Wednesday, 26 February 2014

Crisis Care Concordat Part Four (and final!) - recovery and staying well/preventing future crisis

The Concordat is broken up into four main areas (and so are these posts); the ability to access support before crisis point, access to urgent and emergency treatment when in a crisis, receiving the right quality of care during the crisis and recovery; staying well and working to prevent future crisis.
Mind (
https://www.mind.org.uk/) worked with service users and carers to form statements  expressing the expectations around crisis situations.
The final expectation lies within recovery and prevention and is focused on working with professionals to discover what was and wasn't helpful during the crisis so that efforts can begin to avoid another and also to have a plan place should it re-occur.
The crisis plan should include; early warning signs and coping strategies for them, any support available to prevent hospitalization, a hospital preference if this appears to be the only solution, details of any advanced statements and practical information regarding any people or pets reliant on the person and how involved the person wishes relatives to be involved.
I think that the best thing staff did for me before being admitted to this Hospital, was when I was asked to sign an Advanced Statement. These, are legal documents that you can write when you are of sound mind and have capacity to decide how you would like to be treat when you are too poorly to say.
I had countless Hospital admissions for overdoses in which the voices would get loud before the end of my antidote treatment and I'd have to refuse the rest. More times than not, I'd be given a Mental Health Act assessment and more often than not, I'd be allowed home having not finished treatment that could protect my liver from failing as a results of ingesting too many paracetamol. I think the assessors came to their decisions for two reasons; the first, was that it was a bit dramatic to section someone merely for them to have ten or so hours of a drip when they'd already had the most important part of the treatment, and second; that I wasn't exactly 'mentally unwell.' The turning point came when I was in a medical Hospital for the usual antidote treatment and refused to have a central line put in for it. The Doctors spent hours trying to decide what to do, in the end my capacity was assessed and it was determined I didn't have it. I was sedated with ketamine, had horrific hallucinations and a central line was put in for me to have the entire treatment.
Afterwards, I met with my Psychiatrist. She told me how I make it hard for professionals to determine whether or not I have capacity because I'm not a standard psychotic patient; I hear voices but from trauma not a chemical imbalance. She asked how I feel when they let me go without finishing the treatment and I told her things will go quiet again so then I start panicking that I might die for not completing the antidote. She told me that so long as I'm requesting to do something that would put my life in danger and so long as it's because of things others don't experience, I should deemed to not have capacity. I signed an Advanced Statement which read...
‘I recognise that at times when I have overdosed and presented for treatment at A&E I may not have full capacity to make decisions about consenting to treatment. I recognise that if I refuse treatment at these times it may be necessary to assess and treat me under the Mental Capacity Act. I recognise that I can seem quite convincing that I am making a decision with full capacity but this is not always the case because there may be psychological factors influencing my decision making.’
And from then on I always completed treatment. So these kind of plans to prepare for future crisis can work and be beneficial, especially if they're put in place soon enough!

To read the concordat yourself and make your own opinions, you'll find it here: https://www.gov.uk/.../36353_Mental_Health_Crisis_accessible.pdf