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

I remember discussing with the psychiatrist what I should do when my OH was saying completely mad things - should I challenge them or not? He said that delusional thoughts are held more strongly than ordinary ones - for example a normal person might say it is 4 o'clock when it is 5, but they could be persuaded that they were mistaken. Someone who is in the grip of a paranoid delusion (e.g. my wife is trying to kill me) holds that view very strongly indeed and is not open to discussion about it as they are sure they are right.

Glorianny perhaps we should write a book about it? 😊
Let me think a bit….

Glorianny My father wrote to Mrs Thatcher following my mother’s treatment in a Nissan hut used as a ward. Mrs Thatcher visited the hospital and a substantial rebuild happened quickly.

Re electric shock treatment.. a young relative with bi polar wasn’t responding to treatment after one whole year in hospital and reluctantly electric shock treatment was tried. I think the recovery was helped by this.

Pre Mrs Thatcher’s time I have a clear recollection of visiting my mother held in a padded cell wearing a Monro jacket. Also I vividly remember asking the gp what was wrong with my mother only to be told in a very forceful fashion that she was mad! I remember crying all the way to the fish and chip shop as I needed to feed my four siblings.

So what is a way ahead now?

Glorianny

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.

I don’t agree with your summary of why mental health services moved to a care in the community model Glorainny. The former model was huge psychiatric hospitals operating as self contained communities, which effectively removed people with mental health issues from society. I disliked Thatcher as much as I’m sure you did, but to blame her for moving away from huge institutions to a community based model which was kinder and more appropriate for a majority of people with mental health conditions is wrong.

The problem is that due to a lack of funding, and consequently, staff it has now moved too far to community based care, and some people who need inpatient care and intensive support are unable to access it - but that isn’t the fault of the model itself.

Casdon I was told that there’s not a funding problem in mental health, the real problem is very few people want to work in mental health. It’s the Cinderella service.

I will always regret not trying to qualify as a psychiatrist but I wasn’t nearly smart enough or rich enough to go through a very prolonged training. I don’t really understand why a psychiatrist needs a full training in physical health when the reverse is not true. I mean a physical health physician is not trained to be a mental health specialist…

There is a colossal problem in funding for mental health services despite what someone once said to you ronib!
People are not machines and all conditions perhaps especially psychiatric and psychological conditions are not necessarily fixable. It's is an extremely complex area.

ronib

Casdon I was told that there’s not a funding problem in mental health, the real problem is very few people want to work in mental health. It’s the Cinderella service.

I will always regret not trying to qualify as a psychiatrist but I wasn’t nearly smart enough or rich enough to go through a very prolonged training. I don’t really understand why a psychiatrist needs a full training in physical health when the reverse is not true. I mean a physical health physician is not trained to be a mental health specialist…

I don’t know who told you there isn’t a funding problem in mental health ronib, but they certainly weren’t telling the truth. It’s true that there are recruitment difficulties, in older adult services in particular, but the main factor is funding - not enough training places, not enough roles in some branches, particularly psychology.

I’m no expert on psychiatric medical training, but I know that GPs do a training placement in psychiatry as part of their training programme. GPs are the only doctors who have training in a wide variety of specialties after the initial degree, so for example a general surgeon would know very little about, say ENT, or Diabetes. In that sense, Psychiatry is no different to other specialties.

Aveline

There is a colossal problem in funding for mental health services despite what someone once said to you ronib!
People are not machines and all conditions perhaps especially psychiatric and psychological conditions are not necessarily fixable. It's is an extremely complex area.

Am only too aware that people are not machines and that not all mental health problems are treatable. In fact my own gp shared with me that a close relative with bi polar had died whilst in a recovery care home. He had committed suicide. This gp also said that no family had escaped from having at least one member with mental health problems. Everyone is affected.

The nurse in charge of a mental health ward said that it was difficult to find staff and it wasn’t a budgetary issue, rather he has a full budget, but rather a reluctance to work in this area. Therefore no trained staff!

Where did you get that information from Ronib? I've watched it deteriorate since 2006 due to year on year cuts in funding. I've watched several "re-organisations" in the local Trust, each one cutting resources - inpatient beds, community care centres, drop in centres for User and Carer support, OT and other "necessary" roles cut altogether (remaining OT's now work basically as nurses), numbers of Psychiatrists cut, numbers of workers cut, psychologist numbers cut, people being taken on as temporary locums, contracts not the more expensive permanent contracts, workers moved around at short notice meaning work relationships falter, admin workers cut

and all this with increasing numbers of referrals each year.

Its probably about time I told you why I know so much: I'm a trained psychotherapist and in the past worked in Community Mental Health support in SSD but have also been a Service User since 2002 (depression and anxiety, not bi-polar or a PD) I have been a governor on the local trust. In addition, a lot of Quakers (I'm one) work in Mental Health, and I've discussed it all at length. I've been an inpatients, had electric shock treatment, has a long and fortunate time psychotherapy, attended drop in centres, been to OT groups - every word I'm saying is accurate.

I've just got divorced from an abusive man - violent words, and a great deal more and who has bi-polar and a PD but would not let himself be treated beyond a certain point despite my efforts which of course were as effective as they might be given I know the system well.

Casdon - only 50% of GP's do a Psychiatric placement as part of their training - I suspected this from discussions, but have just looked it up to be sure.

