Having chronicled a good crisis team response and a bad one over the past few weeks, I’m going to conclude this snapshot look at the state of our mental health crisis services with a trilogy of horror stories from a blog correspondent of mine (we’ll call her Tania) who helped two friends through emergencies, and then had to face one of her own.
All of these events occurred within the past two years.
Friend number one, whom I’ll call Rachael, was 6 months out from the end of her marriage with three children to look after. One was at school, the other two were at home with her. She was on medication for depression and anxiety, but on their own the pills weren’t helping and her situation had deteriorated. She’d stopped taking the meds, she’d withdrawn from the world, and was rapidly losing weight from not eating.
“I rang her one morning and her 4-year-old son answered the phone,” Tania remembers. “He said mummy won’t get out of bed. I went straight over and the house was upside down. I’d never seen her like this, the house was normally immaculate. She hadn’t showered in days, she was shaking and crying. I tried calling her doctor, and spoke to a nurse there. She was out of pills and hadn’t been in for some time. I then rung the crisis team.”
With the state she found Rachael in, Tania knew she couldn’t provide help on her own. Her call to the crisis team was bad from the start.
“They said they didn’t want to talk to me unless she gave them permission,” she says. “I told them that she won’t even get her head out of the blankets, let alone talk to anyone. There are three kids here and she needs help. They told me she just needs to take her meds, get out of bed and look after her kids. I said it was deeper than that, she’d crashed, she needed help and she needed it now. They told me that unless she feels she needs the help, there isn’t much they would do about it.”
Told to call back in an hour if nothing had changed, Tania set about tidying up the house and organising the kids. An hour passed. Nothing had changed.
On the second call, the team continued to deflect responsibility, asking if friends and family could take over, help and take turns to watch Rachael. Tania didn’t know many of Rachael’s friends, and her family (apart from an elderly disabled mother) were all overseas.
“I said, she needs your help! You guys are the professionals. I finally got her on the phone with them. She was weak, tired, and could hardly string a sentence together, but she told them she was fine. I got back on the phone and was told, ‘she’s tired and needs sleep, we’ll call back in a couple of days to do a follow up but there’s not much we can do right now.’”
Rachael ended up being in the care of mental health services for a year and had intense therapy. She’s on the road to recovery and now wants to train to work in mental health, but Tania will never forget those initial calls to the crisis team where she felt “they really didn’t care and were looking for others to take control so they wouldn’t have to get involved.”
* * * * *
The initial response when Jenna needed help was better. She and her kids were staying with Tania for the weekend after Jenna’s husband had left her. Her moods became increasingly dark and she began talking about being dead. Tania hid her car keys, but Jenna decided to head off under her own steam, running out of the house.
Tania rang the crisis team, who told her to call the police. The police found Jenna, and deposited her back at Tania’s house, saying that mental health services would call for a visit. “I said no, they were to take her to hospital and mental health services can see her there,” Tania recalls.
Despite the runaround, Tania says the crisis team were “really good” when they saw Jenna, sending her to respite for a few days, giving her a relaxation CD and calling her every day at home on the phone after she was discharged.
The following weekend was a different story.
“I got a message from one of her friends on Facebook saying she was talking about being in a bad place,” Tania remembers. “I talked to her online (she wouldn’t talk on the phone) and she said she’d researched how many pills she’d need to kill her and was counting them as we spoke. She said I wasn’t to call anyone because if I did then I wasn’t a true friend.”
Tania immediately dialled 111 and stayed online with Jenna at the same time to keep them apprised. The ambulance arrived as she was about to swallow the pills. At the hospital, Jenna faced a wait of between five and six hours in a corridor with Tania before the crisis team arrived.
“They talked for a bit, then asked me if I would stay at her place with her. I said no, I have my children at home. They asked if she would stay with me, she said no. She was exhausted, she told them all she wanted was to go home to bed.”
The crisis team asked Tania for her opinion. “I said, she’s just tried to kill herself, it would be nuts to send her home on her own. They then said to her that if she wasn’t going to go anywhere or have anyone stay with her then they were stuck. They asked me if I would sign her over under the [Mental Health] Act. I was quite prepared to, but she talked them out of it.”
After a two suicide attempts in two weeks, Jenna was again sent home – with Tania. She was given a single dose of sleeping pills, and Tania was told to take her home, strip the house of pills and leave her alone. “Make sure she uses her relaxation CD more” was the final piece of advice.
The crisis team didn’t call for another three days, and visited Jenna once during the following week. By the third weekend, Tania took another friend and dragged Jenna to the hospital.
“She couldn’t walk or talk, she hadn’t eaten or drank in days. We got her into hospital and she was so dehydrated that they couldn’t get into a vein because they were so shrunken. I spoke to the crisis team on the phone, and they said this was a medical issue not a mental health issue. I said it was a form of self-harm, they didn’t agree and they didn’t come and talk to her.”
Four litres of fluid were put into Jenna overnight. Tania left the hospital at 1am, and Jenna was discharged at 10am the next day.
After more lobbying of the A&E staff by Tania, the crisis team became more actively involved in Jenna’s case and she was given home-based treatment, a medication change, counselling…and told to use her relaxation CD more.
* * * * *
Tania’s own story centres less around the mishandling of a single crisis and more on how an ongoing patient is handled, buffeted from pillar to post within the mental health system and other related government agencies with few signposts and a wealth of misinformation.
Tania has spent nearly five years under the care of mental health services. She’s had the crisis team called on her many times. She’s had so many different doctors, key workers and social workers that she’s lost count. She’s had several different diagnoses, the most recent of which is bipolar disorder.
Despite asking for therapy multiple times, she says she was never offered it – until fairly recently.
