My sister has been sectioned

[Munnery]

Please be patient: this is my first post and not sure where to start. My sister's husband was 24 years older than her and before he passed away just over two years ago, she became his carer. Amongst other problems, he had the early stage dementia. Since then she became forgetful, started stuttering and lost the ability to find the right words, etc.

The rest of the family put it down to the shock of losing her husband and having to live on her own for the first time in her life. However, over the following year her behaviour became increasingly odd. I live some distance from her and we organised for her to visit me for a weekend. Her behaviour that weekend shocked me so much that I called her GP's surgery and eventually managed to talk to her doctor. As a result, he arranged a hospital consult which then turned into 10 months of brain scans, EEG's, MRI's and a lumbar puncture - all to determine if she had dementia. After nine months of this, the consultant eventually diagnosed her with early Alzheimer's with short term memory loss. The consultant advised my sister's GP to start her on Aricept. Her GP didn't prescribe it and nor did he prescribe anything else.

By this time she was going out of her house between five and eight times a day to walk to the town centre to buy a pint of milk, or just because she could. She would also leave the front door wide open whilst she was out. Another time, she asked her neighbour to investigate a strange smell in her house. When the neighbour went in, she found all four gas rings turned on but not lit. Heaven knows how long they had been on. She had also lost the ability to cook anything and appeared to live on biscuits. She told meals on wheels not to bother because she didn't like the meals.

At this stage, my other sister and I decided she was unsafe in her home and after talking it thru with her, she was happy to stay in a local care facility for a four week trial, to see how she got on. Initially everything went quite well but following the honeymoon period, she has deteriorated beyond recognition. She has attacked members of staff and other residents (another resident hit her in retaliation); she doesn't want to wash or shower. I visited her a couple of weeks ago and whenever I tried to talk to her, she sat on the floor of her room banging a biscuit tin on the floor and wall.

Two days later the manager of the home called me at work to say that she had contacted the local mental health service and requested someone come out to assess my sister that day. If they failed to turn up, the manager said she would have no option other than to call the police who can section someone.

My sister is now in a specialist unit within a hospital that assesses the needs of people experiencing dementia. I'm told they can keep and treat her there against her will for up to 28 days.

I can't believe it has come to this and I'm devastated for her. I feel totally responsible: should I have shouted louder for her to receive Aricept or something else? Did I too readily accept the 'professional's' opinion that this was the natural progression of dementia, albeit a very quick progression in her case?

Apologies again for this post being so long but I am not sure what to do next. Any suggestions would be appreciated.

[sue38]

Hi Munnery and welcome to TP.

I'm sorry to hear about your sister. I know it must be a huge shock for your sister to have been sectioned, however she might finally be getting the help she needs.

I don't know why the GP didn't prescribe aricept, but it may have been for a medical reason. My dad's consultant recommended aricept, but because of other conditions (mainly heart related) the GP advised against it.

I think most of us here can look back and say 'if I knew then what I know now I'd have done things differently'. Please don't blame yourself for how things have turned out.

This factsheet on The Mental Health Act explains about 'sectioning'.

I hope you find lots of help and support here.

[Nebiroth]

Please rest assured: this has nothing to do with what you either have or have not done. In fact I would say that you have done everything you could possibly have done. So you have nothing to feel guilty about (although I suspect you will regardless)

It is certainly true that dementia progresses in different people in different ways - and progresses at different rates too. This makes it impossible to predict. Some forms of dementia are notable by sudden and unpredictable declines and these can be severe.

A diagnosis of dementia is made mainly by face to face examination and history - there is no physical test. The ones your sister had were almost certainly to eliminate other conditions (for example a brain tumour) that might produce the symptoms. It is also very difficult to tell what sort of dementia someone has, espescially in the early stages. And you can have more than one form together, too.

The decision as to whether your sister was given Aricept wasn't in your hands - but in those of the doctors responsible for her. Even if she had been given the drug, she may not have benefitted from it - some people don't - and even if she had, the imrprovement could be expected to be mild and temporary at best. So please do not think that it would have made "all the difference" because this is extremely unlikely.

