Wednesday, August 20, 2008

Sectioned

September 2003

If you have been following our story in order this is quite a jump forward in time, but the subject of having a loved one detained under a section of the Mental Health Act is one that has been discussed recently, but not in depth. This was our experience.



It was a Sunday morning. I awoke earlier than usual, not having slept very well after being woken during the night by Mr Man repeatedly banging his head on the pillow in an attempt to get the voices to stop. He had been discharged from hospital five months earlier, but the medication he was taking seemed to have less and less effect on his symptoms as time went on. It had been decided some months previously that Mr Man would be admitted into hospital to start treatment of Clozaril, but he was still on the waiting list for “the Clozaril bed”.

Despite a growing history of self harm, suicide attempts, and psychosis, Mr Man still had no Care Plan in place, no CPN, and no Care Co-ordinator. We “coped” alone. Earlier that week the strain had become too much for me and I had resorted to alcohol, just to experience one night without the worry and the emotional pain of watching Mr Man suffer. Not being a regular drinker, when I wanted to repeat the experience two days later I realised I wasn’t coping.

Without a support system in place, when I realised how bad the voices were getting I didn’t know what else to do except call the usual “out of hours” Doctors surgery. I explained that Mr Man was waiting to be admitted for treatment with Clozaril, but that in the mean time his condition was deteriorating quite badly. The Doctor agreed that I should bring him in to be seen.

The problem was that although Mr Man had previously agreed to go into hospital to start his treatment of Clozaril, whilst waiting to be admitted his symptoms had deteriorated to the point that now he was confused as to whether he was really ill or not. Mr Man refused to get up. To begin with I thought this was merely part of the ongoing problem I had with getting Mr Man to do anything, because of the negative symptoms of his Schizophrenia. I called the surgery to explain. I was sure that the Doctor wouldn’t understand and would think I was wasting his time; after all, that was the response I was used to from Psychiatrists and Psychiatric Nurses, so I didn’t expect much from a GP, but he suggested I try again. Mr Man still wouldn’t get up, but this time it became clear to me that it was because he didn’t want to be seen by a Doctor, rather than just not wanting to get up. This worried me even more because I knew from experience that once Mr Man had lost the insight that he was ill his delusions would take hold and there would be no reasoning with him. I called the surgery again to cancel the appointment. I was embarrassed that I had called the surgery for an appointment and now Mr Man was refusing to go, and I felt so helpless. The Doctor must have discerned the anxiety in my voice and he threw me a line.

“Are you saying he is refusing to be seen by a Doctor?” Something in the tone of his voice told me what he was thinking.
“Yes” I replied.
“Are you concerned that he could be a danger to himself?” he asked.
“Yes” I replied, and I went on to explain that that was why I was so worried; because the voices were worsening and they often tell him to harm himself.

I was so relieved and so grateful when he said he would arrange a home visit for Mr Man to be assessed. Mr Man was a bit sulky with me about that, but once the Doctor arrived he agreed to go down stairs to be seen by him. After discussing his symptoms with him, the Doctor asked Mr Man if he would go into hospital voluntarily, but he refused. The Doctor asked me if I agreed that Mr Man needed to go into hospital, and I did, so arrangements were made for a Psychiatrist and a Social Worker to attend.

Mr Mans mother visited us that day, which had been pre-arranged earlier in the week. She was obviously confused by the presence of strangers in our home, so I took her into the kitchen and explained what was happening. She was overcome with emotion at the thought of her son being taken into hospital against his will, but for me – as someone who had needed to hide knives and blades, and constantly reassure Mr Man that he doesn’t have to slice himself open when the voices tell him to, and that no harm will come to him or me for not doing it – having him “sectioned” seemed far less traumatic than the thought of his condition deteriorating further.

The lesser of two evils?

