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Total absence of crisis team since COVID-19

Posted By Golden Slumber

"Total absence of crisis team since COVID-19"

About: Camden and Islington NHS Foundation Trust / Adult mental health Camden and Islington NHS Foundation Trust / Crisis resolution

(as a service user),

I have a bi polar diagnosis.  I am usually seen bt a psychiatrist, a CPN ( nurse) and have monthly injections of my MH medication.

In this Trust we are told got to A&E when in crisis and we have 3 A&E. The crisis teams are across the 2 council areas that make up this Trust. For 10 yrs they have not increased the staff from one worker only per borough on duty. Not a single professional in this MH Trust seems to think that 2 workers for a population of half million residents a problem. Even when they tut and shake their heads and say that's awful when pts tell them how poor The crisis team or line in before coronavirus. 

The management here actually justify the appalling treatment of people in crisis by using this ratio as an excuse. God knows what the CCGs who fund have been doing all this time, maybe someone should ask why mentally ill pts aren't getting emergency access to treatment. I don't care about the words MH workers use saying a crisis and an emergency are different - No they are not if you are the person about to jump off a bridge or in front of a truck!

Once COVID-19 came it got so much worse- it was like they forgot they are actually emergency NHS and just like in physical healthcare expected to see pts. I went to 2 of the 3 A&E's in March before official lockdown on 23rd. Except the A&Es by then were already turning away MH pts unless had taken overdose.

But at the same time there was NO place to be seen in crisis. None. Not until weeks later when a hub was opened in the psych hospital grounds and then twice I was screamed at for going there without ringing ahead, when the A&E had told me to. Who on earth in a MH trust thinks someone in a life-threatening situation should have to call what is always an answerphone to get life-saving treatment?

On 5 separate incidents in March alone, I was getting more and more suicidal. I was agitated, not sleeping at all, they knew I had attempted suicide before and ended up in ICU. I am under the Care of the MH Trust but the community team completely shut down at same time. No letters about what to do, no appts, no duty line as ALWAYS engaged or to answerphone or sometimes just diverted into the void.

ALL GPs had shut down and because the MH Trust had not updated my GP re: medication it was stopped dead, which is probably why I was getting so unwell. The clinic i am meant to go to in my mh team just shut its doors so my injections stopped and no gp so no one to chase it.

4 times my friend rang the crisis line and was told there was NO crisis team because of the virus. And the crisis houses told me they were only taking patients from the wards. It took 3 weeks for the hub place to see me then they sent me to Whittington hospital because I had by now taken too much of an old medication because I couldn't get mine and A&E there sent me back. The crisis team at the hub told me to go away because they don't deal with overdoses and so in one night I ended up there twice and 2 different A&E. Everybody said go away even when I told them I was suicidal had missed injections now twice.

Still now they are not working. I was sectioned by police in another part of London and spent 3 days in a different MH Trust. This one said they had no beds so I was discharged and still no follow up. In the end police and ambulance kept coming to my home because I was at risk and they could not take me anywhere either as nowhere would take a MH patient who needed medical care as well . I needed blood tests and also had a cough but I didn't think it was coronavirus because I have asthma. 

I don't know if these are real nurses in the crisis team and they said they had no doctors when I went but who knows if that was true. It is a mess in mental health and they STILL not giving appts when I know others who have appts for routine  physical care in the same hospitals and elsewhere.

My GP says she hasnt heard from the MH Trust and has contacted them again and again. I can't be supported on the phone when very unwell like many many mental health patients. I have friends who don't even have phones and have been sectioned because this. Trust staff didn't make face to face appointments for people who couldn't do phone ones. The GP says the NHS told MH Trusts to make sure they saw pts and they didn't. In the end my GP had to do some special arrangements and send me to a different place to get my depot injections.  I think this Trust is a very dangerous place and wonder what sort of doctors and nurses behave like this? I felt that they were so aggressive, even the police and ambulance seemed to agree and were arguing with them and said it was a real problem they couldn't take anyone for mental health safety. It is their job so what have they been doing this whole time and WHY STILL no appointments face to face?

