"Kings College Hospital A&E Psychiatric Crisis 'service'"
About: King's College Hospital (Denmark Hill) / Accident and emergency King's College Hospital (Denmark Hill) Accident and emergency London SE5 9RS Liaison psychiatry (Southwark) Liaison psychiatry (Southwark) SE5 8AZ
Posted by Turquoise (as ),
I've just seen that someone else has posted their concern about the King's A&E for Psychiatric services just last month. My comment about the service is not so dissimilar, although my needs are different.
I had to present 6 times to King's A&E in the past 6 months; 3 times for overdoses, 3 times attempting to resolve crisis before suicide attempt. There is also a more recent refusal to see me (including one made by my GP). None of these occasions has, in my opinion, had a successful outcome, and I believe this has led to my overall condition escalating. I’m just hoping I can get them to accept my Advance Directive to minimise my dealings as my suicide attempts get more successful.
In my opinion, the main issue is that I don’t felt that A&E is set up to deal with psychiatric emergencies, both from a facilities and staffing perspective. I saw a triage nurse and was sent to sit in a corridor in 'majors' for hours. I'm not able to sit that long without developing pain and growing distress, so as time has gone on, I have been yelled at by staff wheeling beds around for being 'in the way', only furthering my distress.
The last 2 times I've been for pre-suicide crisis, I've ended up walking out as the stress has grown so acute, meaning I've then turned up later (and costing much more) having made suicide attempts. I once asked the triage nurse to leave me somewhere 'safe' and I was put in a room where I was told security were keeping an eye on me but I was able to self harm without being disturbed whilst waiting the 4 hours to be seen.
Post-overdose, I was admitted, but waited 2 days for someone from the Psych team to come, which I believe only happened (even with the Dr's request it took 4 hours) because the ward doctor thought she was going to have to section me because I'd grown so distressed I was going to walk out with a canula still sticking out my arm.
But even if the facilities/staffing levels were good, I don’t believe the psych staff are. I've mostly seen the Patient Liaison Nurses (PLN) when I've been drugged/sleepy/stressed as a result of hospitalisation for overdose, but it doesn’t generally feel like they've taken this into account when talking to me; I've been expected to make quite complex decisions about my care and condition, and one PLN was, I believe, quite aggressive when I couldn't remember things they'd told me.
A few nights ago, I had to walk out of A&E because I'd grown so distressed waiting (in a hot, noisy environment for 2 hours despite being told I'd be the next one they saw) that the voices telling me to kill myself had actually started hitting me about the head for refusing them. I was still felt at considerable risk 12 hours later, so tried phoning. The switchboard couldn't get the Mental Health Team to answer the phone so I was on a busy/hold tone for 5 critical minutes. When I finally spoke to the PLN, they had no record of my presentation the night before, and moreover, said that because it was during the day, that I had to go to my GP and ask them to refer me to CMHT (who have previously refused to accept the referrals).
My GP operates a phoneback appointment system, so although the receptionist seemed to sympathise with what was going on, I was sitting by myself for a further 2 hours until the GP called back, and their response was that -with my intent and other signs such as voices - that I had to go to A&E, and that they would speak to them to ensure I had an immediate assessment for hospitalisation (which I've never wanted anyway). I refused to go until I'd had an assurance that they would actually see me at A&E (which I think is reasonable, given that I know my crisis escalates during the hours-long wait in the unsuitable environment), to which the GP agreed. Another 2 hours later, I chased the GP, whose calls King's had not returned.
My husband has contacted the PALS, who say that assessment is done on a points system which means that unless you're about to harm/kill others you may not get immediate psychiatric help, which means that my condition continues to escalate without treatment. There seems to be no support for managing mental health before it becomes critical, but even when I get into crisis, I go in circles, with each of the GP, CMHT and A&E all advising that I contact one of the others in the loop and telling me that I’m not their responsibility.
At the moment, I believe I'm expected to manage my own care with no support, and although this sounds 'cost effective' in reality it means that I've become a lot more expensive as my condition has escalated and needs increased. It seems to me that the cost of a community psych nurse (whom I probably wouldn't even need to call- it's just knowing there's support there when I hit a rough spot in the self-managed recovery I've been forced into by what seems to me to be a lack of resource) is thousands (tens of thousands?) of pounds less than medical hospital treatment.