"Sectioned Lady" by Philippa King


The whole process was very drawn out with much waiting around, firstly for the appropriate people to attend and then for an ambulance to take Mr Man to the hospital, which wasn’t really necessary but apparently required by law. From the time I called the surgery to the time Mr Man was finally admitted took about 12 hours. During that time Mr Man was anxious but quiet. He didn’t argue, and he didn’t struggle. He was resolute that he didn’t want to go to hospital, but he seemed to have resigned himself to the fact that he would have to. The Social Worker was very chatty and friendly, and even managed to get a smile out of Mr Man a couple of times. There was no drama, and apart from that edgy feeling of expectation when you’re waiting for something to happen, the day was quite boring. I was relieved when the day was over and Mr Man was safely on the ward, although leaving him on the ward was never easy for me. I could never quite decide which was the lesser of the two evils.

I’m not sure if I had Mr Man admitted for his own safety or my own sanity, but it prevented him from having to wait many more months before starting his treatment of Clozaril – the first medication to really make a marked improvement on his symptoms.

15 comments:

margerydaw said...

it must have been a really difficult time for you both. thanks for all that you share on your blog. The stuff that you say on here, along with things that i pick up from other blogs by service users/carers, sticks in my mind, and will go towards making me practise in a certain way when i qualify.
learning about mental health nursing from the clinical perspective is obviously really important. I also think though that taking note of people's real life experiences is equally as vital. After all, when i qualify, i won't be working with Patient X from page 900 of my text book.
Anyway, I'm rambling on, just wanted to say thanks :) lots of love to you and MM X

Barbara K. said...

Your question about - did you admit him for his safety or you sanity - made me think that in world where most of the corners are sharp, there is no way of knowing, for sure, which way to turn.

I think what matters is that at least a small portion of the energy used in the act of turning comes from a place of compassion -- for MM & for yourself. I see that portion of compassion in your writing.

I hope this medication helps, a lot.

Mr Mans Wife said...

Thank you for you comment Margery. I agree that people are not always text book cases. I'm glad to know that you are educating yourself through reading real life experiences rather than just relying on the clinical perspective - and that is why you are going to be so good at what you do.

...

Barbara, thank you for your thoughtful comments, as always. I think I made the right decision at the time for both of us. I wouldn't like to have to make that decision again though.

Anonymous said...

YS11 here, made an anonymous comment about hot weather a while back, and can't seem to log on properly...yes, in our relative's case hot weather seems to be a problem, maybe a combination of less sleep and dehydration/drinking way too much!

Hope you are feeling more yourself - don't think you should feel bad about rejecting "minor" extra burdens, because the baseline demands on you are already high, no matter how used to them you may be.

I hope that readers are understanding about sectioning - as barbara k. says, you don't have the benefit of hindsight when you make that decision. In our relative's case, the issue of self-harm wasn't there, and so he simply ran off on the day he was supposed to go to hospital. He was anxious not to let us know where he was, yet when we did find him, he kept saying over and over again, "Thank you for coming to get me, thank you, thank you...". Like Mr. Man, once the issue of decision-making was out of his hands, he didn't seem to resist the idea of hospital.

However, by then he was physically too sick for antipsychotic medication - recovery was longer, harder, and less successful than it might have been. If sectioning could have avoided that, it would have been worth it.

Seratonin said...

My Hubby was close to being sectioned once a long time ago in the very early days of his illness.The Psychiatrist put it to him straight, that unless he went in voluntarily he'd be sectioned.A lot of the footwork for getting him into hospital was down to me & this was at a time that there really wasn't a great community mental team where we lived.Because we didn't have a car & I couldn't drive then anyway, we had to rely on either friends or relatives & even once a CPN to ferry Hubby to hospital.The thing that really got me on one occasion was when Hubby absconded from hospital & indeed went missing for 24 hours.During this time he had apparently been sitting on railway bridges ready to jump in front of trains & actually climbed an electricity pylon at one point aswell.How on earth he never did himself any permanent harm I'll never know.

Mr Mans Wife said...

YS11, thank you for sharing your experience with your relative. I find it interesting that your relative didn't resist going to hospital once the decision was out of their hands, just like Mr Man. I wonder if deep down they both knew that that is where they needed to be?

Although I didn't have the benefit of hindsight at the time, that particular hospital stay turned out to be the least traumatic because the consultant on the ward was fantastic and the nursing staff seemed to respond well to having a consultant on the ward that knew what she was doing, so they followed her lead and treated the patients with more respect. But neither Mr Man nor myself liked him having to be in hospital.

