “go to the library and study.” I gave up speaking to them and tried to cope on my own but deteriorated and ended up being detained under a S136 after the police were called by concerned college staff. I was admitted for a very short admission but as soon as they could they discharged me.
- Following the above, I tried to pick myself up for two weeks. I wasn’t prescribed any medication or given any support. College called the police again after a friend had seen me in town in a bad state and persuaded me to go to the nurse. I was detained under S136 and spent the night in a cell due to no ‘places of safety’ being available before being transferred on to an acute psychiatric ward.
- I was not on any medication at the time and had recently gone through a trauma. I don’t remember the weeks leading up to this day but I had been to see my care coordinator that morning and I told her I wanted to die, she took the mick out of my voice and I left in tears. The police intervened and detained me under S136 before I was admitted to a ward.
- After my failed treatment with the eating disorder team after I was only offered 20 sessions after an 18 month waiting list I believed life was over for me. I thought I’d never get better. I tried to take my life and scarily nearly did. I was found barely conscious by police after being reported missing. After a stay in a general hospital, I was admitted to a psychiatric hospital and spent the admission being passed from ward to ward as no beds were available near my home.
- I had been speaking to my mental health team constantly, saying how strong the suicidal thoughts were getting, how I was struggling to take my medication due to the side effects. I was convinced someone was trying to kill me. I was terrified, hopeless, caught in depression and trying to cope with the weight I’d had to gain in hospital. I was given an urgent appointment at my CMHT and wasn’t taken seriously. I was crying and told to leave the room as someone else needed it so I went into the toilets to compose myself and was told to leave the building as they needed both cubicles. Later that day the police stopped me from taking my life.
‘Pre-crisis care’ requires a lot of change. Crisis care is important and life saving and we absolutely must get that correct but if we are to truly help people and help the strain on crisis services then we must get the care right in the first place before the patient experiences horrific and life threatening distress. I survived, but I often wonder how many people haven’t? How many people have died because they haven’t been able to get the care and treatment that they need? It’s a scandal and it needs to change.