Not quite "sectioned" so what's likely to happen next and who pays for what?

AlsoConfused

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Sep 17, 2010
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Sorry, long post and lots of questions needing answers ....

Background: Mum's lashed out at my Dad (her carer) on a number of occasions over about a year or so - low-level stuff like stamping on his feet, punching, pushing, etc. She's very rarely had a mild go at other people (eg my brother, sister-in-law and me).

The major event: Mum had what seemed like a full-blown paranoic episode late at night, screaming (aggressively rather than fearfully), punching and kicking out at Dad (her carer who's still recovering after a big operation). I pulled her off, indicated Dad should leave her to me and Mum and I then sat together for some time.

Mum asked whether I had a weapon, then said we could get knives and scissors to protect ourselves from Dad hurting us. I said she was perfectly safe, there was nothing to worry about and we'd just sit quietly for a bit. Mum said when your life is at risk, it's OK to hurt someone to protect yourself ... she didn't calm but went on repeatedly about the danger we were in, the unspecific threat within the house (she couldn't get downstairs to get the knives because - thankfully - it wasn't safe to leave the bedroom) and how I just didn't understand the danger but I'd learn.

I said I'd go and make us a cup of tea (praying she wouldn't follow me to where the "weapons" were more easily accessible) - but Mum didn't want me to do that because she was afraid of what would happen to me. Dad - hovering nearby - said he'd go and make us some tea; and Mum then begged him not to go because he might get hurt if he went downstairs. After more only marginally successful efforts at reassurance, Dad managed to slip away to make the tea (and get hold of the emergency dose of diazepam to slide into Mum's cup).

Even when feeling sleepy with the dose of diazepam inside her, Mum still talked about using weapons to defend herself (she picked at the cord of the dressing gown, saying she could use it to strangle someone, and she could hurt anyone attacking her by using her long toe nails).

Mum's a loving wife in a loving marriage, she's not nasty; this is an illness or medication induced paranoid-type reaction.

I called in emergency medical help early the next day. The physical health tests appear to rule out a UTI or other infection and there hasn't been any recent change in medication. Having spoken to Mum's own mental health team doctors, the GP persuaded Mum to become a hospital in-patient that night in the local dementia assessment / treatment unit. The doctors were as worried as I had been by Mum's talk of using weapons so I think Mum would have been "sectioned", if she hadn't gone in voluntarily. Mum's in the unit for at least 2 weeks to let them begin to assess her, then for whatever period may be necessary if it's possible to improve the treatment she's being given.

Questions I want to put to TPers please:-

This was a one off though potentially serious incident - to what extent should we allow it to shape Mum's future?

Any thoughts on how likely it is that Mum will be able to safely return to her own home (perhaps with an extended care package)? Our "bottom line" is that my physically frail Dad shouldn't be put at risk.

How long is Mum likely to spend at dementia assessment / treatment unit?

Mum hasn't been formally "sectioned" though I think she came very close to it. As an informal patient taken in for her own protection and that of others, what is the position if she can't safely return home? Do we get a say in where she goes after she leaves the dementia assessment / treatment unit? As she's not been formally "sectioned", is her residential care our financial responsiblity?

Any advice will be most welcome.
 

Chemmy

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Nov 7, 2011
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Yorkshire
Gosh, that must have been very frightening and terribly upsetting for you all. Well done you for rescuing your dad and taking control. You're clearly thinking this through with your head as well as your heart.

I've never been in such a position so can't offer any real advice. The only thing I would ask is that even if the medical staff say she can go home at some stage, are you really going to be able to trust her alone with your dad again, if as you say he's physically frail?
 

Grannie G

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Apr 3, 2006
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Kent
My husband had one episode of violence which made me frightened to be in the house with him alone.
He agreed to be a voluntary inpatient at an assessment unit.

He was there for nearly 3 weeks and it was a dreadful time for all of us. But it gave the medics time to observe him when he was with me and when he was alone.

He was discharged , being prescribed an antipsychotic which helped a great deal. It did not stop him sundowning, nor did it stop his aggression, but it reduced his aggression and we had no repeat of the physical violence.

In addition, we were allocated support for twelve weeks from the Mental Health Team and then a CPN, who monitored him every two weeks.
I had access to the CPN by email and text as well as by phone.

So I was given excellent support which enabled me to keep my husband at home for longer than I would, if he hadn`t volunteered for assessment.

I must emphasise this is our story in our location. Your mum might have a different story but please don`t lose hope.
 

AlsoConfused

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Sep 17, 2010
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Thanks Chemmy and Sylvia.

are you really going to be able to trust her alone with your dad again

We'd need a pretty good guarantee of Dad's safety and the medics may well not be able to provide it.

Our initial reaction was that of course Mum must come home again when it was safe for her to do so; however, we're beginning to waver on this. Mum's feelings obviously vary but she enjoys a lot of her experience in the assessment centre, is very chatty with us (and everyone else!) and seems calmer and less frustrated even during the evenings. Dad's beginning to realise fully the enormous strain he was under caring for Mum and to wonder whether alternative care would provide them both with a happier future.

