How to cope with someone with erratic behaviour due to a mental health issue

Am not into one upmanship you understand but my experience of involvement with mh in my family spans 64 years.

Not a competition but I've been involved in both sides of the issues for decades as family member and mental health professional. It's just not straightforward.

Aveline first of all thank you for your involvement in the mh. It’s a difficult area to work in and good professionals are very valued by families.

Please don’t be offended but perhaps you are so involved in the system that it’s difficult for you to take a step back?

All the mental health professionals, including psychiatrists, that we dealt with admitted that the system here is broken and there are just not enough resources. The Cinderella service. There has been a huge increase in youth suicide since our dear Premier locked us up for two years but what are they doing about it ? Lots of words, no action.

ronib

If a person has a known history of bi polar over a period of say 40 plus years,
why are they denied timely treatment and support? Why the incredible hysteria surrounding admittance to hospital?

They are denied timely treatment and support because there is a lack of funding.

There is no money for it .

Our Nephew went for an interview with his Mental Health team and some support was promised - that was last August, our daughter rings them and still nothing has been arranged because of the long waiting list, the GPs aren’t interested because he is now under the ‘care’ of the Mental Health team.

In our case the ‘hysteria’ is from our Nephew who is distraught at his circumstances and can see no end to the hell he is living in.

ronib I'm not too close. I can clearly see the cracks that people fall through. That makes it worse!

There’s actually a lot of funding in the case of my sister… Social worker, care workers, cleaners and probably more.

In a recent crisis the crisis team refused to attend, the home treatment team refused also and the gp is unavailable because the patient is under the care of the home treatment team.

It’s the most bizarre and frustrating experience which someone suffering from a physical illness does not have.

I have had to make some leek and potato soup to calm down!

Unfortunately difficult choices have to be made. For everyone with a lot of services set up there are those who have to do without as the funding just isn't there to provide the best (sometimes any) services for others.

Does the psychiatric profession not have a system of at least discussing the many problems facing its patients?

The new head of the Nhs, Amanda P? did a very upbeat presentation available on YouTube. Is there any mechanism for ordinary mh workers feeding an insight of problems facing both themselves and patients?

I forgot to say that the last time my sister was in crisis, she somehow got to A&E and the duty psychiatrist found her a bed. The psychiatrist in charge of her care recognises that she is very unwell.

Of course it does! That doesn't mean it has a magic money tree or retrospective workforce planning powers!!

Oh dear that’s very much against the information other mh professionals have suggested.

I doubt they'd tell you all the ins and Outs of the bigger picture. Sounds like your family member has a good range of services.

Ronib, the duty of care also means that relatives are NOT told "Everything" about a service user.

Your sister has rights to privacy: the professionals are not allowed to disclose details. You can give information about them if you are NoK or named carer but you will not generally be told treatment details.

Aveline thank you for saying so many times what needs to be said.

the workers know very well what many patients need but cannot offer the help they do. They are constantly triaging the patients in most immediate need and that often leads to fractured care. They have no choice, it's not what they want, its a rotten stressful way to work, with little satisfaction.

There has been a steady shrinking of acute services (ie Inpatient) for the last 20 or so years, in favour of "Care in the Community". And C in C wasn't so bad, 20 years ago.

You could for example ring in crisis at the weekend and a crisis worker would actually come out and visit you.

Now (I found out as I've had to be involved in care of ex abusive husband with bi-polar and BPD) on one Saturday night recentlythere were just 2 workers, based in A and E, for the whole of the city, trying to fend phone calls, A and E referrals - the lot.

Those in need all had a worker and beds were available for those in need, including voluntary patients there to actually "heal" not just pull out of suicide or very severe disturbance. They were reasonably caring places to be.

Very disturbed patients were in "intensive care' wards - now ALL wards are just 'intensive care" and when "intensive care" ends, there is no longer any transfer to an ordinary MH ward for time to settle on Meds and for MH workers to work with families.

(Although people were generally discharged too quickly and even then professionals in the Community were constantly frustrated by the "revolving door" situation - in hospital - out before not really ready - re-referred to hospital etc. )

However, as I've said above, there were local MH community centres around the city geographically and patients and carers could drop in - all gone, gone, gone.

Ronib. I don’t believe Aveline is too invested in the system to take a step back. She seems very experienced in it professionally and personally.

My experience is that getting care for patients with complex physical health problems is very similar to mh problems, that is frustrating g, distressing and complex

Fair enough Iam64 and Wyllow3… maybe I miscommunicated… what I was trying to say was that with even the best discharge plan, fully funded, it still went completely wrong. Again.

Maybe some types of bi polar alter as the patient ages and treatment becomes even more problematic?
Also I contrast the very upbeat presentation of the new head of the Nhs with the reality of current mental health provision and wonder why it’s like this.

On a lighter note, my sister will happily list all her meds to me without prompting!

ronib

Fair enough Iam64 and Wyllow3… maybe I miscommunicated… what I was trying to say was that with even the best discharge plan, fully funded, it still went completely wrong. Again.