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Responses

Response from Simon Africanus Rowe, Patient Experience Lead, Camden and Islington NHS FT 3 years ago
Simon Africanus Rowe
Patient Experience Lead,
Camden and Islington NHS FT

Submitted on 23/10/2020 at 12:18
Published on Care Opinion at 13:57

Thank you providing feedback on the services you receive from Camden and Islington NHS Foundation Trust. I am a Service Manager for the Mental Health Crisis Assessment Service (MHCAS).

Firstly, I would like to apologise for the way our service has made you feel and the experiences you have clearly described. I think it is important to thank you for documenting your experiences. I appreciate this is not an easy thing to do but it is ultimately the feedback and lived experience from people who use the service which enable us to change and improve services.

From the experiences you describe I am very sorry you were turned away from an emergency department. This should never have happened. We know unfortunately of some instances where this did happen early in the pandemic, we addressed these together with the emergency departments and it should not happen again. We operate MHCAS from the Bloomsbury Building at St Pancras Hospital. The service was set up in March 2020 in response to the pandemic. Similar services were set up across London as nationally it was felt unacceptable to leave people in emergency departments for longer periods who were not medically unwell and putting them at risk of contracting the virus. As this was an urgent request from Acute Medical Hospitals and the service was set-up with very little notice, we accept at the beginning the initial referral processes in emergency departments was not as clear as it should have been and again, we are sorry for this. We now have a Clinical Nurse Specialist from MHCAS in each of the emergency departments 24/7 who will complete a rapid triage assessment and arranging transfer to MHCAS or if you are medically unwell seen in the emergency departments. Again, this is to limit exposure to the virus.

The staff of MHCAS are made up of those who worked in the three emergency departments and will be able to offer the same level of assessment and support as before. We are aiming to create a more therapeutic environment MHCAS compared to a busy and noisy emergency department (there has also been lots of national research from people reporting receiving poor mental health care in emergency departments) and are having building works completed now to do this. We are available 24/7 and people can self-present and GP’s can refer through the Crisis Single Point of Access as well as ambulances and emergency departments. Everybody seen at MHCAS or Crisis Teams will have their assessment(s) sent to their GP and sometimes these may include recommendations for GP to follow-up, this should be discussed with you at the time. We also now have peer support workers at MHCAS during the day (people with lived experienced of Mental Health Challenges) on hand to offer support- this was not previously available in emergency departments.

With regards to the Crisis Teams, there was never a blanket policy to refuse face to face visits due to the pandemic but rather a more stringent screening of referrals. The crisis team prioritise seeing service users who are acutely mentally unwell and at risk of requiring hospital admission, as well as facilitating the early discharge of service users from hospital. The threshold of accepting referrals into the Crisis Team had to be reviewed and to reduce wherever possible transmission of the virus and to manage with reduced staffing especially earlier in the pandemic due to many staff on sick leave or the need to self-isolate. We do apologise for the distress caused and the feeling of being let down by services and invite you get in contact so we can look into your individual experience in more detail. There may be learning for staff we can take further if we have more information I.e. details of when you or your friend called the Crisis Single Point of Access as all our calls are recorded for training purposes.

The staffing in the Crisis Team has improved over the last few months with a focused recruitment drive of qualified nurses and other extra posts funded by the Clinical Commissioning Groups. We now as standard have three staff on at duty at night.

We are very concerned regarding the comments you made regarding staff conduct and would appreciate it if you contact me directly so I can discuss this with you. Whilst we recognise the importance of online feedback, we really want people who come into contact with our services, whether service users or carers, to contact us directly so we can look into the specifics of the case and give a more tailored response.

Matthew Cully

Interim Operational Service Manager MHCAS

Email: Matthew.cully@candi.nhs.uk

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