"My cousin overdosed after her diagnosis"

About: Manchester Mental Health And Social Care Trust / Adult mental health Manchester Royal Infirmary / Accident and emergency

(as the patient),

My cousin has recently been diagnosed with bipolar II, after years of being treated for depression, anxiety and OCD. On giving the diagnosis, her doctor withdrew her medication and left her to deal with it on her own - no support, no counselling, only the assurance that she was "on a waiting list" for an assessment, which could take 18 months.

A few weeks later I went to stay with her. She has been writing a play about mental health to try and raise awareness, and had just heard she'd been rejected for an arts grant. When I went to see her in the morning, she told me she hadn't slept, and that she wanted to die. She was crying. I hugged her, told her to get some sleep, and we'd talk properly about it later. Next thing - she knocked on my bedroom door, telling me she'd taken an overdose. I immediately rang NHS Direct, who got an ambulance to her in half an hour. The paramedics were professional and kind, and insisted on taking her into hospital even though she'd vomited by this time and kept saying, "They won't do anything to help me anyway. "

We got to A&E, where she was assessed, had an ECG and was put in a private room in the observation ward - pretty dismal, with no natural light or even windows. A nurse came to take her vitals, listed the pills she'd taken. After a couple of hours she said she wanted to be alone, so I went home, having heard the nurse say she would see the doctor and mental health team in a couple of hours. The next morning, she was still on the same ward, with no progress having been made. Finally a 'gatekeeper', as they are called, came to see her, and in my cousin's words, bullied her saying, You didn't want to die, did you. My cousin found this very distressing. Thankfully, a friend was visiting and told the staff my cousin didn't feel safe at home, so they agreed to keep her in, possibly transferring her to the psychiatric ward.

Eventually, my cousin saw an exceptionally kind mental health worker, who spent over an hour with her. This MH worker said she didn't think the psych ward would help her, but that she wouldn't let her be sent home without support, so my cousin agreed to go home. It was at this point she realised she should have been given support for her condition, but her doctor had failed to inform her of this or arrange for it to be put in place.

She is now back at home, again with no support, no medication (beyond the three days she was palmed off with), and still facing an 18-month wait for the assessment alone - never mind any treatment.

I just feel so upset and disgusted that it was allowed to get to this stage. My cousin was not naturally suicidal, but ended up taking desperate measures to try and get the treatment she needed. Regardless of her intentions when she took that overdose, it could still have killed her. She should have had sufficient support way before that point. I think the whole process, from misdiagnosis at the beginning, to the treatment of her 'crisis', showcases what feels like the extremely poor mental health provision in the Manchester area.

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Responses

Response from Patrick Cahoon, Head of Patient Experience, Manchester Mental Health and Social Care Trust

Thank you for your recent post to the patient opinion website. First of all, please allow me to apologise on the Trust’s behalf for the distress that both yourself and your cousin have experienced. As a Trust, we are fully committed to providing our service users and their families with a responsive, high quality and appropriate service. We believe there is nothing more vital for any care provider than to meet the needs of service users and to do that well.

It doesn’t appear that this was your experience on this occasion, and I’m sorry that this was the case. Thank you also for your comment regarding the mental health worker. Kindness, compassion and dignity are of the upmost importance and its reassuring to hear at least partly that this was your experience.

I have shared your comments with our Urgent Care Manager here at the Trust, Emma Hinchcliffe, and by way of an explanation Emma has set out what is likely to have happened in the case of your cousin, and in general for other patients who present at an accident and emergency department with similar issues. It is routine practice for medical wards and A&E departments to refer someone who has taken an overdose to mental health liaison services.

The mental health Liaison service would then complete a detailed health and social care assessment and collaboratively agree a plan with the patient and their relatives or carers where this was appropriate. Sometimes a decision is made that a person may need to be admitted for an for assessment. Depending on the outcome of this assessment the individual may be admitted onto an inpatient ward for further assessment and treatment. If however it was felt that the person would not benefit from an inpatient admission, then an alternative home based support plan may be offered instead, with some follow up from a home treatment team if this is felt to be appropriate.

Emma has suggested that it may be helpful for you to contact her directly so that she is able to discuss this with you in some more detail, and importantly, to take on board any learning from your experiences so that we can improve the way in which we support service users and their families in crisis situations.

To make the necessary arrangements to speak to Emma I would be grateful if you could contact our Patient Advice and Liaison Service (PALS) who will be happy to set this up for you. You can contact our PALS service in the following ways:

• By telephone on 0161 882 2084 / 2085 during normal office hours 8:30am - 4pm, Monday to Friday (excluding public bank holidays)

• By email to PALS@mhsc.nhs.uk

Once again, thank you for taking the time to share these comments, and for bringing your experience to the attention of the Trust. We take feedback from our service users, their carers and families very seriously and look forward to discussing this with you in more detail when you are ready to do this.

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Response from Central Manchester University Hospitals NHS Foundation Trust We are preparing to make a change

We are very sorry to receive your comments and concerns via the Patient Opinion website about you and your cousin’s experiences of our services in the Emergency Department at the Manchester Royal Infirmary.

In response to your comment about dismal environment, with no natural light or even windows in our dedicated mental health observation room, this area has been identified as requiring refurbishment and work is being carried out, which will address the issues you have raised and will certainly provide a better environment for patients attending the department who are cared for in this area of the department.

It is very difficult to respond to the specific concerns you have raised about the care and treatment of your cousin without being able to investigate in detail. We take all issues surrounding patient care very seriously and would very much like to hear from you directly about this. If you contact our Patient Advice and Liaison Service on 0161 276 8686 or by e-mailing pals@cmft.nhs.uk they will be happy to discuss this with you.

The Patient Experience Team

Central Manchester University Hospitals, NHS Foundation Trust

Response from Manchester Royal Infirmary

We are very sorry to receive your comments and concerns via the NHS Choices and Patient Opinion websites about you and your cousin’s experiences of our services in the Emergency Department at the Manchester Royal Infirmary. In response to your comment about dismal environment, with no natural light or even windows in our dedicated mental health observation room, this area has been identified as requiring refurbishment and work is being carried out, which will address the issues you have raised and will certainly provide a better environment for patients attending the department who are cared for in this area of the department.

It is very difficult to respond to the specific concerns you have raised about the care and treatment of your cousin without being able to investigate in detail. We take all issues surrounding patient care very seriously and would very much like to hear from you directly about this. If you contact our Patient Advice and Liaison Service on 0161 276 8686 or by e-mailing pals@cmft.nhs.uk they will be happy to discuss this with you

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