Elder brother in dire straits - Dr can no longer help
Discussion
Elder brother 62 always been in good physical health, non smoker light drinker, walked frequently but always been a worrier
Has been going downhill since christmas - covid, house sale, family worries have got on top of him and he has spiralled down mentally.
Dr prescribed 20mg setraline in v early Jan so 7 weeks or so in with no change to his demeanour.
Now bedbound for last 2 weeks.
Hasn't been eating drinking virtually anything for 5-6 weeks and now refuses food drink medication for last week or so
Been taken to hospital twice upon advice, but they kick him out the next day.
Dr has been doing tests such as st scan etc but he is now refusing and won't have a physcholical assessment.
We are looking into power of attorney but this takes many weeks and he will be dead before that becomes an option.
Dr now seems to be saying that if he refuses treatment there is nothing more she can do.
Not sure what we can do next - wait until he passes out and then 999?
Has been going downhill since christmas - covid, house sale, family worries have got on top of him and he has spiralled down mentally.
Dr prescribed 20mg setraline in v early Jan so 7 weeks or so in with no change to his demeanour.
Now bedbound for last 2 weeks.
Hasn't been eating drinking virtually anything for 5-6 weeks and now refuses food drink medication for last week or so
Been taken to hospital twice upon advice, but they kick him out the next day.
Dr has been doing tests such as st scan etc but he is now refusing and won't have a physcholical assessment.
We are looking into power of attorney but this takes many weeks and he will be dead before that becomes an option.
Dr now seems to be saying that if he refuses treatment there is nothing more she can do.
Not sure what we can do next - wait until he passes out and then 999?
Jamescrs said:
Im sorry to hear about your brother. It must be a traumatic situation. Can I assume that the doctor has made a mental health assessment or has made a decision that he does have capacity to make his own decisions about his health and welfare?
Hi my understanding, through is wife, is that his Dr has said he should have a psycholical assessment, not sure by whom, which he has refused.At his second hospitalization the hospital said they were going to do a psych assessment and he did receive a follow up call at home from 'someone' to which it seems my brother would not converse.
It is all so difficult because the hospital won't discuss with his wife who has taken him to hospital and picked him up subsequently and my brother won't or can't confide...
Sounds like he needs a Mental Health Act assessment. Assuming this is severe depression he has the profile of the kind of patient who would respond to ECT. You're right - he might die if he doesn't get appropriate help and I assume the hospital hasn't identified a significant physical health problem to account for his decline.
GP should be first port of call but social services emergency duty team are responsible for coordinating and making the application to hospital.
If he lands in hospital again, wife needs to refuse to take him home and insist on psychiatric assessment. He cannot refuse this and he can be detained under s.5(2) of the MHA by any registered medical practitioner to facilitate this
GP should be first port of call but social services emergency duty team are responsible for coordinating and making the application to hospital.
If he lands in hospital again, wife needs to refuse to take him home and insist on psychiatric assessment. He cannot refuse this and he can be detained under s.5(2) of the MHA by any registered medical practitioner to facilitate this
semisane said:
It is all so difficult because the hospital won't discuss with his wife who has taken him to hospital and picked him up subsequently and my brother won't or can't confide...
This in particular is so wrong - how can they know what's going on if they don't listen to her? I get very frustrated with health professionals who cite 'patient has capacity' in order to choose the line of least resistance.Edited by oddman on Saturday 20th February 17:08
I had some experience with a mentally ill relative. This is just what I learnt, I’m not a Dr.
Basically there seemed to be a line between “a bit mentally ill” and “rather ill”. In the former category you get treatments at home; pills, appointments etc.
Once a patient crosses the line into the latter then they get a DOLS (I think that’s right, it’s pronounced “dolls”) which is where they are under some kind of hospital version of grounded. They are kept in to receive treatment. If they leave the police bring them back.
More serious than is being sectioned, which is where they are basically under hospital arrest and are under the care of a psychiatrist in a specialist unit.
I decided to speak out and say “look we can’t handle this, what’s next” in order to advance the case. It was a relief when they were sectioned.
In your position I would be looking to call an ambulance as soon as you have reason to be worried, which seems like now as they are so weak? Tell the Dr how bad things are, and say you can’t manage them at home (which it seems to be the situation).
Good luck mate, it’s an awful situation.
Basically there seemed to be a line between “a bit mentally ill” and “rather ill”. In the former category you get treatments at home; pills, appointments etc.
Once a patient crosses the line into the latter then they get a DOLS (I think that’s right, it’s pronounced “dolls”) which is where they are under some kind of hospital version of grounded. They are kept in to receive treatment. If they leave the police bring them back.
More serious than is being sectioned, which is where they are basically under hospital arrest and are under the care of a psychiatrist in a specialist unit.
