"Mental health crisis care experience"

About: Leeds and York Partnership NHS Foundation Trust York Teaching Hospital NHS Foundation Trust

(as the patient),

I'm 23 and I wanted to give my opinion of mental health services from a young persons point of view. Having been with mental health services on and off since the age of 13 I feel I am more than qualified through experience to pass judgement on these services.

At age 18 I had my first major breakdown. I went into an increasingly deepening suicidal depression. I eventually saw my G. P who prescribed anti-depressants and gave me an urgent appointment with the local CMHT. At the CMHT I was fobbed off as a moody teenager/angst ridden youth, and 3 different people there gave me three different opinions on whether I should be taking the anti-depressants. I went on and off them as a result, eventually deciding to come off them for good due to insomnia they caused (and very little relief of the depression).

Following this period I had sporadic contact with an occupational therapist, and a CPN. The occupational therapist turned up (usually without warning) at my house and repeatedly told me that getting a job and 'not being so lazy' would stop me feeling the way I was feeling. My CPN gave similar advice and I saw her very little. I resorted to taking increasingly dangerous overdoses and often ended up in hospital hooked up to drips and vomiting for 4 days. I would see the psychiatric liaison team after I was medically fit, and it took 4 life threatening attempts before I was admitted to hospital. Before this admission I was either told simply to go home, or that I was an angsty teenager and this was an unfortunate phase I had to go through. I received no care whatsoever from the crisis team, my CPN, or the OT after my first admission to hospital.

In hospital I was kept safe, started on medication, and released after 6 weeks. I had no therapy, no crisis care, and no consistency or rapport from the CMHT. I relapsed after 4 months and was admitted again, for quite some time. Care in hospital when you are psychotic consists mainly of 'aggressively treating' the psychosis with enormous amounts of neuroleptics that cause extremely uncomfortable side effects. Of course, being on a section means that your opinion about how these drugs are affecting you are disregarded as delusional or simply taken as evidence of your 'lack of insight'. I did get some therapy, but really was in no fit state to participate fully in it, being almost solidly floridly psychotic. I was released and thankfully weaned myself off the medications, which I felt were impairing my quality of life and squashing my spirit.

Fast forward to the last year or two, I've had periods of wellness and periods of illness. I was discharged to the Early Intervention in Psychosis team, who I believe are amongst the most well resourced mental health teams around.

Since being discharged from the Early Intervention Team, I was handed back over to the CMHT. I have to say I am again extremely disappointed at their very poor organisation, disasterous communication skills, and lack of resources to do anything that I feel is supportive enough to be on par with EIT. When you ring to speak to your CPN they are usually out of the office, you leave a message and you can count on it that the message will never be passed on. You ring again 3 times in the next week. Your CPN eventually makes contact with you 2-3 weeks after you have finished harassing them to call you.

The crisis team is similarly appalling in my view. I've had a few nice nurses speak to me but their lack of communication with other services and continuity of care is non-existent. When they come to your house it is always a different person and they make you feel bad about using their service because you have a GP's appointment in 2 weeks/family/a cat that needs you. Their psychiatrists are hard to access and the last one I saw was extremely rude and abrupt with me and it almost felt like they had made their mind up about me before I saw them, they refused to listen to questions I had about medication and hadn't read any of my recent notes (or previous ones) in any depth. Another psychiatrist I saw there told me I was having an existential crisis and that I needed to go to therapy to address my Oedipal complex regarding my Father. Just for the record, I'm not a Freudian and I don't as far as I'm aware have an Oedipal complex. At A&E they mostly seem to hide in their office and drink tea.

The GP has always been kind to me, mostly listens to me, and seems to want to help. I understand that they are under a lot of pressure and sometimes they don't have time to do anything else than make sure you are alive but often I would like it if I had a bit more of a chance to say how I am feeling before I am made to feel like I should leave and go home and continue to feel awful.

I've been arrested on a 136 twice and been taken to A&E by the police/had the police and ambulance called quite a few times. In general the police are very good with me, and generally seem to have better people skills and more of an ability to treat you kindly than most trained mental health professionals. The 136 suite is somewhat claustrophobic but generally better to be in than a frantic A&E. The first time I was there though I got sent home after seeing a doctor who told me to breathe into a paper bag if I felt like killing myself again. This was after I had been arrested for trying to throw myself off a bridge into a river. The second time I saw a much nicer psychiatrist who came out to see me at 4am and had good listening skills, didn't give me any patronising advice, and fully considered the best way forward. This was surprising considering I had been drinking and was less than co-operative with the police. I'm grateful for the patience and leniency that the police and certain other people have shown me.

Other times I have rung helplines who call the police if you are suicidal, who are then duty bound to phone for an ambulance, who then drop you at A&E where you are generally triaged last and wait 12-15 hours, even if you have a serious wound on your body that requires many stitches and you are in pain and distressed and highly frustrated. When I have not got any physical injury I get put into a side room with no where comfortable to sit and no human contact. I often get fed up with what feels like a pointless scenario so I discharge myself and go home.

Crisis teams/HTT will tell you on the phone to have a bath/listen to music/drink tea/talk to your family (even if like mine, they don't really want to talk to you). Even if you are suicidal and desperate. They may also try to guilt trip you as a way to try and talk you out of your feelings or somehow discredit them. Sometimes they will come out to see you or agree to put you on their case load but you are usually discharged within the week. They are always late for appointment and don't think twice about dropping you at the last minute or missing your appointment completely. When you try to discharge yourself from them because of this, they tell you it is not their fault but actually because you are "not engaging" with them.

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Responses

Response from Andrew Howorth, Head of Patient Experience, Leeds and York Partnership NHS Foundation Trust

Dear Alexiii011

First of all thank you for taking the time to contact us via this posting site. I was so saddened to read of your experiences and what must feel like a systematic failure for you. It is very difficult to identify which particular services have been less than helpful towards you, other than the crisis team, and I will pass your thoughts on to that team. In the meanwhile I wonder if you would find it helpful to talk things through with our PALS team, who might be able to make a few suggestions as to how we can improve our relationship with you and ensure that you get the help that you are looking for.

The telephone number for PALS is 0800 052 5790, and I'm sure you would find a friendly response.

Once again many thanks, if you want to let me know which area of the City you are accessing services from I will be able to pass yourcomments on to the right CMHT too.

With very sincere wishes

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Response from Hester Rowell, Lead for Patient Experience, York Teaching Hospital NHS foundation Trust

We are very sorry to hear of your experience in our Emergency Department. We recognise that the Emergency Department can be a frightening place in the kind of situation you describe.

Thank you for taking the time to tell your story, which we will share with the Emergency Department team. We genuinely value the insight we get from patient experiences and will use this as part of our evaluation of the service and what we need to improve for the future.

If you do decide that you would like your experiences to be looked into further and contact Leeds and York Partnership PALS we can work with them to answer any questions about your experiences in our Emergency Department.

Alternatively, if you would like to contact our PALS Team directly, their number is 01904 726262.

With best wishes

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