3/4 Of Mental Health Patients Receive No Care

A new report published today by the independent Mental Health Taskforce to the NHS reveals that: “One in four adults experiences at least one diagnosable mental health problem in any given year” and “Three quarters of people with mental health problems receive no support at all.” Suicide is also rising, the report says, stating that: “A quarter of people who took their own life had been in contact with a health professional in the last week before they died.” And so, the report concludes, David Cameron has pledged an extra one billion pounds per year to mental health care in the NHS, hailing it a mental health “revolution” – it's an odd choice of word. Now, I love the NHS. Every member of my family (except me) works for the NHS as doctors and nurses. As a family, we love the NHS; we are grateful for it; we believe in it; we (except me) have dedicated our lives to it; we support the nurses’ strike and the junior doctors’ strike because NHS staff work exceptionally hard, and save lives and care for people, and it’s one of the best things about this country. That said, this new statistic about mental health care in the NHS saddens me, but it doesn’t surprise me. It’s a bit of a long story… In September 2014 my 32-year-old older sister attempted suicide, taking 178 tablets that she knew (because she’s a doctor) would stop her heart and end her life. She had, I later found out, been contemplating this seriously for some time, and finally on that day at about 4pm, she double locked her front door, switched off her phone, wrote a note I was never permitted to see, and, as far as she knew, committed suicide. Though she hadn’t expressed her intentions to me, she had sent me some concerning texts about something unrelated that morning (her phone bill I think), but her tone in these texts alarmed me. At the time I was living abroad and she was in London, so time was against me, but I alerted our parents and asked them to go round to her house and check on her. They said “She’s probably just asleep”. A few hours later, when still nobody could get through, I insisted they go anyway; by this time it was 11.30pm and she had been unconscious for up to 8 hours. After breaking down the door and finding her half dead, they called the ambulance, who told us that 10 minutes later and we would have been too late. She died repeatedly that night, going into cardiac arrest for about six hours and being resuscitated again and again by the emergency team. Members of that team were her colleagues at the hospital Then, once they had stabilised her heart, she was moved to intensive care. She was in a coma and we were told she may be brain dead. She was put on a ventilator, her body was chilled to protect her organs and her brain, and she was given lead to counter the effects of the overdose. I remember very well the nurses washing and brushing her hair and moisturising her face; they asked me to bring in her own products from her flat, which I found very touching. They took wonderful care of her. My family and I made friends with the other families whose relatives were on the intensive care ward. There were six beds, and the other five patients had all been in accidents resulting in head trauma; they were unlikely to wake up. Their relatives asked whether my sister had also been in an accident and I hesitated; my mum answered for me, “yes”. Thank god, on about day four, she woke up, but was so delusional from the effects of the drugs in her body that she thought everybody was trying to kill her. She couldn’t verbalise these fears however, because there was a tube in her mouth, which she tried to pull out repeatedly, from sheer panic, and with a look of total terror on her face. It was very painful to watch, and, not recognising me, she kicked me in the stomach, afraid I was trying to hurt her. A nurse comforted me behind the curtain while doctors restrained and eventually sedated her. I wasn’t told at the time, but this was actually quite normal behaviour for a patient waking up from a coma. Once my sister had woken up properly, and was getting her voice back as her throat healed from the tube in her mouth, she started to make more sense, but kept asking what had happened. “You took an overdose and now you’re in intensive care,” and then she would ask me again three minutes later, “Where am I? What happened?” And I would answer, “You took an overdose and now you’re in intensive care.” She would say, “Oh, yes I remember, okay.” Three minutes later we would begin again. When she was able to breathe on her own, I took her for a shower which the nurses kindly allowed me do. She was very thin at that time and felt faint standing up. If I hadn’t have been there, a nurse would have showered her – I’m sure with care and kindness – but my sister is a very private person, and in the strange state she was in, she would have found this embarrassing and difficult; well, as anyone would. When she was well enough to be moved out of intensive care, she was allocated a bed in a ward. A professor (a senior doctor at the hospital) came to talk to us, and told us she was “extremely high risk” because, “this wasn’t a cry for help, this was a very determined attempt to end her life.” I asked the doctors and nurses if I could stay with her in her room and after some persuasion they obliged, providing me with a duvet and a pillow – probably because my sister was a doctor at that hospital; this was not common practice for relatives of patients in these circumstances.