Maybe some types of bi polar alter as the patient ages and treatment becomes even more problematic?
Also I contrast the very upbeat presentation of the new head of the Nhs with the reality of current mental health provision and wonder why it’s like this.

On a lighter note, my sister will happily list all her meds to me without prompting!

I wonder why the head of the NHS does that too, frequently, in fact have stopped listening when they do. Its a gross facade, and everyone involved working, getting care, admin taking incoming desperate calls, knows that too.

"what I was trying to say was that with even the best discharge plan, fully funded, it still went completely wrong. Again".

Thats the sad thing about some MH issues Ronib. If a service user has the sort of personality where they want - need? to play personality 'games' with workers, like they do with family, the workers are truly limited in what they can ever do.

Ageing, and some conditions - some mellow, accept: but for some it gets worse.

Whatever is troubling deep inside, because it's not "being addressed", (despite all efforts, as people may not really accept help) "comes home to roost". And the people around them have in the end to protect themselves.

But many conditions are treatable; I don't want to sound too negative. People do get better, people come to terms with their difficulties, and accept limitations, may drop ideas about themselves or life that are unrealistic, and so on, and the drugs we have now are so much better than they used to be.

To return to the OP, Allsorts: I walked away, involving a lot of pain, loss and guilt, and got help to do it (ie made sure I was not all alone) : but everyone is different.

I sympathise ronib. Trying to support a relative with m.h problems is so often exhausting. As for the nonsense where heads of service prattle in about how good everything is/will be, that’s another exhausting thingIm with Wyllow3 on the significance of personality. That underpins m.h problems and can be more difficult to manage

BTW, the trouble with "Personality Disorders" as diagnosis is that we sort of all have them in a way, it's a matter of degree, as to how far we can function well with others - ie accept responsibility, be able to be empathic, see other people as living breathing with feelings not as objects or "things" to use - lot of other factors.

In fact in the profession "Personality Disorder" diagnosis is apparently being replaced with "Complex emotional and Relational Needs' which is all very accurate but.....

Personality Disorder has always been a diagnosis psychs are reluctant to use. In my working life though, it was usually self evident. Complex emotional and relational needs sounds even more like all of us than PD 😉

Wyllow3 and Iam64 well I have had a day cooking just to try and get some perspective! Thanks both for trying to help. You can of course distance yourself from the problem but it still hurts if you think too much about it all.

Allsorts, I know what you're saying - no help out there when you need it and how to cope? Remember, always, that you choose to cope - or, at least, attempt to. You do have a choice.

A wise friend once told me 'You can put on your coat and just leave - anytime!' I thought it quite ridiculous. Leave? Leave my home - along with four children, two cats and a dog? To go where, exactly?

Of course, the real problem was that I loved him - and he was very ill so it wasn't his fault. I spoke to his doctor and he was kept in hospital for a week - for 'tests' but really to give me a break.

Had I left, though, the help for him would have come, either at home or (more likely) in hospital.

Hetty 💖

Accessing services for both physical and mental health problems is pretty hopeless at present.

My OH had both - physically disabled by Parkinsons, and also paranoid and delusional. Accessing care was like banging my head against a brick wall and was in many ways worse to deal with than his illness itself. It took a toll on my mental health and I have waited 7 months for an appointment to find a way to quell the awful flashbacks that I have.

Watching "Ambulance" on BBC there have been a number of scenarios where they have been called out to someone who has a mental health crisis, and the paramedics have been trying to get some help for them. Inevitably the "crisis team" will only see them if they are already registered with that team, and even then seem to refuse a lot of the time. The paramedics are left with no other choice than to go to A&E, but the patient often refuses, which means they are there for hours trying to settle the situation. Someone could have been having a heart attack while they, non-mental health professionals, are trying to calm the situation.

When a mh patient is discharged from hospital and the after care team, the gp resumes responsibility for care.
If you have not had any treatment, then surely legally you are still the responsibility of your gp?

Lucky girl 13 I found Sertraline a great help for 2 years to cope with the mh trauma of other family members . My locum gp worked it out. Good luck

rnib if you have such long experience of MH issues you should realise that the treatment of these conditions in this country has two conflicting issues to deal with. One is the lack of proper funding because Thatcher found a way of cutting costs which was termed "care in the community". The other is the traditional way of treating some MH issues was not only seen as abusive but actually harmful and certainly unacceptable and in conflict with human rights. I'm speaking of course of electric shock treatment, which was seen as a common way of treating what was then termed manic depression well into the 1970s.
Growing up with a father who was diagnosed with the condition when I was in my teens I was fortunate in that he was never violent but very emotionally manipulative.

In answer to the OP I can only tell you what my mother was told when my father was diagnosed and she asked his psychiatrist how she should treat him and deal with him. He said you treat him like anyone else who is ill, when he shows symptoms you deal with him as if he was ill and accommodate those, when he is well you treat him like anyone else and perhaps explain to him how he has made you feel. But don't feel you have to change your behaviour to suit him.
I don't think that will really help with the violence. As I said my father was never really violent.
I hope you manage to find a way. I'm pleased we can now discuss MH issues openly.