"Thoughts about an earlier mental health intervention"

My 95 year old mother was affected with delirium following a urine infection in early 2019. (She had had similar urine infection/delirium in 2014 and spent many weeks in hospital.)

Mum's delirium was causing her to fluctuate between times when she was lucid and other times when she was confused and extremely agitated and even aggressive. She was admitted to Ayr Hospital and spent 3 weeks there, moved to rehab in Cumnock hospital as the delirium began to resolve and her mobility after hospitalisation improved. To be honest, the delirium was, I felt, still a cause for concern. 

Within 2 weeks she was back in Ayr hospital with increased delirium because of a second urine infection. Mum's mental state, I felt, was a cause of great concern.  At this point, I asked one of the staff nurses on the ward if a mental health practitioner would be brought in. The nurse's response was 'We're all trained to deal with delirium' and I would be given a leaflet to explain the disease. I wasn't very happy with that response though I didn't make that known. My thinking was that if particular physical diseases necessitate specialists to be brought in, why not mental illness? It also seemed illogical that, mum's feet were dealt with by a podiatrist (certainly the nurses dealt with any wounds), her mobility was seen to by a physiotherapist (again, the nurses helped by assisting her to the toilet with her zimmer), a nutritionist (on a former occasion) had been brought in to deal with mum's decreasing weight (of course the nurses did encourage her to eat/drink) and at other times mum was attended by opticians, ent specialists and rheumatologists. All of this specialist treatment, yet at this moment in time when mental health was causing concern, no MH specialist was involved.

About a week later, the doctor and staff nurse looking after mum met with me to discuss future treatment etc. At that meeting I again asked if a mental health practitioner could be involved. The doctor agreed and someone from the Elderly Mental Health Liaison Team began to deal with mum's delirium. Haloperadol was prescribed and I felt mum's mood improved to an extent and to a greater extent when the dosage was increased. I was also able to ask the member of the EMHL Team a number of questions that were bothering me and get answers that put my own mind at rest. For example, when I looked in the ward, mum seemed 'content', yet when I spoke to her she often became agitated. I thought my presence was unsettling, but the Team member said that the 'agitation' was going on anyway in mum's head. It was  also helpful that  'mental health' words like 'paranoia' being used and just generally having a more detailed discussion about mum's mental unwellness.

Mum was finally allowed home. Her mental state continued to fluctuate but I felt reassured that the EMHL Team had arranged for a Community MH nurse to see mum in a few weeks and was at the end of a phone if need be. 

Sadly after a few days at home mum had a stroke and passed away about 2 weeks later. Mum's delirium had, of course, not completely resolved, but there was enough of a difference for the 'good times' to be really good and the 'challenging' times to be (apart from one occasion!) less intense. This allowed us, I feel, some good quality time together and with those who visited in what turned out to be her final weeks. 

I must also say that the nurses on the wards (mainly Ayr Sts 1, 16, 12 and Burnock Ward, Cumnock Hospital) were exemplary, responding with professionalism, compassion and care to mum in the face of extremely challenging behaviour at times and I certainly learned from observing them how to better respond when mum was agitated etc. However, and this is my main point, I believe that when mum presented with delirium and (because of continued/recurrent presence of physiological and other triggers) the delirium continued, the intervention of a MH practitioner should have happened MUCH MUCH sooner. Essentially (adding in the 2014 experience when she was in hospital for about 8 weeks), mum was suffering from delirium (an area of mental unwellness) for about 4 months before, at my request, she was referred to the MH team and I at last felt we had been thrown a life-line.  

I also feel more generally that delirium is a 'neglected' illness. While visiting mum and looking after her at home I felt very inadequate to care for her (and for me!) as well as I felt I should and would have valued more info about the illness and help from a support group. (The EMHL team member did offer suggestions and volunteered to make further enquiries.) 

My thanks to all of the staff who looked after the two of us over these past months.