Being sectioned

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Edwin Strohacker

Original Poster:

3,879 posts

85 months

Sunday 19th February 2017
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I've just had an unsettling phone call from an old friend. A mutual friend, whom I've lost touch with was sectioned yesterday. It seems he's been living a chaotic lifestyle going from short term contracting job to contracting job, never settling anywhere, has lost contact with his child & has been taking lots of Cocaine recently.

I was told he's been telling people his computers are being hacked, his neighbour wants to kill him, he's being spied on and so on & matters came to a head yesterday in a row with his neighbour. The police were called & he was carted off to a secure unit AIUI on a 28 day section 2 thing for assessment.

I've not seen the guy for a few years & when we did knock about together, he was always a bit semi detached & always liked his drugs, although in those days it was nearly always a few ecstasy pills at the weekends. Things appear to have progressed from there & ended up like this.

I guess my question is supposing there's a few professional health care guys around here, what happens now? Is there a process? Is it possible to suggest a success rate for getting someone out of this hole or is it all too individual to say? What happens if he doesn't respond to the medical staff?

This isn't a world I've ever experienced & I obviously want to see a guy I've known for years & who is otherwise a reasonably hard working albeit flawed man get back on his feet.

gasman712

55 posts

137 months

Sunday 19th February 2017
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Paranoid ideation seems likely to be schizophrenia, but it could beasily something else like schizoaffective disorder. I suspect he will progress to a longer term section for treatment. He probably will be in hospital for weeks to months.
I have minimal psychiatric training although I do occasionally work in a psych unit and I can't give you an idea about outcome, but what I have seen is that treatment compliance is usually a major determinant of success.

paulmakin

653 posts

140 months

Monday 20th February 2017
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one of the most common side effects of stimulant misuse is paranoia.

regardless of aetiology, paranoia to the point where the criteria for detention are met is what it is.

diagnosis by exclusion - stop the drugs, see if the paranoia goes away. usually it is temporary and it will fade. for approx 25% of users it won't. diagnosis here is a drug induced psychosis, not schizophrenia. possibly mental and behavioural changes secondary to psycho-active substance misuse but the history is known so no need to quibble over diagnostic coding really.

without doubt, this is a Sec 2 MHA - admission for assessment. don't forget the small print though as S2 is also for "further treatment" (within the legal framework of the S2, consent etc) given that the Act does not differentiate between the two. as far as the commissioners are concerned, they are the same thing. his rights to refuse treatment are somewhat limited and, again, he needs to discuss with the treating team as things could escalate.

lasts for up to 28 days, rights of appeal are maintained etc. he needs to discuss this with his treating team. must apply within 14 days (of the 28) if intending to appeal. whilst laible to be detained he cannot leave the hospital without the written permission of the RC (consultant in charge of care) and must be prevented from doing so. this may become unpleasant if he insists on leaving.

if he improves then that's about it really and he goes home, often within the 28 days. if the clinical symptoms persist however and the criteria for detention continue to be met than an application for a Sec 3 may be made. here he gets into the "up to 6 months, no rights to refuse treatment after 3 months, limited rights of appeal, etc" scenario

paul

Edited by paulmakin on Monday 20th February 01:30

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Monday 20th February 2017
quotequote all
Guys, I appreciate this. It's all come as a bit of a shock & listening to the story, my first thoughts were it was all around the coke. The guy's always had a touch of paranoia about him but nothing you would say even approaches problematic if that makes any sense, so I'm thinking forced withdrawal will alleviate whatever's got into his head.

FWIW, my mate who went along to the hospital says the staff were effectively asking questions designed to let him go home but he said while he was being rational & lucid, it was like a switch being flipped & he went off into paranoid delusions & that was that.

zeDuffMan

4,054 posts

150 months

Monday 20th February 2017
quotequote all
Edwin Strohacker said:
I Is it possible to suggest a success rate for getting someone out of this hole or is it all too individual to say?
I can't add too much, however...