Wyllow3 the ward manager at a London psychiatric hospital told me this.

I have just done a very quick Google search and there are studies supporting my view.

The reports refer to mental health nursing only

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

Ronib, the number of Acute Wards in my area has been reduced from four in 2010 to one. Do the maths.

To help someone with a mental health problem you need assessment and treatment quickly, almost impossible, if prescribed medication is prescribed many won’t take it for long periods. You usually become a target with violence for example, you can’t reason with a person if they become violent or if they get an idea in their head that is pure fabrication.. all time is centred on this person to the detriment of everyone else in the house. They can be extremely selfish as everything is about them, they don’t seem to see you’re exhausted and not coping yourself.mmmm
We need more GP’s and especially those interested in mental health but I can’t see that happening.

ronib

‘Casdon - only 50% of GP's do a Psychiatric placement as part of their training - I suspected this from discussions, but have just looked it up to be sure.‘

That means though that there are mental health trained doctors available in every GP practice. If you think about the role of a GP, they have to cover every possible specialty, it’s not unreasonable for someone to be trained in, say Obstetrics and Gynaecology, and someone else in Psychiatry, surely?

One nurse telling you about staffing on his unit told you the truth as he saw it I’m sure, but what he didn’t mention by the sounds of it is that the reason there weren’t nurses to fill the vacancies on his ward was that not enough nurses are trained, that many who are trained leave because of the pressure of the job, etc. and of course, nurses choose where they want to work.

Iam64

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

5 years medical schools
1 year hospital
Plus I think in excess of 2 years psychiatric training
I respect psychiatrists very much. I think 8 years plus is a long time to spend in training and wondered if training could be shorter? Given the huge shortage that is.

Wyllow3

Ronib, the number of Acute Wards in my area has been reduced from four in 2010 to one. Do the maths.

Wyllow3 I think we are talking at cross purposes. There’s a world shortage of mental health nurses. It’s not confined to the Nhs.

I don’t know why the number of wards has been reduced from 4 to 1 in your area.

ronib

Iam64

ronib, psychiatrists need general medical training. There are well established links between physical and mental health. Psychiatry gets a lot of criticism , a lot of it unfair

5 years medical schools
1 year hospital
Plus I think in excess of 2 years psychiatric training
I respect psychiatrists very much. I think 8 years plus is a long time to spend in training and wondered if training could be shorter? Given the huge shortage that is.

I think the short answer to that question is no. It’s only after they qualify as a doctor that people decide which branch they want to specialise in, most will try out several different areas before they decide, as it’s a huge decision, affecting the rest of their career.

Casdon that’s maybe part of the problem? I’m looking at how Cuba runs its health system and training immediately jumps out as a having a different model. Truce?

There was a report in 2011 which blamed the failure of care in the community on lack of funding. Of course it was a good policy but one thing is certain if you introduce a policy for the wrong reasons and then fail to properly fund it you practically guarantee its failure.
www.nationalelfservice.net/publication-types/policy/care-in-the-community-has-failed-the-most-vulnerable-says-new-think-tank-report/

Well, absolutely, Glorianny.

Beds wise - the cuts are greater in my area (its known for it) but here is a 2021 report comparing the situation then to 2010.

If you go back just a bit further then it's substantially more.

www.theguardian.com/society/2021/jul/05/number-of-nhs-mental-health-beds-down-by-25-since-2010-analysis-shows

That’s the point I think Wyllow3, it’s the cumulative effect of many years of underfunding that’s got is to where we are now. The strategy was, and is right, but the implementation is no longer possible within the resources. In the early days, funding was tight, but services were on the whole safe and protective of service users. Given a return to huge psychiatric institutions isn’t the way forward, more needs to be invested in training urgently.

Yes, not to the huge old institutions, but...cutting acute wards wholesale has caused immense problems.I watch the excellent "Ambulance" series on BBC 1 as well and notice the time now spent on MH calls for people who clearly need acute beds before they can be treated in the community.

Its true that staff shortages are the same all over the NHS of course, but article after article points out that if there were a 25% cut in beds in other significant sectors - can you imagine the public furore?

I realise this isnt directly addressing the O/P - ie how to cope with long term N and D, but it is indirectly addressing it, because of lifelong stories of people coping because their N and D has spent chunks of time as an inpatient when needed - and that has shrunk beyond recognition.

I don't think a return to huge institutions is at all advisable. I do think looking at the original intentions behind those institutions and how they were intended to work, before they became overcrowded dumping grounds for socially unacceptable people, could be valuable. The original intention was that patients would have a place of safety and be given jobs which might help them, provide them with work which was physical and productive, and at the same time create a community which was self supporting. Gardening and agricultural work were considered to be helpful and being away from everyday stresses was ought to be healing. They never really worked the way they were intended to, but I do wonder if some people with MH would benefit from time in a caring and supportive environment maybe communes would be a good idea.

In the 1950 and 60s one of the groups of people put into mental hospitals were the elderly and confused. As a child I vividly remember encountering a crocodile of old ladies being taken on a walk round the grounds of our local hospital. They began waving and shouting at me and I was terrified. I realise now they were just rather unfortunate old ladies, but at the time I thought they must be dangerous.

Allsorts there are some online sites such as bipolar.uk and others listed by the Nhs which might prove helpful.