I decided to speak out and say “look we can’t handle this, what’s next” in order to advance the case. It was a relief when they were sectioned.
In your position I would be looking to call an ambulance as soon as you have reason to be worried, which seems like now as they are so weak? Tell the Dr how bad things are, and say you can’t manage them at home (which it seems to be the situation).
Good luck mate, it’s an awful situation.
toastyhamster said:
20mg of Sertraline is tiny, my ex M-i-L was on over 100mg and she just had anxiety, don't take my word for it, have a google on dose sizes. I'd be chatting to the Dr about that.
No amount of sertraline will fix this. It's my #1 antidepressant choice, safe and effective. But in this situation its role is for keeping a patient well after emergency treatment.Chainsaw Rebuild said:
I had some experience with a mentally ill relative. This is just what I learnt, I’m not a Dr.
Good luck mate, it’s an awful situation.
Chainsaw is not on point with the law but 100% on appreciation of the situation. Good luck mate, it’s an awful situation.
Edited by oddman on Saturday 20th February 20:11
As posted aove, local authorities have a number of key duties relating to assessments, including (but not limited to) the provison of the Approved Mental Health Practitioners (AMHPs - pronounced "amps") who are reposnsible for arranging and coordinating assessments under the Act, making the appliaction for detention if the grounds are met. The "nearest relative" is entitled to cold call and request. Section 26 of The Act sets out the hierarchy applicable to "nearest relative", brother/sister is , i think, 4th on the list so have a quick google.
Note however that this duty is limited to considering the request. expect that the AMHPs will then invariably liaise with their local community mental health crisis type services to see if they can get a response. if not achieved, they then have collective processes to follow which could lead to them being granted access, regardless of consent.
Whether he has sufficient capacity to weigh in balance his options is something which the assessors will take full account of - a capacitous decision to decline assessmnet/support/treatment must be respected but i doubt that he currently has such capability.
Profound depression can become life threatening even in the absence of suicidal ideation or intent so act sooner rather than later.
Edited by paulmakin on Sunday 21st February 09:58
Thanks for all the feedback - very much appreciated.
He threatened to kill his wife in the early hours and poked her in her eyes - never been a violent man
Enough is enough - initial assessment care team have been in and are recommending sectioning to the formal team, who will be there later today or tomorrow.
Due to Covid they have to find him a bed which will hopefully be in the county, but there are no visitations so that is not such as issue - any bed with the appropriate care will do atm.
Hopefully we have reached rock bottom and that he will get the appropriate care to get him mentally and physically well....
He threatened to kill his wife in the early hours and poked her in her eyes - never been a violent man
Enough is enough - initial assessment care team have been in and are recommending sectioning to the formal team, who will be there later today or tomorrow.
Due to Covid they have to find him a bed which will hopefully be in the county, but there are no visitations so that is not such as issue - any bed with the appropriate care will do atm.
Hopefully we have reached rock bottom and that he will get the appropriate care to get him mentally and physically well....
semisane said:
Thanks for all the feedback - very much appreciated.
He threatened to kill his wife in the early hours and poked her in her eyes - never been a violent man
Enough is enough - initial assessment care team have been in and are recommending sectioning to the formal team, who will be there later today or tomorrow.
Due to Covid they have to find him a bed which will hopefully be in the county, but there are no visitations so that is not such as issue - any bed with the appropriate care will do atm.
Hopefully we have reached rock bottom and that he will get the appropriate care to get him mentally and physically well....
Crikey that has happened very quickly, took 30 years for my brother to get that sort of help from the system. You need to stay in touch with the mental health team from the council, eventually he will be placed some where and a single family member will get contact with his doctor as the doctors will need to understand his history.He threatened to kill his wife in the early hours and poked her in her eyes - never been a violent man
Enough is enough - initial assessment care team have been in and are recommending sectioning to the formal team, who will be there later today or tomorrow.
Due to Covid they have to find him a bed which will hopefully be in the county, but there are no visitations so that is not such as issue - any bed with the appropriate care will do atm.
Hopefully we have reached rock bottom and that he will get the appropriate care to get him mentally and physically well....
You need to stay on top of this but not an easy situation, best of luck.
Agreed with the section advice. An individual can admit themselves and so authorities such as the Police can act under a section 135 to take a person to a place of safety i.e. hospital. If he self-admits which it sounds like he won’t then he can self-discharge. Police/social carry a bit more clout and a section 3 is initially 6 months.
It sounds like his Mental Capacity is in question as well.
The GP can arrange a safeguarding assessment as he sounds like a vulnerable adult. The social worker will conduct this and see what is going on and a good social will involve the community mental health team. The wife also needs support so the social will take that into account. However, the GP can weigh up whether it’s one for the community mental health team (CMHT) or Crisis Team.