My mum was sectioned for a few weeks when I was young for severe depression, suicidal thoughts, delusions, etc etc. When she came out all the neighbours that had been affected by her crying/screaming/etc expected to her to be totally fine again, as if she had gone into hospital with a broken leg and came out again with it fixed. Mental illness doesn't work like that and it's likely to be a very long term process. But as the neighbours didn't understand that, they got frustrated and we ended up having to move away because we were dealing with harassment from the neighbours as well as my mums problems.

My point is that trying to give a 'success rate' probably isn't a good idea, and is the wrong way to look at it really. There are a lot of variables involved. Expect it to be months/years and be there for the guy when he needs it, but don't let it burden you.

andy-xr

13,204 posts

203 months

Monday 20th February 2017
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You have to look at it as 'that's who he was, and that wasnt working out great for him'

I say that from 2nd hand experience of someone I knew very well being committed and a few years of working more closely with a crisis team and mental health units.
They were great at a party, but that kind of caught up with them, and the New version of them was very different.

It was hard for them to accept, let alone friends and family, as they were for all intents and purposes a different person. Sometimes they were a medicated person, sometimes they were a suicidal person. Other times they were A Normal Person

What's important to recognise is that they've got a journey to go on, it's mostly up to them if they get on the bus. Incase you were hoping/expecting them to get back to how they were, they probably wont. On the up side, hopefully they're getting the help they need. I guess it's up to you if you want to support them (personally I would draw some very thick dark unmovable lines on what you will/wont do)

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Monday 20th February 2017
quotequote all
Even in the good times he was a bit of a liability but yep, I think it's time to recognise the party's over. I'm sure it's the coke that's tipped him over the edge, amplifying the worst aspects of his character.

Mate visited him yesterday & said he was agitated, wanting to go home & that the feeling was the realisation he'd been sectioned hadn't sunk in, so like you say, it's a journey but he has to take the first step.

jonamv8

3,145 posts

165 months

Monday 20th February 2017
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How old is he?

Ive a few acquaintances that dabble a bit too much in that world and often think the party is going to be over for then soon

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Monday 20th February 2017
quotequote all
I don't actually know, early forties I would guess. Wider point, like you allude to is I never knew anyone who was improved by sticking that rubbish up their nose.

paulmakin

653 posts

140 months

Monday 20th February 2017
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we always apply the "least restrictive" option as we have to. hence, allowing him the scope to give the "right" answers and be on his way. experientially, if someone can't tell me what i need to hear even when i spoon feed then generally speaking they're being detained.

it's not just about risk btw; there's a little used 3rd option which is "in the interests of the person's own health". also, the assessors will have considered capacity - i suspect that when undergoing a stimulant induced psychosis capacity will be lacking anyway so how could he consent to any alternatives to admission that he may have been offered?

toxbase suggests benzodiazepines only as required for treatment of stimulant intoxication. he shouldn't be yet prescribed anything more "heavy duty" as the treating team need to see how this situation develops. trust me, once he ceases to be "sectionable", he'll be on his way home. at this age, with no clear history of functional psychosis, it's almost certainly drug induced.

he has a 75% chance of recovering completely with no residual psychosis. however, he needs to make some lifestyle choices and changes which, frankly, he probably doesn't want to.

paul

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Tuesday 21st February 2017
quotequote all
For various reasons I won't go into, this lad is pretty incapable of hurting anyone either through character or physical capability, although I accept anything is possible when the balance of the mind is disturbed.

What I'm really saying is I agree that the sectioning was entirely for his own safety, he was apparently unable to pick up on questions obviously intended to reassure the staff he could be on his way & slipped back into the paranoia there & then, leaving the hospital little choice but to admit him, I am told by my friend who was present.