“A few weeks ago, I was offered all the weekly therapy they said I needed. In fact they said I would never be able to get well until I had therapy and counselling,” Tania says. “But first I had to find childcare for my son.”
Tania is on an invalid’s benefit, thankfully not one of the welfare payments being targeted for extinction by the Bennett regime. But it didn’t make finding childcare any easier. She has few friends and no family where she is living, although after chasing a few referrals she managed to find someone. “I was told that all I needed to do was give them the weekly appointment times and they would send someone out.”
Then came the rug-puller. After securing the childcare, Tania was discharged from mental health services and told she could find the therapy on her own in the community.
“I’m gutted,” she says. “I’m left with a diagnosis I know nothing about, I don’t know where to look for therapy because it’s all so expensive, and I feel completely brushed off. I was so close to getting the help I needed and it was ripped out from under me. I feel back at square one.
“It’s like they diagnose, script meds, and discharge while crossing their fingers that you won’t be back. If they keep discharging people that need the help before they have the tools to cope or the resources to know where to go, then people will never be well.”
* * * * *
Why is our system like this? Disenchanted staff? Underfunding? Lack of communication between services? Poorly organised services? Lack of understanding?
While one can accept that the good work done by crisis teams, like any good work, will often go unsung, the failure stories are so frightening that it raises serious questions about what needs to be done.
We often hear the phrase “ambulance at the bottom of the cliff” when referring to mental health emergencies. From what I’ve been hearing and experiencing, it would seem that a lot of the time, the ambulance simply isn’t there.
[...] be sitting on a powder keg of potential crisis horror stories as expressed in our “bad” and “ugly” [...]
[...] In our snapshot series on mental health crisis services in New Zealand, we’ve seen examples of the good, the bad and the ugly. [...]
Just being devil’s advocate (when aren’t I?!?) for a bit – isn’t this all symptomatic of an overstretched crisis service? If people are being fobbed off then it certainly suggests it. I guess I am uncomfortable with the blame being laid at the feet of the front line workers.
The point of this exercise is to flush out these stories into written word, rather than having them kept in conversation where they normally remain. I’m hoping that the volume and severity of these accounts will encourage a serious review of the services we have. In some cases, it’ll be a case of crap management and bad systems that lead to these horror stories. In others, it’ll be compassion fatigue and an indication that staff need to be rotated through crisis teams rather than staying there for decades.
I had a bit of a horror story with a mental health crisis team. My flatmate was hearing the voice of god telling her to kill my daughter. Understandably, this frightened the hell out of me – she had very poor impulse control at the best of times, and severe dissociative episodes where she wa not in control of herself. When we made contact with the crisis team, together onspeakerphone for mutual support, a long discussion evolved in which I begged for help, as her behavior and mental state had been deteriorating for a week and I had not slept much in that time (I watched over her constantly, at her own request, because she was so scared). I begged for some respite, a break, a night off. In the end, all mental health had to say can be summed up as: 1)We have no space for her, 2) We don’t think that she’s actually that sick (they actually phrased it as ‘she has been known to exaggerate) and 3) If she hurts your daughter, she is not sick enough for it to be mitigating circumstances in a court of law. How on earth does it make a very tired, very scared young mother feel any better to know that IF a girl under her roof loses it and harms her child, well, it’s ok, she’ll be held criminally responsible? I lost my faith in the system forever that day.
When i was 23 or so (i dont really remember because i overdosed 13 times)they told me i wasnt mentally ill and discharged me i was homeless at the time..they took me off all the meds straight away and sent me packing.i was referered to a psychologist who saved me really she only charged me what i could afford i mannaged to claw my way back to working 3 days and staying out of trouble ..i largely self medicated with pot and clung to my cat so i wouldnt off myself recently at the age of 42 i was diagnosed bipolar 1 you see everytime i went manic id freak eat all my pills end up in a psyc ward then come down get depressed be discharged with antidepressants which made me manic id overdose ….you see the pattern?i had so many different drs and nurses no one talked to each other because of that i lost 15 odd years of my life the crisis team only picked up the pieces occassionally but i was largely ignored back then i think they thought i had a personality disorder sometimes i feel bitter but whats the point???
These 3 stories sadden and anger me so much. But today, when i took my friend to the Emergency dept. of my local hospital because she was in crisis and suicidal, i am so pleased that they swung into action straight away and i was able to leave her there knowing she would at last be safe. Big bouquet to Coffs Harbour Regional Hospital’s (Northern NSW) Mental health Unit once again. They have never failed to act with understanding and compassion. Wish it were the same for all people in crisis.
Having worked in a support centre for people with mental illness I unfortunately have a very very long list of incidents such as these. It’s almost too overwhelming the feeling that no one out there wants to help people who need it so very desperately.
My own crisis team experience (a week ago today!) was reasonably positive. The staff were empathetic, helpful, assuring and professional. But, and having been assisted through the crisis I feel a bit mean and niggardly, but . . . all done by phone! I did not see a mental health professional in person. Now, as it happens, that was OK and the phone support, plus my GP and family, got me through. And perhaps, probably, these people are very skilled at making quick assessments on the phone. But still . . . no actual face to face!
It worries me. I could have spun a line of positive bullshit on the phone and gone home and topped myself anyway – without body language to observe, without situational clues (the pile of naaasty pills sitting in the open on the kitchen table ready for use) how can these people, no matter how skilled, make fully informed call as to whether the person needs respite care or just phone monitoring?
I am sure it all boils down to cost and the serious under-funding of mental health services, an issue I covered as a baby health reporter in ’73. Nothing has changed.
This SO ANGERS me i have worked in MH and a helpline that supports people in crisis its sickens me to hear this over and over again desperate people needing to be heard and cared for in a safe and respectful way. To diagnosis and discharge leaving people overwhelmed and lost in a system that does not really CARE that SUCKS