Thanks Grannie G for sharing your experience of such a positive outcome after a similar episode to ours. Mum must now be a high priority patient after this emergency and we hope it'll result in more rigorous monitoring of her condition.
 

Chemmy

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Nov 7, 2011
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Yorkshire
Mum's feelings obviously vary but she enjoys a lot of her experience in the assessment centre, is very chatty with us (and everyone else!) and seems calmer and less frustrated even during the evenings. .

I think you've answered your question right there; I'd certainly be looking at respite with an option for a permanent place if there was any suggestion that she should return home. In the end you're only bringing forward the inevitable - and just as important, giving your dad his life back too. It's good to see that you recognise this isn't just about your mum.
 

sue38

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Mar 6, 2007
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I'm sorry you and your dad had such a frightening experience, but it sounds as though you handled it really well.

My dad too was 'voluntarily' admitted to an assessment unit after a violent incident. He was there for 2 weeks before being discharged to a care home. We were fully consulted throughout the process. Like you, once he was in the assessment unit we realised how much strain we had been under as a family trying to keep dad safe, and that it was time for the professionals to help take the strain.

I would say at this stage don't rule anything out, but if your mum is to be discharged either home or to a care home, that you request that she be 'on leave' so that if things don't work out she can be readmitted.
 

AlsoConfused

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Sep 17, 2010
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Thanks for that advice Sue.

Dad's wobbling over what is best for them both. The current wobble is Dad wants Mum home at lightning speed but is at least willing to wait until he gets the doctors' assessments.
 

ROSEANN

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Oct 1, 2006
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Hi
My Husband was sectioned last year but was taken off the section after a few days.
He was then taken to an assement ward where he stayed for six weeks but because of his complex needs was kept in hospital for six months.
While he was there they sorted out his medications and found one that kept him calm but he was not able to come home and went into care twelve months ago.

While this was and still is upsetting I now know it was for the best for him and me,
I now have quailty time with him without worrying about looking after him.

This my not happen to your mum but they may be able to sort out medication for her.
I hope it all goes well for you.
All the best Roseann x
 

AlsoConfused

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Sep 17, 2010
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Thanks Roseann.

We won't get any guidance from the doctors on their aproach to helping Mum before the first working week in January. The period of total uncertainty is uncomfortable, to say the least.
 

Grannie G

Volunteer Moderator
Apr 3, 2006
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Kent
Good to see you here Roseann. Glad you are now able to have quality time with J. I am too so I know how it feels. xx
 

AlsoConfused

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Sep 17, 2010
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Reassurance, advice and help sought plse!

Currently Dad's thinking of getting Mum to leave the assessment centre (where she's an in-patient receiving detailed assessment following her attack on Dad) and to attend the unit only on an out-patient basis. I've tried to persuade Dad this is a stupid idea and not in Mum's interests (let alone his) but with zero success.

Dad misses Mum dreadfully (even though he's able to visit several times a day). He thinks she's scared and her mental state is being worsened by the contact with other dementia patients. He also can't see the unit are doing anything significant to assess or help Mum (he sees the other patients as being so much worse than she is that the lion's share of staff's attention will go to them).

In reality, the unit have done a lot already to assess Mum in the short time she's been with them - ongoing OT assessment, blood and urine tests, a scan arranged, ongoing observation of her behaviour by nurses and care assistants and so on. I feel Mum's getting a lot of staff attention and support and she's not particularly distressed. I think the person most scared by the contact with the other patients is Dad.

I've emailed the SW to ask his help in getting the unit to persuade Dad it's in Mum's best interests to stay as an in-patient, explaining that the best way of convincing him is to show him in detail what's already been done and the value of the information they've gathered in guiding Mum's treatment. I've already spoken to the Nurse in Charge to make the same suggestions but I don't think she saw the absolute necessity for bringing Dad on board to stop him unwittingly sabotaging Mum's treatment.

I also asked the SW whether "sectioning" Mum would be regarded as an appropriate response to the original emergency and to ensuring Mum gets the assessment and treatment she needs now.

If I can, I'll get through to the Duty Mental Health team to put over the same messages and to ensure the SW sees my email to him as soon as possible.

I'm not sure what kind of help I'm asking for from you. I'd love any reassurance you can offer that my very determined, extremely risk-tolerant Dad will be stopped from taking Mum out of the unit; or that it won't matter as much as I think it might if he does. I'd also be grateful if you've any advice on anything else I should be doing to safeguard Mum's assessment.

Happy New Year????????
 

Christinec

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Aug 8, 2007
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Hi Alsoconfused,
I was really hoping that someone else would reply to you but having checked I can see no one has and I hope I can at least say that I really appreciate how difficult this is for you trying to do the best for both parents.

I think you have done exactly the right thing by alerting SW and health staff involved but if your dad decides to remove your Mum and she is willing to go with him it may be that no one cannot legally stop him. I may be wrong as I live in a part of the UK where the law is differant from England however I assume there will be similarities and if that is the case it may be that your Mum needs to sectioned or have a guardianship order or equivalent if you and others involved really feel that she needs to stay in the assessment ward. However I would also emphasise that any action you take to support this may have dire consequences for your relationship with your father.

