"Kings College Hospital A&E Psychiatric Crisis 'service'"

About: King's College Hospital (Denmark Hill) / Accident and emergency Liaison psychiatry (Southwark)

(as the patient),

I've just seen that someone else has posted their concern about the King's A&E for Psychiatric services just last month. My comment about the service is not so dissimilar, although my needs are different.

I had to present 6 times to King's A&E in the past 6 months; 3 times for overdoses, 3 times attempting to resolve crisis before suicide attempt. There is also a more recent refusal to see me (including one made by my GP). None of these occasions has, in my opinion, had a successful outcome, and I believe this has led to my overall condition escalating. I’m just hoping I can get them to accept my Advance Directive to minimise my dealings as my suicide attempts get more successful.

In my opinion, the main issue is that I don’t felt that A&E is set up to deal with psychiatric emergencies, both from a facilities and staffing perspective. I saw a triage nurse and was sent to sit in a corridor in 'majors' for hours. I'm not able to sit that long without developing pain and growing distress, so as time has gone on, I have been yelled at by staff wheeling beds around for being 'in the way', only furthering my distress.

The last 2 times I've been for pre-suicide crisis, I've ended up walking out as the stress has grown so acute, meaning I've then turned up later (and costing much more) having made suicide attempts. I once asked the triage nurse to leave me somewhere 'safe' and I was put in a room where I was told security were keeping an eye on me but I was able to self harm without being disturbed whilst waiting the 4 hours to be seen.

Post-overdose, I was admitted, but waited 2 days for someone from the Psych team to come, which I believe only happened (even with the Dr's request it took 4 hours) because the ward doctor thought she was going to have to section me because I'd grown so distressed I was going to walk out with a canula still sticking out my arm.

But even if the facilities/staffing levels were good, I don’t believe the psych staff are. I've mostly seen the Patient Liaison Nurses (PLN) when I've been drugged/sleepy/stressed as a result of hospitalisation for overdose, but it doesn’t generally feel like they've taken this into account when talking to me; I've been expected to make quite complex decisions about my care and condition, and one PLN was, I believe, quite aggressive when I couldn't remember things they'd told me.

A few nights ago, I had to walk out of A&E because I'd grown so distressed waiting (in a hot, noisy environment for 2 hours despite being told I'd be the next one they saw) that the voices telling me to kill myself had actually started hitting me about the head for refusing them. I was still felt at considerable risk 12 hours later, so tried phoning. The switchboard couldn't get the Mental Health Team to answer the phone so I was on a busy/hold tone for 5 critical minutes. When I finally spoke to the PLN, they had no record of my presentation the night before, and moreover, said that because it was during the day, that I had to go to my GP and ask them to refer me to CMHT (who have previously refused to accept the referrals).

My GP operates a phoneback appointment system, so although the receptionist seemed to sympathise with what was going on, I was sitting by myself for a further 2 hours until the GP called back, and their response was that -with my intent and other signs such as voices - that I had to go to A&E, and that they would speak to them to ensure I had an immediate assessment for hospitalisation (which I've never wanted anyway). I refused to go until I'd had an assurance that they would actually see me at A&E (which I think is reasonable, given that I know my crisis escalates during the hours-long wait in the unsuitable environment), to which the GP agreed. Another 2 hours later, I chased the GP, whose calls King's had not returned.

My husband has contacted the PALS, who say that assessment is done on a points system which means that unless you're about to harm/kill others you may not get immediate psychiatric help, which means that my condition continues to escalate without treatment. There seems to be no support for managing mental health before it becomes critical, but even when I get into crisis, I go in circles, with each of the GP, CMHT and A&E all advising that I contact one of the others in the loop and telling me that I’m not their responsibility.

At the moment, I believe I'm expected to manage my own care with no support, and although this sounds 'cost effective' in reality it means that I've become a lot more expensive as my condition has escalated and needs increased. It seems to me that the cost of a community psych nurse (whom I probably wouldn't even need to call- it's just knowing there's support there when I hit a rough spot in the self-managed recovery I've been forced into by what seems to me to be a lack of resource) is thousands (tens of thousands?) of pounds less than medical hospital treatment.

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Response from Su Glazier, Head of Improvement, Innovations and Involvement, South London and Maudsley NHS Foundation Trust

Dear Turquoise,

I am very sorry to hear that you have had such difficult experiences with your care and that you are so distressed. The issues you have raised are clearly very urgent. Our advice is for you to seek help from your primary healthcare practitioner face to face - your Care Co-ordinator if you have one, or your GP if you don't. Ideally you need to have someone with you to help explain what is going on, e.g. your husband or a friend and/or an advocate. Local MIND organisations will tell you how to access an advocate in your local area.

I am also sorry to hear about some of the waiting problems in Kings A&E Department and the lack of safety you have experienced. We work closely with Kings College Hospital NHS Foundation Trust to provide help for people who are experiencing a mental health crisis as swiftly and effectively as possible. We are sorry if you have experienced problems with your own care and we would welcome the opportunity to discuss your concerns further.

If you would like to email me directly or phone me to discuss your situation further, please contact me at su.glazier@slam.nhs.uk or phone me on 0203 228 1669 (I am not always in the office but you can leave a message and I will call you back).


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Update posted by Turquoise (the patient)

I am not surprised to see that this response feels like another "it's someone else's problem" statement.

I know my statement was long (there was a lot to cover), but included in there was the point that my primary healthcare practitioner (GP) cannot get A&E to do the urgent assessment required for hospitalisation/other urgent treatment.

My husband brought me to King's again recently - I don't remember the waiting time- I was far too out of it and as he'd had to drag me outside due to the stressful environment I'm sure I was forgotten about only increasing waiting time. The doctor doing the assessment asked questions in such a way that I didn't feel I was able to say what was going on, and claimed that as I'd previously been assessed (in April, and in May) by other (more senior) psychiatric staff there was no need for any revision to my care plan, despite it having escalated.

My GP (who is again having no luck with referrals to secondary treatment despite their assessment being that this is urgently required) said this was clearly ridiculous. My GPs response was that "passing any other medical test at one point in time doesn't give you a permanent clean bill of health" and I believe if it wasn't for my husband having been there they would have clearly assumed I was making it up.

I hadn't realised that SLAM operates King's psych service. This is one of the largest mental health providers in the country, and I don't feel can ensure the wellbeing of their patients (and the people they affect).

I never used to be mad - I feel it's my experiences with mental health services that have made me this way!

Response from Su Glazier, Head of Improvement, Innovations and Involvement, South London and Maudsley NHS Foundation Trust

Dear Turquoise,

I am sorry that you are continuing to have a distressing time. I would really like to talk to you directly to get a better understanding and to support you to get the help you need from mental health services. Please could you contact me or PALS so we can help. If you wish, we can also put you in touch with an independent advocacy service so you are not on your own when trying to move forward with all this.

Also, thank you for taking the time to feedback about your experience. We take each bit of feedback very seriously. It plays an important role when we review our services provided on the Kings College Hospital site and when we look at how we can make improvements to the service we offer.

Just to repeat again, we would really like to concentrate on supporting your individual concerns through direct contact rather than further responding through the Patient Opinion site. You have my contact details in my first response above.

Best wishes,


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