Your sister is almost certainly under a Section 2. That is called "assessment"; it can last a maximum of 28 days. During this time she will be required to remain in hospital and to accept some forms of treatment. It can be migrated to a Section 3 which lasts up to six months and can be renewed. Her "nearest relative" (what used to be called next of kin) should receive information leaflets about all of this.

Note that the police cannot section anyone. However, they can remove someone from 'a public place' to a 'okace of safety' if their behavior endangers themselves or members of the public. If they are called to a private home then they can arrange for prompt examination by doctors who can authorise a section.

A section usually requires two independent doctors (one of whom should know the patient, it is often their Gp or consultant, however this requirement can be waived in an emergency) to agree to it.

It sounds horrible, but sometimes in the sort of situation you describe, a section can be the best thing to happen. It brings the full attention of the relevant authorities. Without a section it can take months for doctors or social services to take action

[nicoise]

Hello Munnery,

Welcome to the forum, but I'm sorry that problems for your sister have meant you need it. I do hope that you will get information and support here.

I'm sure you are incredibly upset at this rapid downturn in your sister's health.

From your story, I don't know that you could have shouted louder or your sister had any other treatment that would have prevented things from reaching this stage.

Aricept (or the other medications prescribed for dementias) can help to slow down the progression in some people; in others they don't make any difference, in others they are not tolerated. So they aren't a wonder drug, just worth trying.

Sometimes an infection can cause a sudden downturn in abilities and increased confusion or odd behaviours. I suspect that this is not the case for your sister, but it is possible. You can ask if she has been tested for any infections just in case.

Sectioning sounds terribly shocking; but for your sister's safety and wellbeing (and those around her) she is probably in the best place for her at present; she can be monitored and medications to help with her aggression might be tried out.

Have a read here on the forum to glean some information from other people's experiences; but remember each person's story is unique. I'm sure others will be along shortly who may be experienced in this and give you more specific support or information.

This is very upsetting and so not what you want for your sister - it is very difficult to deal with. I hope you get some better news soon. xxx

[Munnery]

Many thanks for your replies, advice and understanding.

I do believe my sister is in the right place and trust that they will do everything they can to get her onto the right medication. In fact when a social worker called me on the day of her 'sectioning' to explain where she was going and why, after the initial shock I cried with relief that at last, something was going to be done.

The assessment unit where she is staying has invited me to attend a CAP meeting in 10 days time to discuss her care and assessment. I am hoping they will be able to advise if the care home she came from is the right place for her to be (it is a care home for dementia sufferers). She is in her mid 60's but was considered to be 'high-functioning'. Not so sure now...

Thanks again for your support.
Munnery.

[Witzend]

Please be patient: this is my first post and not sure where to start. My sister's husband was 24 years older than her and before he passed away just over two years ago, she became his carer. Amongst other problems, he had the early stage dementia. Since then she became forgetful, started stuttering and lost the ability to find the right words, etc.

The rest of the family put it down to the shock of losing her husband and having to live on her own for the first time in her life. However, over the following year her behaviour became increasingly odd. I live some distance from her and we organised for her to visit me for a weekend. Her behaviour that weekend shocked me so much that I called her GP's surgery and eventually managed to talk to her doctor. As a result, he arranged a hospital consult which then turned into 10 months of brain scans, EEG's, MRI's and a lumbar puncture - all to determine if she had dementia. After nine months of this, the consultant eventually diagnosed her with early Alzheimer's with short term memory loss. The consultant advised my sister's GP to start her on Aricept. Her GP didn't prescribe it and nor did he prescribe anything else.

By this time she was going out of her house between five and eight times a day to walk to the town centre to buy a pint of milk, or just because she could. She would also leave the front door wide open whilst she was out. Another time, she asked her neighbour to investigate a strange smell in her house. When the neighbour went in, she found all four gas rings turned on but not lit. Heaven knows how long they had been on. She had also lost the ability to cook anything and appeared to live on biscuits. She told meals on wheels not to bother because she didn't like the meals.

