"Trying to access urgent mental health services, and trying to get a bed"

I wandered off one evening and eventually was found slumped in a chair at a local further education centre. I may have had a seizure whilst there, and an ambulance was called and I was brought home, not mentally well. I continued to get worse and was dissociating as well as becoming manic. I was eventually out of control and grasping a large kitchen knife, with the result that my carer tried to call the emergency out of hours mental health team at Hill Rise in Newhaven. This number continually gave the engaged signal and my carer was therefore forced to call 999. The police arrived first, because a knife was involved, and then after some time the ambulance arrived.

I had immediately relinquished the knife on request by the police, and the three police officers were helpful and kind - one of them had been trained in mental health and knew about the condition of DID. In consultation with my carer the two emergency services agreed to take the patient immediately to Eastbourne Hospital A & E, because it was close to the associated mental health unit where there might be a bed. My carer could not drive me to the hospital herself because she and a friend had had a few glasses of wine.

The ambulance, followed by a single police officer in a police car, took me to Eastbourne A & E, where the paramedics were instructed to put me in an empty waiting area next to the ordinary A & E seating area. There I was basically left to my own devices with virtually NO input from staff or doctors. I was left unattended from midnight until 6 am the following morning, and I could have quite simply walked out of the hospital with no one either noticing or caring.

Finally at about 6. 30 am, I was moved out of A & E and placed in the Urgent Care Lounge used for mental health patients awaiting assessment. A sofabed in the lounge meant that I could finally lie down, and at 7 am a nurse named Pam was engaged to stay in the room and look after me. Pam was very helpful and kind, and I was essentially in her care until she left after the end of her shift at 2 pm, by which time Rapid Response was on the case.

I was not seen by anyone else until about 11. 00 in the morning, when at last the Rapid Response Team took notice of my plight. Piecing things together exactly isn't easy because I was having periods of severe mixed mania and dissociation. I do remember that the excellent Rapid Response nurse, named Stella, assessed me and tried to get me a bed in the nearby psychiatric unit. It seemed that a bed might be found, but not only was the pressure on beds a factor but, more importantly, when Stella asked the ward psychiatrist, if I could have a bed on the unit, the answer was negative on the spurious grounds that hospital admission is not always helpful for this patient.

It is pretty clear in my view that they deliberately obstructed what would have been a fruitful short-stay admission to hospital, and Stella apologized for the situation. I should say that at the end of my previous admission to hospital, their associate,  had made it clear that if I needed respite then I should not let things get too bad but come into hospital.

With no possibility of a bed, I accepted the alternative option of being seen by the Crisis Response Team, so the Rapid Response team handed me over, and so began the rather confusing and all too short dealings with Crisis Response. In the few times I managed to see the Crisis Response Team, there was only one occasion when I saw the same person twice. In addition, when I had the appointment at Hill Rise, which was meant to be a proper assessment of my mental health needs and initiation of some adequate support, the two staff members at the meeting were NOT the persons I was stated to see, and it turned out that it had already been decided that Crisis Response should now turn me over to Hill Rise, and the savageries of having no care coordinator.

I am now caught in a nightmare situation. Crisis Response had alternated between reinforcing the shortness of my contact with them and a more caring and considerate approach, and in the meeting at Hill Rise, there was little empathy shown. My care coordinator, who understands my condition and knows how to deal with it, has been on sick leave for a quite a while, and at the meeting, we were told that this might extend a for as a long again. I am therefore basically without appropriate mental health support.

My condition is unpredictable and quite severe. The major episodes of dissociation affect my memory and mood, and part of my condition involves me having seizures and wandering, sometimes far from home. Currently, my mental health is also being adversely affected by major pain as my arthritis and PMR (Polymyalgia rheumatica) march onwards through my body. My good right arm is due for an elbow replacement at some time, but until that is done I am in massive pain, with almost no practical use of that arm. I also have a number of other difficult appointments to deal with in the very near future, including an inpatient colonoscopy and a scan to check a bony lump in my hip - I already have two hip replacements.

I am well aware of the pressures on the NHS, and especially on mental health services where government money has not really been forthcoming and where beds are now scarcer than ever. I was very ill on that night, and I was flitting in and out of serious mixed mania and dissociation during the following day. It is clear that my carer, who has co-written this text to help fill in facts and to take over the functioning of my own handwriting/typing, was placed in a very difficult position.

I have no criticism of Rapid Response and Stella did her best to provide me with the support or bed I needed. I also have no criticism of Pam, and then Melissa, who stayed with me while I was restricted to the Urgent Care Lounge. What shocks my carer and myself is that I was dumped in A & E for a whole night, dissociating on and off and feeling increasingly depressed and anxious, and then, even when I was put in the Urgent Care Lounge, there was no input from psychiatry or other care professionals for a long time. Also, my carer and myself are angry that the psychiatrist should pontificate on whether or not I should be granted a bed without seeing me or taking account of the real outcomes of previous hospital admissions and the psychiatrist express advice. Finally, I feel that Crisis Response should be more consistent in their dealings with patients in obvious distress. The fact that I never knew for sure how long I might stay with Crisis Response, and the use of too many different people on one case, meant that the stability I needed since the described crisis of mid February just wasn't there. This was made worse by the fait accompli at the meeting at Hill Rise, whereby Crisis Response had decided to drop my case before I had a chance to object.

NOTE: This is a joint text by patient and carer