I am sorry that you are in this position and I really hope that your Mum can get professional care and that your Dad can come to terms with this situation and that you can all continue to work together to do the best for both your Mum and Dad. In the long term it sounds as though it is unrealistic for your Dad to take Mum home and think everything will be fine.

Whatever happens you have my sympathy and best wishes.
 

sistermillicent

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Jan 30, 2009
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I am sorry, Also confused, that I did not see this thread when you first posted it. My mum has been the same, threatening violence of a very dangerous nature and being generally viscious, hitting and punching and throwing things quite unpredictably. Mum has not ever been admitted to hospital with this but has had very good attention from specialist psychiatrists who have prescribed drugs, antipsychotics especially, which have helped a lot.
Dad has a room which he can go to with a phone in it if mum gets too much for him, he would be able to keep her out of there if he felt in danger and ring for help. He hasn't needed to do this to my knowledge in a year, the violence still comes and goes a bit but on the whole is much less awful. My dad has regular respite now and day care for mum. He hates hates hates her being away, but recognises that he has to have breaks, the story in the next paragraph persuaded him of this.

A friend of my dad's was looking after his wife until he had carer breakdown about 18 months ago, his wife was taken into a nursing home and when he felt better he said he could cope again with looking after her. He was told that he could not look after her again, she had to remain in the nursing home. I think this shows that it is not always a question of what the carer wants. I think that if you intervened, and you have done, they will listen and act on what you say.
I also suggest that you ring the Alzheimers Society local to your parents, even if just to talk through your fears. In my very worst time they helped me enormously and made phone calls on my behalf too, which was well beyond the call of duty, I, like you, was so worried about my parents and felt so helpless.

Dad thought he was going to be killed one night at the start of last year, 2011. He and mum went out for a meal with friends on New years eve two days ago and had a great time. (mum coped and went along with things) Things can be okay again, not normal, but you know what I mean.

love Pippa x
 

Nebiroth

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Aug 20, 2006
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I am sorry to hear you are having so much trouble. It does sound as though your dad's heart is ruling his head in the matter. I strongly suspect that he is already rationalising your mum's extreme and violent behavior as a "one off" or "she did not mean it" or due to some trigger that can be avoided in the future. Unfortunately, it is likely that the first two of these are untrue, and whilstthe third might be, it may not be possible to avoid the trigger or even work out what it ultimately was. Your mum's paranoia are prompting her to take the same action as anyone would if they were confronted with a real threat because to her it is real.

As has been said, it is not so much your dad discharging your mum, but his encouraging her to discharge herself. As your mum is a voluntary patient and not under section she is free to do this as things stand.

A lot depends on how likely it was for your mum to have been sectioned if she had refused to go to hospital voluntarily. From what you have said I think a section would have been quite likely - indeed refusal to go to hospital would have been further evidence suggesting she should.

The other factor is the assessment and treatment she has undergone whilst in hospital. The time should by now have given the doctors there a chance to assess your mum's state of mind and the liklihood of her endangering herself or others, particularly if she is outside the safety of the ward and without professional care. This will also depend on whether effective treatments have been found - she may at the moment be stabilised with short-term treatments which are unsuitable, for various reasons, for long term use or use outside of a hospital ward. It is probably too early for a long term, effective treatment to have been settled on yet - mainly because such treatments take take to show the benefit and, because of the way the drugs react in different ways to different people, finding the best one at a suitable dose can be a process of trial and error and it can take time.

It is possible that the doctors at the hospital would consider your mum a danger to herself or others if she discharges herself.

In that case it is possible for a doctor, and some senior nurses, to order what is called a section 5. This applies to voluntary patients already in hospital, essentially it prevents them from leaving. It lasts for 72 hours and may only be rescinded by the clinician in charge of the patient. It can also be extended to a section 3, if this is necessary.

If your mum is under section she cannot discharge herself. Her Nearest Relative (in this case her husband) may "order a discharge" - a formal notice, in writing, that they intend to discharge the patient. However, this can in turn be blocked by the clinician if they can show evidence that it is against the best interest of the patient.
 

AlsoConfused

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Sep 17, 2010
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Thanks for all your replies.

It's "snakes and ladders" time for us with a vengeance. At the moment, we're on a blip upwards.

The Nurse in Charge today did do what I'd asked - I hadn't expected her to and I'm so pleased. Now Dad's had a detailed explanation volunteered to him of what they're doing for Mum and a provisional end date for her stay, he's willing to go along with Mum staying as an in-patient for a bit longer.

Thanks particularly for your info on Section 5 etc and also your professional perspective on the violence, Nebiroth. I actually needed reassurance that I wasn't over-reacting, even though I was sure I wasn't!

I'm also 100% sure Dad's looking at the future with rose-tinted spectacles (he hopes Mum will "magically" be more tranquil in future because she'll "remember" staying home is so much nicer than being in hospital). Can't see it somehow .....