At this stage, my other sister and I decided she was unsafe in her home and after talking it thru with her, she was happy to stay in a local care facility for a four week trial, to see how she got on. Initially everything went quite well but following the honeymoon period, she has deteriorated beyond recognition. She has attacked members of staff and other residents (another resident hit her in retaliation); she doesn't want to wash or shower. I visited her a couple of weeks ago and whenever I tried to talk to her, she sat on the floor of her room banging a biscuit tin on the floor and wall.

Two days later the manager of the home called me at work to say that she had contacted the local mental health service and requested someone come out to assess my sister that day. If they failed to turn up, the manager said she would have no option other than to call the police who can section someone.

My sister is now in a specialist unit within a hospital that assesses the needs of people experiencing dementia. I'm told they can keep and treat her there against her will for up to 28 days.

I can't believe it has come to this and I'm devastated for her. I feel totally responsible: should I have shouted louder for her to receive Aricept or something else? Did I too readily accept the 'professional's' opinion that this was the natural progression of dementia, albeit a very quick progression in her case?

Apologies again for this post being so long but I am not sure what to do next. Any suggestions would be appreciated.

Please don't feel guilty - she may very likely have deteriorated anyway.
Some cases do progress very fast. I was shocked at the incredibly rapid decline in one lady in my mother's CH - at first she had seemed so 'normal' you wondered why she was there at all.

Incidentally, Aricept only made some of my mother's symptoms worse - it was no help at all. And I gather that at best it only postpones the inevitable for a while.

[handyjack]

I'm with Nebiroth and Witzend on this. Dementia varies between sufferers. Some have the slow steady decline, and others seem to enter a downward spiral fairly quickly. Yet others may decline quickly then seem to level off for a few months, before declining further. It all depends on the form of dementia they have. I see nothing in your post for you to feel guilty about whatsoever. You have done as much for your sister as you possibly could have. ((((((((( Big Hug)))))) to you.

[Butter]

You have done really well, you know. My mother has been sectioned three times and each time she has left hospital better, and better cared for, and safer. Sectioning is for the benefit of the patient and anybody who might get hurt because of the patient's illness.
What is brilliant for your sister is you are still alongside, you are still in touch, you are there for the professionals to talk to. If she is in hospital for a long time (my mother's longest stay was 9 months) you will see many patients who have no-one. Their illness have driven everyone away.
I wish you loads of courage. And I advise you to rely on the professionals who have seen all this before many times. Most of them are just amazing in my long and painful experience.
My other advice is that you don't take any responsibility at all for your sister when she leaves hospital unless you have 100% confidence in all the arrangements and you are not on your own. You would not help her by doing that.
That may sound cruel but I can assure you it is the kindest thing.

[seaurchin]

Hi,

I agree with Butter on this. Sectioning was a really scary concept when it happened to my husband but it was for the best in the long run. He was stabilised and did return home to us after a 9 month spell in hospital. It is hard to witness the stress this causes on everyone but hopefully your sister will be better off with the increased attention and assessment. I hope things settle soon.

Kind regards

Helen

[Munnery]

You have done really well, you know. My mother has been sectioned three times and each time she has left hospital better, and better cared for, and safer. Sectioning is for the benefit of the patient and anybody who might get hurt because of the patient's illness.
What is brilliant for your sister is you are still alongside, you are still in touch, you are there for the professionals to talk to. If she is in hospital for a long time (my mother's longest stay was 9 months) you will see many patients who have no-one. Their illness have driven everyone away.
I wish you loads of courage. And I advise you to rely on the professionals who have seen all this before many times. Most of them are just amazing in my long and painful experience.
My other advice is that you don't take any responsibility at all for your sister when she leaves hospital unless you have 100% confidence in all the arrangements and you are not on your own. You would not help her by doing that.
That may sound cruel but I can assure you it is the kindest thing.

Hi Butter
Thanks for your post and encouragement. I'd really like to know what you mean by not taking responsibility for her when she leaves hospital - if they want to send her back to the care home, can I disagree? She is self-funding so I have to make the payments whether she's there or not.

Hoping to learn more about her situation at the meeting next week. Before she was sectioned we were trying to get her assessed for CHC.

Appreciate any help/advice.