I`d like to tell you about a young adult of 23. who I know. Recently, he has been significantly troubled by a lack of clarity, balance and joy in his life. Over time he has become seriously off kilter, depressed and like many young people, disillusioned with life, the universe and everything. He tried to purge himself of his morose thoughts by commencing various diets such as gluten free, low carb`, low protein etc. or by not eating at all. He sometimes binged and then vomited. Over time he lost quite a lot weight and became very pale and withdrawn and further down the line, he was clearly very unwell. Eventually he became delusional and paranoid, he started to hear voices, he believed he was being pursued by people who wanted to harm him, he thought everyone was talking about him.
A recent global study evidenced that 72% of people who experience psychotic episodes have a single experience. https://www.nationalelfservice.net/mental-health/psychosis/psychotic-experiences-how-common-are-they-and-how-can-we-predict-their-onset-course-and-consequences/
In the UK, it is generally recognised that about 50 percent of young people who have a psychotic episode will not have a further episode throughout the remainder of their lives. We do not understand why, or what triggers these events and there are many schools of thought as to why they happen relating to hormones, inherited likelihood, diet, stress, street drugs, head injury as a child and imbalances of chemicals which affect the way the brain behaves, amongst other factors.
One night this young person finally hit his crisis point and had to be taken to A and E. The event was inevitable really since he had managed to hide or “mask” his symptoms and cope alone possibly for several years. After much persuasion at A and E, his parents finally got agreement for their son to have a psychiatric assessment. By now he was utterly exhausted by the thoughts that constantly harangued him and even he had some insight that he was unwell. He was kept waiting 18 hours to be assessed by which time he had become so agitated that in the early hours of the morning he ran away from the hospital. The police became involved. He was found in the city centre by his father and the police helped him to a nearby secure unit where he would be properly assessed. He was placed under Section 2 of the Mental Health Act which meant he could be detained for up to 28 days for a full assessment. His parents were relieved to know that their son would be safe and that they would be able to get their first decent night`s sleep for some days. After just five days the section was lifted and the family received an excited call from their son saying that he was coming home.
The family went into shock. They could not see how an authentic assessment could possibly have taken place in such a short period of time. During visits, their child still seemed rambling and delusional, they were terribly worried. After much to-ing and fro-ing, they finally spoke to a consultant. He said, “I spent an hour with your son today, he was rational, articulate, he made plenty of eye contact, he was not agitated, I cannot in all conscience keep him sectioned.”
The family were concerned that returning home would be a further “trigger”. They spent two days in negotiation with mental health services while their son remained on the ward and finally it was agreed that he would go to a half-way house for a period of respite. Here he would allegedly be supported by a psychiatric team, keeping an eye on his med`s and his moods until he was able to leave and live independently.
The half way house was pleasant enough but not in a great part of the city. His father negotiated with a mental health housing charity to move him to a shared house nearer to various relatives and in a much nicer area that he was familiar with. For a few days the arrangement went well however, the young man was not always compliant with his medication and the view of the house manager was that his mood was becoming flat and deflated. He had become quite rude which is unlike him and so it was decided that he would have an assessment by the Community Psychiatric Team. He waited all day for the assessment team to arrive and no-one turned up.
At 10.30pm the following night, he was woken up and taken from his bed to be sectioned again on a Section 2. His family could not see how on earth a social worker and two doctors can possibly have made an accurate assessment of him in, it appears, no time at all. He was driven to a unit in another county and arrived after 11pm where it was noted that he was “extremely angry.” This is hardly surprising; we would expect any person to be angry if treated in this way. It is shocking and disgraceful.
The following morning he was still angry, thumping walls and slamming doors. The response to this was to restrain him, in other words, pin him down while Lorazapam was administered via an injection, against his will. This is an unacceptable and archaic way to treat someone. It is 2018 and we would hope that in these more enlightened times, staff would be trained in creative ways of assisting people who are upset but apparently not. The ward manager told his family that staff “could not handle” his anger and so it was recommended he be moved yet again to a high security ward about thirty miles away.
Since being at the unit and in fact since the original section took place five weeks ago, at no time has he received any treatment other than being drugged with Olanzapine and other medications that have a tranquilising effect. He is not being treated he is being contained and his family are deeply concerned about this and very unhappy. It was their hope when he was clearly unwell, that he would receive proactive help and support. He hasn`t. Every-one has simply been reacting around him. Their increasing concern is that he will develop an addiction to the current medication and will then have to endure withdrawal symptoms when he is deemed well enough to reduce or cease the dosage.
In spite of this, he is now making small progress towards recovery and feeling better. He has had some anger issues on the secure unit and again we would suggest that this is entirely to be expected.
His family would like to understand if there is a medical reason why talking therapies and psychological support has not yet commenced? Does he meet the criteria to be kept on a section? He does not pose a threat of injury to himself and in twenty- three years he has never hit another person. He may well have made threats on the ward, but they are empty threats born of frustration at being constantly drugged and although I do not condone his bad behaviour, I can understand it. Does he have a mental health disorder? As far as I am aware, he has not yet been diagnosed.
The family is aware that their involvement is crucial to their son`s recovery. They would like him to be released so that he is free to come and go and spend quality time with them.
The family believes that many of the recommendations in the Mental Health Code of Practice have already been contravened. Four overarching principles are:
- Least restrictive option and maximising independence Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient’s independence should be encouraged and supported with a focus on promoting recovery wherever possible.
- Empowerment and involvement Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this.
- Respect and dignity Patients, their families and carers should be treated with respect and dignity and listened to by professionals.
- Purpose and effectiveness Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines.
It is their intention as a family to put forward their complaints and concerns to the appropriate authority in the strongest way available to them.
Their son will attend his tribunal this week to appeal to have the section lifted. Should the panel make the decision that his section cannot be lifted at this time, then they will appeal again. They would like to ask how are our mental health services intending to help their son recover because after this experience, they are naturally finding it difficult to believe that they will.
One final point, I hate to sound ageist but I question how appropriate is it to appoint nurses who are barely out of school, to comment to tribunal panel and make life changing recommendations on such complex matters?