The Potential Cost of Dismissing a Patient's Concerns
(Trigger Warning: Mentions of suicide, self harm, trauma, and overdose)
I ended up in A&E recently. I’ve been there before for fairly minor things; such as a hairline fracture of my toe (after a friend accidentally stepped on my foot) or the time I hiccuped while eating a piece of apple; and somehow got it stuck up my nose.
This time, however, I went for #MentalHealth reasons.
This was after a particularly unhelpful assessment with my local Community #MentalHealth Team triggered my suicidal ideation and I took an overdose. Let me explain:
I have experienced various traumas in my life. For this, I’d been having counselling. By my last counselling session, my #MentalHealth‘ symptoms had worsened and I was having graphic intrusive thoughts, flashbacks, as well as suicidal thoughts and strong urges to self harm. My Primary Care team decided because of this, I was too unstable for them, and needed to be referred to Secondary Care (aka Community #MentalHealth Team) until I gained stability. The CMHT appointment was booked for the following week, and although I had some hope that they may help, I also tried to prepare myself for the possibility that they may not be able to help.
The CMHT assessment was worse than I expected. I was assessed by a very condescending, judgemental nurse. She asked me to fill in a very short questionnaire (something to do with how often I feel useless, demotivated etc) then told me she’d only ask me a few questions because CMHT had seen me a few times before & they knew my history. She also told me that if she felt I was any risk to myself or others, she would have to inform a colleague. She wanted me to tell her how I was feeling, at first. I told her that I had been struggling recently with flashbacks, graphic intrusive thoughts, suicidal thoughts, and urges to self harm. I made it very clear to her that I was definitely going to harm myself once I got home. She didn’t appear to listen to this. She asked me the usual questions about what stops me from harming myself, what the flashbacks and intrusive thoughts were about etc, but every answer was met with a disbelieving, almost smug, look.
She then asked me how I expected CMHT to help me. I wasn’t completely sure, and I told her this, but I felt I needed to be monitored in order to keep me safe. She replied by bluntly saying that the team did not have the resources for this. I said that I needed a medication review as I felt my antidepressants had stopped working. She said no to this as well. She believed that the antidepressants were helping at least a bit (I do not know what evidence she had for this, I at least knew, from monitoring my moods, there had been a sharp decline in my #MentalHealth). I told her that I may as well stop this medication if it’s not working. She insisted I stay on it.
She asked me if I still had paperwork from my previous sessions of therapy with my support worker. I said I did, and I tried to refer to them when in distress, but I found I could not concentrate and needed some face to face support to help me get that focus back. She was disappointed that I had not carried out the suggestions on the paperwork as often as she would’ve liked. I explained how difficult it was when feeling like this, but she dismissed this.
She suggested the usual things, volunteering, joining classes etc. She asked me about my hobbies, and then decided that I was on my computer too much, and that was the reason for my mental health problems and symptoms. I admitted I did spend a bit too much time online, but it was not the only factor. She assumed I spent all my time there, and pretty much insinuated I was lazy. I brought her back to the reasons I had been referred to her, and tried to get her to understand that I really was struggling and needed help.
A few of my other suggestions were met with a “no” and honestly I felt as if it was me versus her. A battle rather than an assessment that is supposed to help me. By the end, I was in floods of tears, with a desperation to harm myself. I felt as if I was completely on my own, and there was no help left. No hope left even.
Long story short, I ended up attempting suicide. I attended the urgent appointment she had booked for me, explained everything to the GP, and was told to go straight to the hospital. The term “high risk” was used.
From the GP appointment, to the triage nurse, doctor, and psych liaison team, my treatment was excellent. They listened to me, took me seriously, treated me as soon as they could, attended to both my physical health and #MentalHealth. Unfortunately the only place I would’ve been sent to from the Psych Liaison Team, would be CMHT, and they simply would not take me on. The Psych Liaison Team explained everything in a much calmer, informative, and compassionate way. They answered my questions fully, and did not hide anything from me. Although they couldn’t help practically, they gave me advice and signposted me to organisations that could possibly help. I was also told to go back to my GP; where he could either do the medication review himself, or refer me directly to a Psychiatrist (something the CMHT nurse did not tell me).
I am now being monitored by my GP, I have new antidepressants, as well as an emergency prescription to help me sleep. My parents are looking after my medication, and keeping an eye on me. Although the self harm/overdose urges are still there, I do feel safer and more supported.
The treatment I had from the CMHT nurse, and the GP and A&E staff, were poles apart. Even if you are unable to help your patient practically, you need to be compassionate, honest, and informative at least. I know that in the UK especially, resources have been cut to the bare bone. We deserve to be treated with respect and maybe even a little understanding though. Without this, there is a potentially high risk of a vulnerable patient harming themselves. This is the cold hard truth, and it could make all the difference.