And so my sister and I talked. It was very difficult because she was not relieved and happy to have been saved; she was angry. She said that it was her right to end her life, and that though she understood why we tried to save her, and understood that that was our right as people who loved her, she wished we hadn’t. And so, over four days and nights, I tried to convince her to live. The conversation went on for hours, then a bit of sleep, then it would start again as she woke at 4am scared, confused, upset. In the end she promised to stay alive for a year and give life another go, but said that after that, it was her decision and we weren’t to stop her. I said okay. At this point, my sister had been assessed twice by a psychiatrist and we were informed that a “mental health attendant” was to sit with us, on suicide watch. Nursing staffing is limited so they often don't have enough nurses to provide one-on-one care, and in situations like this, an extra person/ attendant is called upon. Under normal circumstances, the attendant would sit in the room, but as I was there, they agreed to sit outside and give us some privacy. The first person to take this post was a man of about 40, and he sat outside reading the paper. So while I tried to convince my sister to stay with us, the attendant sat quietly outside. Then he left, and the second attendant took watch; a woman also about 40. This woman came in at one point in the evening, clearly bored, and asked if she could have some Ferrero Roches (gifts from visitors). Of course we said yes and she proceeded to fill her pockets with them. Then she said to my sister, and I kid you not, “Why did you try and kill yourself, lady?” My sister stayed quiet, tears in her eyes. The attendant continued: “You’re married aren’t you?” My sister shook her head. “But you got kids, right?” My sister shook her head. “Well, do you go clubbing? I go clubbing and it sorts me out, the music and the crowd, you lose yourself man.” I was incredulous. When she finally left, my sister and I laughed about it, because, what was this woman thinking asking these questions? The incident evoked my sister to make her first jovial comment of that week, “She made me feel like the sane one in the room,” she said.

It was sort of funny, but only because I was there and we were able to make a joke out of it. The reality is that the one person hired that night to make sure my sister didn’t kill herself, barged in, scoffed sweets and asked the most insensitive questions imaginable. I didn’t report the attendant, because I had other things on my mind. But I did imagine my sister being alone in that room, visitors all gone because visiting hours are 8am to 1pm and 4pm to 8pm, feeling as she did, and that woman being the only person there to care for her. And I think about what may have happened next. A year on, I’m wondering how many patients in similar situations to my sister are right now sitting in rooms feeling utterly alone and frightened and confused, with an attendant sitting in their room telling them to go clubbing. One week later, my sister was released from hospital and put into an out-patient programme at a centre near our parents’ house. She had to go once a day, where she was seen for 30 minutes or so by a psychologist and given a dose of medication; they have to do this once a day so the patient doesn’t try to overdose on the medication, so patients are only given a few pills at a time. So that was 30 minutes of the day. For the other 23 hours and 30 minutes, my sister was at home, with me and our mum. She woke up in the night, confused, upset and angry. She wouldn’t eat, she wanted to hurt herself, she barricaded herself in her room at one point. So what were our options? Insist she goes back to hospital? Have her sectioned? Then she’d end up back on that ward or one similar – possibly with that woman, or no-one. No, we thought, we’re better equipped than they are to help her through this. And that’s the point I'm making. Eventually, my sister went to see a private psychiatrist and psychologist, who really helped her over a period of four months. It’s the first time anyone in my family has used private healthcare as opposed to NHS care. We know that this was a luxury; we could afford for her to have private care. And we were able to spend time with her, supporting her and talking things through, at any hour of the day. Of course we could only do so much, she had to do the rest, and she did; you can read her story here. But what about the other two million people in the UK who contacted the NHS last year for mental health support? Who don't have the money to go private, and may not have supportive family and friends around them. What care do they receive? Honestly, I have no doubt that most of them receive an excellent standard of care. I am sure that mine and my sisters’ experience was not the norm. It still happened though, and had a few circumstances in that story been different; had she been left entirely in the hands of that NHS mental health team, with no additional support, I don’t believe my sister would be doing as well as she is today; perhaps she wouldn't be alive. The stats released this morning show that this is happening, in more than just a few cases, and with a fatal outcome.