Tuesday, 4 June 2019

A CHAT ABOUT TRUST IN MENTAL HEALTH SERVICES | TW





After self-harming over a week ago I was put under the care of the Northumberland,Tyne and Wear NHS Foundation Trust Crisis Resolution Home Treatment Team (or the Crisis Team basically!) and on the day before I was discharged from their caseload I self-harmed again. When I did it the staff arrived to see me and ended up taking me to A&E for stitches. When they went on to their next visit with another service user, they ended up leaving my care plan at that person’s house and as soon as they realized they returned to the house and got it back. Then I got a phone call with an apology to tell me what had happened and that the Team had reported the breach of data protection. The support worker who called me asked if I wanted the complaints procedure and it didn’t take me long to reply with ‘no.’ I think he was surprised but I came to that conclusion because I knew that the Team had done all that they could to rectify the situation; they’d realized what had happened, gotten the care plan back, reported it, and apologized to me. It was that last bit that really helped in my decision not to make a formal complaint. I’ve talked before about how important apologies are to me and how I think they’re essential in mental health because they’re the cornerstone of building – or maintaining trust in a person or a service. The Manager of the service called me and asked if there was anything else they could do because she didn’t want me thinking that I couldn’t trust the Team and therefore wouldn’t utilize them as support in a crisis. But that trust has been maintained with the apology.



Having trust in services is something I’ve learnt over time. When I first overdosed and was sectioned under the Mental Health Act, I was left with no choice but to trust our NHS mental health services because I didn’t know that it was even possible to question their judgement. I mean, why would I? They had done nothing to make me feel the need to doubt them. And then the admissions and self-harm increased, and services adopted a new attitude that replaced their original concern and caring response. Instead, for some, I was an attention seeker who was wasting their time. It was frustrating because as I said this was only true for some of the staff which meant a lot of confusing and unreliable care. I could say something at a Mental Health Act assessment and be discharged or I could say the same thing to a different panel of assessment staff and be sectioned! And this wasn’t the only frustrating thing about it; I knew in myself that I wasn’t doing this for attention and knowing that the people with the potential to help me didn’t believe that made me feel even more hopeless and these two things affected my trust in professionals.


I think that over the three years I was in and out of hospitals (2009 – 2012) my trust and faith in the nurses, the Doctors, the Police, Paramedics, the Psychiatrists, Social Workers, Support Workers… everyone – it didn’t improve until my admission to Cygnet Hospital Bierley in June 2012. In the months leading up to the Cygnet admission I actually had a good little support network behind me; my Community Psychiatric Nurse (CPN) was thoughtful, my Psychologist was determined to help, and my Psychiatrist was focused on helping me. The two greatest things the three of them did for me was firstly, to teach me about the multiple selves I have. This meant some work with the Psychologist in discovering that there are lots of different Aimee’s in me; there’s an angry one who isolates, there’s a child-like one who craves love, there’s a happy one who’s always positive, there’s a depressed one who wants to die… And all of these Aimee’s needed different help and therefore a different response from the professionals so she created a document that allowed for a description of each Aimee and meant that I could easily tell professionals which Aimee I was at that time. The other greatest thing my care team did for me was to write an Advanced Statement. I had overdosed and it had taken over five hours for the Hospital staff to determine whether or not I had capacity until eventually it was decided that I didn’t, and I was sedated with Ketamine and treat against my will. The Ketamine gave me horrific hallucinations and nausea and the delay in determining my capacity resulted in my liver deteriorating so my Psychiatrist thought devising an Advanced Statement would help avoid a repeat of this. The actual document is quite lengthy, but the basics are that it allows me – when I’m well – to instruct professionals what I would like to happen when I’m unwell. The most important aspects we agreed on was putting in that if I refuse treatment then it should be assumed that I don’t have capacity and that if that was to happen, and sedation was necessary, then Ketamine shouldn’t be used. Writing the Advanced Statement meant a great deal to me because it meant that I was trusting professionals to read it and do as it said. I worried that we’d put all of this work into writing the statement and it would be ignored whether that meant reading it and not doing as it said or not even bothering to read it at all. But it worked and on my next overdose when I refused treatment, I was immediately treated under the Mental Capacity Act and sedated with a different drug. I was also put on life support, which was something we hadn’t predicted but, in the end, it was a good thing because it gave me the fear to agree to go into Cygnet.


Leaving my local services on a bit of a positive note in terms of trust, meant that I was able – and willing – to trust in a whole new set of staff at Cygnet. Over the two and a half years I was there, my trust in the staff fluctuated depending on my own mood and their actions. There were times when they’d failed to replace empty medication boxes so that when I needed it there was none. Then there were times when staff would make a promise to facilitate my authorized, and escorted, leave yet when it came to it, they failed to do that too. There were so many instances where the staff let me – and some of the other service users – down, so my recovery meant learning to forgive people for their mistakes and without letting it affect my trust in the entire system. In the past, if one member of the staff let me down then the way I saw it was that they all had. I saw each member of staff as representatives of their service and now I’ve learnt that they are but that doesn’t mean their errors should impact my trust of the entire service.


Coming back to the North from Cygnet, I had no trust in services whatsoever; I mean, I hadn’t had the best experience of them and then to not have seen them for over two years, I didn’t know what I should expect from them when I returned. There had been so many changes though – improvements really! I mean, our mental health services aren’t perfect, but they are a hell of a lot better than they were!