Friday, 30 November 2012

MIND campaign for better crisis care...

Mind are currently campaigning for better care for those experiencing a mental health crisis.  This is my contribution; my own experiences of crisis care and a few thoughts along the way...

I have experienced mental health services in two different counties and crisis care has been next to non-existent in both.  The worst occasion involved being told I was a “waste of time” and to “just go away” by a nurse in A&E, after being taken there by concerned police officers.  This was a few years ago, and since then my treatment in general has improved (due to changes in treatment criteria) so I will focus on the more recent and relevant experiences of 'crisis' care.

One thing that really sticks out is the futile, circular nature of trying to access crisis services, especially out of hours.  For a start, it seems that everyone you speak to tells you to call someone else – GP, Crisis Team, A&E, the Police.  In my experience, this does not lead to any support, yet if the person/service you speak to is actually concerned you may be at risk, they resort to calling the police rather than offering any help directly.  The police can't do anything except take you to A&E to be assessed, perhaps under a section 136. I have been assessed many times in A&E by the Crisis Team, who talk to me for a bit, raking up all sorts of upsetting things from the past and dismissing any present issues, and then send me on my way.  If I'm in a particularly anxious state I might be given a sedative or two to take home.  The ridiculous thing is, the Crisis Team always say “call us if you need to”, yet it is usually them who have called the police in the first place when I rang up in crisis!
I have also spent nights in police cells when the crisis team had refused to see me but the police were too concerned to just let me go.  In addition, I have been held in the '136 suite' on several occasions waiting for assessment.  Although the daytime room there is fine, the room for overnight is basically a cell – a plastic mattress on the floor and a toilet in the corner, without the basic dignity of somewhere to wash your hands after using it.  Both here and the police cells are the last places anyone in crisis should be.  Also, there is usually a lengthly wait to be assessed wherever you are – the longest I waited was eleven hours (under section so couldn't leave).

I feel my experiences of crisis care are particularly unfortunate, as they have actually contributed greatly to my present mental health difficulties.  I have nightmares and flashbacks of these occasions, and seeing things that remind me of them sends me into a confused, anxious state.  Seeking help involves going back to the places that I associate with feelings of despair and terror, meaning I often feel I would take my own life before seeking professional help in a crisis.
Fortunately I now have some good, understanding friends who I can chat to or just be around if I'm feeling vulnerable.  And that, I think, is key – someone just showing some humanity and compassion makes all the difference.  There was a security guard in my local A&E who chatted to me whilst escorting me outside for a cigarette, and his kindness helped far more than anything the Crisis Team did.  All too often basic care and respect is lacking in professional crisis care.  I always wonder – would they treat me like this if I was a member of their own family or a friend?
I have, very occasionally, spoken to very helpful members of the Crisis Team who have listened to me, empathised with my situation, and encouraged me – without being patronising or dismissive of the pain I feel inside.  This makes so much difference, and doesn't really cost anything, especially when the longer-term costs of an escalated crisis are factored in.

Finally I would like to mention a concept very relevent to crisis services – 'failure demand'.  Failure demand basically means a service fails to do what it is supposed to, causing even more demand for the service.  I believe this is rife in mental health services; people cannot access appropriate help and support and so get more unwell and need more help in the long run.  In particular, a failure to provide adequate, useful treament means people end up in crisis far more often.
I think that addressing the reasons people end up in crisis should be part of the discussion on crisis care – could a crisis be prevented with earlier intervention or support?  After all, prevention is better than cure; and in these times of austerity and cutbacks, I'm sure it would be much cheaper too.