Sectioning ?

[ohno!]

Hello all,
On the 28th of October my poor mum was sectioned under section 2 of the mental health act 1983. The way in which the whole event was carried out was in my view totally inhuman.
Quick bit of background:
Dec 2011 mum started to forget things of minor importance. (mum79)
Feb 2012 mum had a bad fall while crossing a road, hitting her head badly. (No xrays done discharged into my care).
From Feb - July mum seems to physically decline and become a little frail.
July 2012 mum does a return train trip to visit my sister on her own from Devon to London.
Aug 2012 we find mum has started to be very confused around time, she now hallucinates daily, she has become paranoid, confabulates and has low to high moods at the toss of a hat.
We badger mum's GP to look into to mums issues, as mum wants to stop feeling so low. GP does blood tests which came back as mum has major B12 deficiency. GP feels B12 injections will cure all mums aliments!
Nov 2012 tentative diagnosis of dementia with Lewy bodies. (AMHT psychiatrist now involved).
Nov - March mum can no longer safely cook a meal for herself and she has become more and more, what my sister and I can only describe as depressed and anxious. (We contact CPN and psychiatrist about this, but told mum is fine).
April we contact Social services as I can not sustain the level of care mum needed by that point, as I also have very poorly son at home to look after.
April 4 & 1/2 hours per day (week day) and care 1 and a half hours weekend care put in place.
May 2013 poor mum was diagnosed (privately) with congestive heart failure.
Mums mood has been very up and down no doubt due to the dementia and because the poor thing has been basically a prisoner of her own home as she lives in a 1st floor council flat out of town, had been unable to safely go up and down her stairs due to many health factors.
From October 2012 to October 2013 We had repeatedly requested that the SS send out an OT to asses mum, so mum could either get adaptions in place or at least have an OT report recommending a move. SS continually fobbed us off thus mum had no access to the out side world and even so much more worrying no access to a bath or shower!!
A few days before mum was sectioned, she had become suddenly over night unable to get up off her bed to standing position 3 hours later I called 111 they said call GP, GP said call ambulance. Ambulance crew come out I ma concerned mum has further damaged her bad hip as she was screaming in pain and holding her hip on trying to get up!
Ambulance crew get mum up and mum was able to potter off to the loo, then into the lounge to sit in her chair. (mum in very confused state). Ambulance Crew say they can not leave mum as they feel she may possibly have some damage to her hip even though she eventually walked unaided but as she is so confused they do not want to risk making her more so by taking her to hospital, given it was a weekend! So the crew call mums GP to do a home visit to check mums hip, ambulance crew tell me GP has point blank refused to come and see mum as she feels it is all due to mums dementia, she can not do anything about it and she needs to be in a home!! Ambulance crew call on EMT to came and asses mum and they leave. EMT does not turn up mum stuck in chair for 5 plus hours, took all my effort to help mum get up so she could go to the loo. I called the social services emergency team as I did not think mum should be left at night as she could not easily get out of bed or walk.
After 3 night sits, Fri fine no problem, Sat Not sure as no fed back, Sunday, bad police called out to mum due to people hearing mum rant and rave! (carer not able to deal with mum)!!
Mon 28th Oct I call SS to see if they can sort out something for Mon night, they say they will look into it and get back to me.
Mon afternoon I check mums IP cam to see mum has 3 other people there, so pop around to see what is going on to find, mums GP, psychiatrist, and a SW and they are in the process of sectioning mum!
I was not a happy bunny, I explained that I was not in agreement, as mum was obviously physically unwell, I also pointed out that given that mums GP had not sorted out the district nurse to syringe mums ears weeks ago, mum was still deaf as she was unable to use her hearing aids!!
Regardless mum was extracted from her flat, by two ambulance teams two police women and a very hard SW who point blank told me I was by no means aloud to let mum go back in to her flat to go toilet!!
After well over an hour of poor mum being on the landing crying her eyes out telling everyone that she was so scared to go down the stairs as she had bad vertigo and felt wobbly on her legs, I think she just gave up and went in the chair thing, without throwing a fit.

Anyway it transpires that mum did in fact have a bug in her system as the next day at the unit mum was sick when I visited, and the unit has been closed to visitors for the last week due to sickness bug!
Last week I and my sister had a talk with consultant and it transpires, that they have not really been able to asses mum due to the fact that she can not hear them and that it is not possible to give a fair and accurate assessment of mum's condition with her like that!!
Today Saturday I call in to see how mum is, in mid discussion the staff nurse asked me if I knew mums section had been recinened (sp?) I said I had no clue and I did not know what that meant! I am told that mum is no longer under section!!

