Mental Health Care Provision

[crazylegs]

There appears to be a complete break down in the provision of Mental Health Care in the UK.

Last night my collegue, myself and the duty supervisor spent around 6-7 manhours dealing with a schizophrenic who had knocked on the door of the station who was talking constantly about the issues that confused him. He has been in a mental health facility before and has spent extended periods of time there.

However his social worker and Dr. have decided it would be more appropriate for him to be released into society, into a society that he cannot function properly nor can he care for himself completely, for example he has a 'friend' called Bob. Bob has taken some money from him so Bob can buy a car. The value of which (the money) is a grand sum of £7 and £40. Me thinks this car may be running on brown sugar.

The male should be in some sort of sheltered accomodation but, as mental health is 'invisible' it receives a pitiful amount of money for funding. I am not a health care provider in any sense and am most definately not trained to deal with any type of episode, I am definately not equipped to transport someone back to their accomodation, we do not have cage cars like the states nor are there sufficient vans or drivers to transport someone safely if he were to have a full psychotic episode, and yet it is us that are called to assist.

It isn't right.

[Seshat]

This is a topic on which I can rant for DAYS!

However, my best friend (who is mentally disabled) pointed out to me that it's less than a century ago that lithium and valium were discovered, and not much more than a century ago that Freud started psychoanalysis. Before then, the mentally ill were either locked up in what were effectively warehouses, or left to the care of their families.

That said, 'de-institutionalisation', while a good idea in theory, required that the community have the resources to care for the mentally ill. Yet those resources STILL aren't there.

For Crazylegs' specific problem: some ambulances have medical restraints, and can get the patient to a hospital with a psychiatric wing. Check with your ambulance service, see if they can cooperate with you to get patients where they need to be.

My opinion on de-institutionalisation:

For people like my best friend, it's terrific. Keep her on the meds she needs, give her regular visits to her psych, give us crisis services and respite services, and she can be part of the community. Noone other than her family and her medical team needs to even know she's disabled, and unless they see us in a crisis, noone can tell. She needs hospitalisation if her meds need to be changed, but that can be a hospital just like a hospital for physical illness.

Of course, we don't have the crisis and respite services at the level we need them, but we're pushing for those.

For those who can't look after their financial, health and physical needs, but who don't need constant supervision, we need a kind of sheltered accomodation. Places where they can look after themselves to the extent that they can, where they can go off to jobs that they're capable of during the day, but can come home to a place where their meals are planned for them, someone else organises their medical care, and they don't have to handle things that are beyond them.

Then there are those like crazylegs' patient, who needs constant supervision when he's having an attack, but who may (or may not) be fine if properly medicated. Those need hospitals, some of which are as open as any other hospital, and some of which are essentially medical prisons.

Some patients, unfortunately, will forget to take their medication. Some develop a paranoia and believe their medication is an attempt to poison or control them. These need a varying range of care. The forgetful need community nurses who will dispense their medication and watch them take it. The paranoid may need hospitalisation or assisted accomodation.

And there are a pitiful few who, unfortunately, I have to advocate for locking up for life. They're just too dangerous to themselves and/or to others. Hopefully one day we'll find ways to fix their neurochemistry or neural anatomy.

I want all these services available. I want the crisis centres available 24 hours, potentially as part of emergency rooms. I want ambulances and/or police to have safe, secure vehicles in which to take these patients to the crisis centres, and I want the crisis centres to be able to determine which facility is appropriate to send each patient to for diagnosis and further treatment.


I believe that screening for mental health problems is important, I'd like to see screening done in schools at various critical stages of development.

I'd like to see GPs (general practitioners - in Australia, that's what we call the doctor you first see) able to spend enough time with patients to recognise the signs of potential mental illness. I'd like to see them send patients to diagnostic psychiatrists, and to see the diagnostic psychiatrists sending patients to psychologists, counsellors, or treating psychiatrists: and their staff making all the contact calls. People with mental illness often have difficulty making appointments or even admitting their illness to themselves.

Annnd - I'm starting to rant. I'll leave off here.


Edit to add: to me, the distinction between individual personality and mental health problems is a combination of ability to function (eg: someone who can't understand the basics of legal proceedings is mentally unfit to stand trial), and ability to cope with one's own mind. Someone who feels trapped inside uncontrollable emotions has a mental problem. Someone who simply doesn't like school, doesn't have a problem - or at least, that in itself is not a problem.

[crazylegs]

For Crazylegs' specific problem: some ambulances have medical restraints, and can get the patient to a hospital with a psychiatric wing. Check with your ambulance service, see if they can cooperate with you to get patients where they need to be.

Unfortunately the local ambulance service is unable to transport anyone who is or may become violent, we are supposed to transport them in a van and use suitable restraints if applicable. However there are very few vans available and even fewer people who are authorised to drive them (vans over a certain size requre a seperate test on your driving licence and you then need to undergo a seperate test at work).

This lead to the situation where we had to transport someone who was obviously ill, where we had no idea of his mental condition nor his history and we had to transport him in the back of a car with a collegue next to him.

Not the best plan in the world.

*Edit, I only found out at the end of the car journey that he was schizophrenic as he told us, and it was only with a discussion with another collegue who used to work in our local secure facility that he was a resident there.