Our son is psychotic. On Friday his EIT person told us he needed at least weeks more in detention. He was clearly psychotic over the weekend. Our son is 20 years old. I am his NR.
We believed he had been made subject to a section 3. He had a test depo ten days ago and his first proper depo 3 days ago. For weeks he hadn’t come out of his room. In the last couple of days he has been in communal areas but has still been psychotic.
Midday today an AMP and Dr did an assessment and decided not to finalize the section 3. We got a phone call from a newly qualified nurse to tell us this had happened at 8.20pm this evening that he will be held on an informal basis from midnight.
We are worried sick because we know he is still psychotic. He is a danger to himself and others. Should the AMP and Dr have consulted his NR. Do we have any right to the notes and to know the logic of the assessment process ? Is there any way to question the decision ?
Very sorry to hear this. Did they have all the possible available information about risk (and not only since his admission)? Or are they basing their decision solely on how he presents on the ward (ie not a bother because he’s in his room)??
Have they collaborated in the assessment of risk with the EIT team?
Hope they give you some answers and keep him safe.
Please try not to worry. This is pretty standard. It won’t because they don’t think he’s unwell. It will be because they have deemed him to have capacity around his stay on the ward. They will be trialling informal status as the least restrictive option. If he has said yes I’m unwell and yes I will stay in the ward for treatment they cannot go for s3 and hsve to trial this.
That said there are protections in place… If your son wanted to discharge himself and the nurses felt he was a risk to self or others they could use a short holding section (5.4) which would trigger another assessment.
Hope it all works out and the depot works well.
Do we have any right to the notes and to know the logic of the assessment process ? Is there any way to question the decision ?
Excellent questions indeed. Most NR’s are unaware of their rights and powers. This should assist your knowledge: The Importance of the Nearest Relative in Mental Health Law – Investigative Psychiatry - no need to be 'mental health professional to understand it but it does take some study. ‘Armed’ with the knowledge you can better know what to ask for.
You may not have a ‘right to the notes’ - but there are ways around that. Your son can request the notes and pass it all to you. It’s basically two or three lines on a page with his signature. It’s as simple as, “I request the totality of my inpatient records to be supplied without undue delay. I am sure I need the totality of my records. Do not confirm this further.” (to avoid the ‘Are you sure?’ sort of question). I’ve coached relatives to use those words when drafting the letter. The word ‘totality’ is very important. This is business so yes it sounds ‘stern’. But trust me it works like clockwork. The relatives I have coached were then surprised by what they found in the records. The records are a good thing to have in hand but they can take up to 20 days to be supplied (I’m avoiding legal references here to so-called Data Protection rules). Most times (around 90%), from experience, the records will come within 48 hours from the above sort of request (by your son).
We got a phone call from a newly qualified nurse to tell us this had happened at 8.20pm this evening that he will be held on an informal basis from midnight.
Very strange. I’ve never in 35 years of experience as a psychiatrist heard of a patient being ‘held on an informal basis’.
Shared lessons that I normally give to relatives, having listened to many who suffered the effects of ‘the system’:
1 - Phonecalls are a trap. They can easily be ignored.
2 - Plain old ‘pen and paper’ are best.
3 - Emails also tend to be ignored or responses very delayed.
4 - All correspondence should have a desirable response timeframe e.g. In my own business matters wth Trusts I set out a request for written acknowledgement within 48 working-hours followed by full response within 5 working days. [I’m not loved by many Trusts. LOL!]
5 - Keep copies of everything.
6 - Create a log of all phone calls and correspondence (dates, times etc) in preparation for writing to MP or Chief Exec - or even to sue if that becomes necessary. I am not suggesting that you should or have to sue anyone, but preparation is ‘everything’.
7 - For phone calls - seek the full name and status of the professional on the phone. (Refusal to supply is not in their gift). ‘Team leader’ or ‘Health worker’ are meaningless terms. “Are you are nurse, occupational therapist, medical doctor, physician’s assistant (etc)?” is what relatives are entitled to ask for.
8 - Read up General Medical Council Standards in advance if dealing with medical doctors on the phone, or other conversations, from Core list of key standards and knowledge – Investigative Psychiatry - and related links.
We are worried sick because we know he is still psychotic. He is a danger to himself and others.
I feel for you. It’s your child - your flesh and blood. I don’t know you but I’m with you in my mind. Stay strong.