I and my sister are so confused now, is mum free to go? When the ward is open again and mum says she wants to go home what do we do? She now has no care in place at home, the SW said he will firmly argue that mum go into a care home when discharged.

 

[zeeeb]

WOW! I don't know what to say, i would be fuming as well. No way to treat anyone. The GP should be raked over the coals. Sure, they can't fix dementia, but they do need to care and treat for patients and assure that if there is nothing they can do, that social services get involved and try and improve the situation rather than just leaving her in an upstairs flat.

It is disgusting that they try and fob the responsibilities back on to family.

 

[Acco]

Oh, my goodness. How have you coped with all that unhelpful lot of supposedly knowledgeable and caring people? I am sure I would have exploded many times and probably ended up sectioned myself!
Not exactly sure where I would turn next but think I would record the facts in writing as you have here and insist on another review by a different GP, armed with your notes which should be kept for future refererence. Perhaps ask to speak to a high level person within SS and tell them of your concerns and present a copy of your notes to them insisting on help for your mum at home. After some quiet thought and reflection on your mum's situation following GP and SS review (if you can get some) try and consider yourself what you think is best for mum, and yourself and family. Not an easy task and not sure it fully fits your situation but I hope it perhaps gives something to think about and helps you to find a way through this very difficult situation. I wish you strength and determination and all good fortune in getting through this.

 

[jaymor]

Hi,

What do you and your sister want for your Mum?

If she goes back then she needs a care package in place that will cover her needs.

If you think that 24 hour cover is what she needs then a care home may be the way to go. Because of other family commitments it sounds as if you won't be able to cover the hours when carers are not there and that would leave you Mum very vulnerable.

It is a very difficult time for you and you have to decide what is best for your Mum.

Hope it all works out for you, let us know how you get on. Best wishes to your Mum.

Jay


Sent from my iPad using Talking Point mobile app

 

[Brucie]

In my experience, applying a section has been something that has always been done as a last resort. That being said, it is always going to be done as well as possible by some individuals, and badly by others. It always comes down to the professionals concerned.

I even suggested sectioning my late wife at one stage, as I feared for her safety, but the GP told me I really wouldn't want that as it can be brutal. Somehow we managed - I just locked us both in the house so I could try to control the situation myself.

More recently, with a much older relative, I was thinking a section might be needed when we took her home from an assessment ward, believing we could cope. Three of us lasted 3 hours in all and called the ward to ask what to do - they said 'just drive her back'. That was crazy as she was uncontrollable and there was no way I could be safe driving her in that condition.

We called an ambulance, and I can't say just how brilliant the crew were. An ambulance crew cannot take a person to hospital unless they have verbally agreed, so they simply sat with her for about half an hour, talking her around. Then she agreed and they took her back.

She is still there, and it has been nearly 7 months now. About a month ago, we were told they were applying a Section 2 as they felt she was no longer wishing to be there, while it was very clear she needed to be. That was the only way they could legally stop her from just walking out.

The section was invoked totally painlessly, and after evening phone calls from the consultant who explained the process, and meetings at the ward itself.

This worked well because we have sought to establish a relationship with all of the medical professionals involved in her care. In effect, we are micro-managing her care, and guiding the professionals along the route we want them to take. I have even printed out threads from TP to quote to the consultant, to encourage her to trial medication she would otherwise not have considered for someone with vascular dementia.

This collaboration is how it should work, but frequently it doesn't. The NHS and Social Services people don't work holistically and in concert. They seem to prefer to work on a crisis management basis. I suppose that shifts the responsibility to someone else.

None of this helps you, sadly. But it does help me to learn about this sort of story. I have already requested, and been granted, a slot at the next meeting of the PM's Champion Group on Dementia to talk about how this difficult part of the dementia journey is handled, and how it can be handled better. Your post will help me focus even more on the team approach to care at this stage.

As to your last question - what do you do now….

You concentrate on what is really best and safest and most practical for your mum.

There is no universally available care package to cover a person in their own home 24 hours a day, at least none that I have heard of for over 65s. There comes a stage when a specialist home is the safest option, but the family needs to be accepting of a particular placement, There are good homes, and there are those that aren't good at all.

My advice is to do what you are already doing - seek as much information as you can, and learn about all the options, so you can at least understand the process and the options.

The Alzheimer's Society Help line may be a good place to call, as well as asking things of the broad membership of this magic forum.

Best wishes.

 

[ohno!]