Thanks again for your comment.

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Seratonin Sis, you must have been out of your mind with worry when your husband went missing from the hospital. I was always a nervous wreck during Mr Mans hospital stays because I was always so worried for his safety, I can't imagine how I would have felt if he had gone missing for 24 hours.

I'm very lucky that I passed my driving test just weeks before Mr Mans first admission. I appreciate how difficult it must have been for you without transport.

Thanks for sharing your experience Seratonin Sis.


I think it's particularly noticeable that no "service users" have commented on this particular post. It would be interesting to hear some experiences from the point of view of what it is like to be sectioned, and how it feels to read a "carers" point of view on it.

Anonymous said...

(YS11) From the times that our relative has been really ill, he doesn't seem to remember much of the most acute period. He just remembers the final, convalescent period as the total stay (with us or in hospital) - so for him, a hospitalization of 4 months was about a month.

I'd like to know too, how he felt, but it's not worth distressing him by reminding him that his memories are different from ours.

Mr Mans Wife said...

Mr Man seems to have gaps in his memory too, YS11, but not so extreme so as to forget months at a time. That must be very difficult for all concerned, especially as these lapses in memory are distressing for your relative.

Tainted_Halo said...

I find it interesting that your relative didn't resist going to hospital once the decision was out of their hands
It's an odd one for sure - and happens more times than not - when someone is sectioned it's not all wrestling and drama. I often believe that it's important to separate the illness from the person whilst still recognising that the illness alters how that person presents. In that mind - the state of 'becoming' unwell must be like twilight sleep where you drift in and out of consciousness - or awareness/insight drifts from good to worse.
As someone reaches the stages that they can no longer determine reality it's as if they don't trust their own decisions. Having someone to make that decision for you is like having to trust implicitly in your mum again. I think it's a testament to anyone who accepts compulsory admission in this way that deep down they trust the people around them enough to almost give up their responsibility for making decisions for themselves.

Mr Mans Wife said...

You make an excellent point Mr Ian (Tainted Halo) and you have obviously had more experience in this area than I have. I must admit, it is something that has puzzled me, but now that you explain the reasons it seems so obvious.

Mr Man wouldn't have trusted the doctor or social worker, but as I mentioned in a previous post, Mr Man knew from past experience that I would support him as much as I could during his hospital stay, and we have a strong bond of trust between us.

Thank you for your insightful comment Mr Ian.

cb said...

Thanks for sharing this. As a social worker that goes out and carries out these assessments I always try to think about how to make the painful process as trouble-free as possible under the circumstances.

Anonymous said...

Hi, just thought I'd leave my perspective. I've been sectioned a few times..sometimes quietly in my own home and sometimes back to the wall in the corner of a doctors surgery. There have been times when I have been too addled to make any kind of reason out of why "they" are doing this to me but tbh there have been times when I've "dared" them to section me because I can't bear for this to be my fault again with all the upheaval of getting the kids looked after and letting people down again. It is somehow easier to say to the kids that its the doctors idea I leave them than admit that I can't even get my crushed mind to believe that they are enough to live for. When I'm well my friends admit that the thought of being sectioned is abhorrent to them but when it's all thats between you and dying its not too hard a cross to bear.

Mr Mans Wife said...

Hi CB, thanks for commenting. The social worker that day was very pleasant, and I'm sure you are too :) I know social workers are often criticised for trying to avoid out of hours work, but this man happily gave up his whole Sunday for us.

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Anonymous, thank you very much for sharing your experiences so honestly. I appreciate why it would be preferable to have the decision taken out of your hands when you have children. Each time must have been heart breaking for you. Thank you again for sharing that with us.

Helen said...

My mum's just been sectioned and it's left me feeling so confused because she's hearing voices. It was a relief to read someone's account of schizophrenia even though we don't know what's wrong with Mum.

Mr Mans Wife said...

Hi Helen. I'm sorry to hear about your Mum. Take courage though, there are lots of reasons why people start hearing voices and it's not always due to Schizophrenia. Often it can be treated very successfully, and I know lots of people who were given the medication that was right for them first time. I hope this proves to be the case with your Mum.