He can then have a psych evaluation at home. With a community psychiatric nurse and this would be another way to admit him (section). If a section is required. Or the GP can refer to crisis resolution home treatment team (CRHT) and involve a social worker.
Crisis intervention sounds more appropriate here. Sertraline on a higher dose might not cut it. He likely needs a heavier dose of something else. It’s hard to make recommendations without a proper psychiatric assessment.
It’s important to have family around or accompany to appointments as it sounds like he will not go ahead with appointments if he is left to it. This may or may not be related to mental capacity.
The GP should definitely review the medication if he can be accompanied to the surgery but this sounds like one for the crisis team. If he is at risk to himself (suicidal / malnourished) then 999 it. The A+E should have a psych liaison nurse depending on the hospital and they can assess his needs too. Not every A+E has a psych nurse so the GP or 999 can direct the hospital to go to.
So in order of action the plan is:
1. Immediate risk e.g. suicidal, self-harming, mental capacity in question, continued self-neglect: 999. Could be any of those or a combination.
2. Not immediate but high risk e.g. not suicidal, skipping meals and, not self-harming: GP and Crisis Team Referral + Social Worker
Required:
1. Social worker
2. Change of medication. Probably best for a consultant psychiatrist to prescribe this as GP’s get a little lost sometimes when things are complicated.
3. Care coordinator ie. crisis team or community mental health team
NB. Some crisis teams can take up to 72 hours to get around to an assessment. It depends on their waiting list. So if it’s urgent then 999 or take to a hospital.
If he had a call then he’s probably open on someone’s books and on their radar. So that can save a lot of time getting a new referral. If you can find out who the call was supposed to come from then the GP can alert that team.
HTH
It sounds like his Mental Capacity is in question as well.
The GP can arrange a safeguarding assessment as he sounds like a vulnerable adult. The social worker will conduct this and see what is going on and a good social will involve the community mental health team. The wife also needs support so the social will take that into account. However, the GP can weigh up whether it’s one for the community mental health team (CMHT) or Crisis Team.
He can then have a psych evaluation at home. With a community psychiatric nurse and this would be another way to admit him (section). If a section is required. Or the GP can refer to crisis resolution home treatment team (CRHT) and involve a social worker.
Crisis intervention sounds more appropriate here. Sertraline on a higher dose might not cut it. He likely needs a heavier dose of something else. It’s hard to make recommendations without a proper psychiatric assessment.
It’s important to have family around or accompany to appointments as it sounds like he will not go ahead with appointments if he is left to it. This may or may not be related to mental capacity.
The GP should definitely review the medication if he can be accompanied to the surgery but this sounds like one for the crisis team. If he is at risk to himself (suicidal / malnourished) then 999 it. The A+E should have a psych liaison nurse depending on the hospital and they can assess his needs too. Not every A+E has a psych nurse so the GP or 999 can direct the hospital to go to.
So in order of action the plan is:
1. Immediate risk e.g. suicidal, self-harming, mental capacity in question, continued self-neglect: 999. Could be any of those or a combination.
2. Not immediate but high risk e.g. not suicidal, skipping meals and, not self-harming: GP and Crisis Team Referral + Social Worker
Required:
1. Social worker
2. Change of medication. Probably best for a consultant psychiatrist to prescribe this as GP’s get a little lost sometimes when things are complicated.
3. Care coordinator ie. crisis team or community mental health team
NB. Some crisis teams can take up to 72 hours to get around to an assessment. It depends on their waiting list. So if it’s urgent then 999 or take to a hospital.
If he had a call then he’s probably open on someone’s books and on their radar. So that can save a lot of time getting a new referral. If you can find out who the call was supposed to come from then the GP can alert that team.
HTH
Edited by Super_G on Monday 22 February 20:00
corrected sectionsEdited by Super_G on Monday 22 February 20:28
clarification on police powersEdited by Super_G on Tuesday 23 February 06:38
typo on section 3 but agreed this is section 2 territory Edited by Super_G on Tuesday 23 February 06:41
It's moving then - good to hear.
Just for clarity - Police have no powers to admit, neither do the family.
Should he be offered and accept an admission to a mental health unit then this will be mandated as it would be the least restrictive option. as a voluntary (Informal) patient, however, he could decide to self - discharge. There are checks and balances and if the discharge is not appropriate, the hospital has powers that they could employ.
Section 3 is up to 6 months in the first instance. this would be a Section 2 - it's the very circumstances that Section 2 provides for.
Just for clarity - Police have no powers to admit, neither do the family.
Should he be offered and accept an admission to a mental health unit then this will be mandated as it would be the least restrictive option. as a voluntary (Informal) patient, however, he could decide to self - discharge. There are checks and balances and if the discharge is not appropriate, the hospital has powers that they could employ.
Section 3 is up to 6 months in the first instance. this would be a Section 2 - it's the very circumstances that Section 2 provides for.
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