Thank you all for your responses, and kind wishes;

Zeeeb we were stunned at how things have panned out, it got to the point that even the care company mum's care was with called the SW to request an OT visit, as mum was getting so fed up of not being able to just go outside for little walk. The geriatrician we took mum to privately, ended up calling the NHS re enabling team in as he was so cross mum had no adaptions in place or access to the outside world. (we did sort out everything we could do our selves like; comfy chair, special kettle, disconnected, cooker, put in IP web cam, sorted out falls detector and so on).

Acco we will be ? mum's whole dementia pathway with higher level powers that be.

jaymor Back in June we had requested SS try mum in a care home, to see how she got on and because I had to go to Hong Kong for a month as MIL had just had a major heart attack and we needed to take the kids to see their gran just incase things turned out bad! (Due to my 3 kids medical issues it takes me and hubby to travel together for big trips just in case one of them needs medical attention.) SS said NO mum was fine with the cover she had if things went into crisis they would deal with it then!! So I payed for more hours in the evening just to settle mum when I was away, Luckily mum was ok.

Brucie sorry to hear you have been through the dementia mill more that once, it is always striking to see how different professionals handle this dementia pathway, like you say some are good some are bad. I was under the impression that joined up care was supposed to be what the NHS and SS was working to, does not seem to be the case for my poor mum sadly.
In fact from what I can fathom out with all that has gone on is that mum is in the middle of a funding battle with SS and the NHS. As in mums case the AMHT say mum had mild cognitive issues, my family, friends and the care agency see mum struggle to deal with major dementia behavioural issues. SS wants mum to be in an EMI (one which had up to Sept 2013 a major CCG sanction against it) plus up until beginning of Oct. mum was what one could say rather too intellectually high functioning, being very distress when visiting this EMI as a day visitor, expressing to me and others quite clearly that she did not want to be somewhere that she had to be reminded constantly what was in store for her she would prefer to be dead!!
The SS have refused my requests for a list of care homes they would fund, mums SW just kept giving me a copy of the funding scale.
Which without anyone doing an official needs assessment (because mental health and social service differed in thinking of what mums actual needs were), mum only met the low residential band, all the homes I rung said that mums behaviour issues would mean that they could not safely cater for mum's needs!! SW just kept saying it's the EMI or the care pack mum had in place that is all they could offer!!
So here we are poor poor mum still in the middle of funding issues, as now mum is in an assessment unit was under section 2 now not sectioned but nowhere to go as SW said they want NHS to pay for mum or at least top up her fees with the NHS £109 per week founding as my family point blank said we can not top up mums fees period.
I am glad that you have a slot at the next meeting of the PM's Champion Group on Dementia to talk about how this difficult part of the dementia journey is handled, and how it can be handled better, I hope you can open some eyes as to some of the things going on.

 

[Long Tom]

You were right all along, amd the use of the MHA was proven to be unecessary in the end. I agree it all sounded preventable and it is right the s2 was rescinded. If you were the Nearest Relative, you were entitled to be told that this was taking place and should not just find out later on the off-chance.
Now she is technically 'free to leave', but if she tried to (or someone else tried to help her to), the hospital staff (not necessarily a doctor) may decide she cannot make that decision and she would come to harm if she left, so would apply the Deprivation of Liberty Safeguards. If this is mentioned, come back to the forum as I am sure there are many views and experiences of this complex but essential legal procedure. It's part of the Mental Capacity Act (MCA).
The MCA is also the legal basis for any decisions on what should happen once your mum is physically well. If she cannot make her own decision about going home, no-one has the right to just decide for her. There is a process to go through, a decision needs taking considering the pros and cons of staying at home and of going to a care home. Your views MUST be taken in to account. The GP's supposed remark has little bearing, I think. No one professional has the right to state what will happen. If professionals appear to have decided anything without consulting you, stop them and say that decision has not been taken. It cannot be, until you have been properly consulted and all the relevant information considered.
The Mental Capacity Act is not just a tool for professionals to use to have their way-it is a process, designed to ensure they cannot do just that and have to set it out fully, in a clear way, involving others, to see if they are right. Any trouble getting heard, seek advice from your local Independent Mental Capacity Advocacy service.
Best wishes
LT

 

[ohno!]

Hi LT,
I have just got off the phone with mum's hospital, it seems that the consultant has rescinded mum's section because "mum has not tried to get out of the unit and seems quite ok to stay there"! So he has her down as "informally staying in hospital".
I did ask the nurse what would happen if when I went in and mum said she wanted to leave now! (Hospital unit closed last week due to V&D bug, me and kids have immune system problems so I did not go in to see poor mum all last week).
The nurse said like you explained, that they would then implement the MCA!
We have a best interests meeting Mon 25th.