Same guy is visiting again & coming round for dinner tonight, so I should know more later on. FWIW, between us mates, we've decided I should stay away for the time being at least as I'm the friend who drifted away from the bunch & the fear is if I pop up out of the blue with a bunch of grapes & a bottle of Lucozade, I become part of the group in his head who's spying on him, so that's why this is all second hand reporting.

paul makin

56 posts

135 months

Tuesday 21st February 2017
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that's not at all a bad strategy; delusional beliefs can evolve and become systems, best to limit the scope for a few days.

usually, these beliefs abate once the psycho-active substance is becoming less active so watch and wait.

a test/small dose of an anti-psychotic will be considered soon. hopefully, a short episode for him.

paul

Pacman1978

394 posts

102 months

Saturday 25th February 2017
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If he wants to be taken seriously by the relevant health professionals and get access to treatment within the next millennium he needs to be 100% honest and open regarding any substance abuse and give it 130% of his all to stay drug free (hate using the word clean.. opposite word is offensive!) if he tries to tell porkies and still use then rightly so they'll blame his issues on drugs and send him on his way.

His length of stay will be not a minute too long nor too less than he needs, beds are so in demand that patients deemed well enough are packed off home on leave to few up the bed, I say this as a patient, if he tits around and joins in any nightly parties (drink and drugs) he will be wrote off and sent home. If he tries to make a bid for freedom, police will come knocking at his door and wont rest til seen.

28 days could be what he needs, a good rest and recharge, also being an inpatient he will gain access to treatment on the out a hell of a lot sooner, as in discharged with appropriate appointment in hand. I hope he is on a mixed gender ward as all male wards can be very tedious, women floating about kills the thick haze of anxiety that happens to unwell pissed off lads who are all cooped up in the same space!

I wouldn't expect miracles, he is there purely for his safety and that of others, once deemed not a danger he will be discharged ASAP. Any occupational health sessions should be made use of, some of it seems silly and laughable but the little exercises and the tricks that can be learned can really help and make daily life easier to deal with.

(11 stays, some self referred some sectioned over the past 15 or so years, they can be chaotic dirty rough dives, they can also be very calm and safe places to be, if he doesn't take it seriously then he should, they don't offer too many second chances, especially when drugs are in the mix)

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Saturday 25th February 2017
quotequote all
Already out six hours a day apparently. It's not going well. If anything he's deteriorated, demanded to be taken to a solicitor yesterday to file charges against the police for failing to stop enemies drilling holes in the walls to plant listening devices.

Asked the staff & they say he's doing well, we let him out for the day. We pointed out the latest delusions & they say they haven't seen it,so we have an intelligent guy on & off his nut learning to play the system. We (three of us) are talking about making representations to get him closer supervision & no outside access for his own sake.

paulmakin

653 posts

140 months

Sunday 26th February 2017
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usually these conditions are self limiting. are we totally sure that he's not still using when away from supervision ? i assume random drug screening is being conducted although only a quantitative assay will determine current usage - he'll test positive anyway, we know he's been using.

keep the treating team updated and let them do the necessary. i suspect it's time for a trial dose of an anti-psychotic and, perhaps, limit his movements and control his environment a bit more; they have the legal framework to do this so why mess about? if it's an ongoing psychosis then treat it, if it's drug induced then give him the requisite advice and send him on his way once asymptomatic.

paul


Edwin Strohacker

Original Poster:

3,879 posts

85 months

Sunday 26th February 2017
quotequote all
paulmakin said:
are we totally sure that he's not still using when away from supervision ?
No, not at all. I still haven't been to visit but the lads came over yesterday to give me the latest & we know he's with his girlfriend outside of hospital so we will find out if he's still into the gear soon enough. The upshot is the lads managed a chat with the nursing staff but not a Doctor so not much in the way of a clinical update or feedback from their perspective.

This guy is from Lancashire & we're on the south coast, he has in effect cut himself off from his family for years - we are for all intents and purposes all he has, which is why we're persisting with him & the feeling from our end of it is he's in no state to be out of hospital based on his current state - they clearly feel differently.

andy-xr

13,204 posts

203 months

Monday 27th February 2017
quotequote all
Edwin Strohacker said:
Already out six hours a day apparently. It's not going well. If anything he's deteriorated, demanded to be taken to a solicitor yesterday to file charges against the police for failing to stop enemies drilling holes in the walls to plant listening devices.
On the upside, it doesnt sound as though he thinks his neighbour is trying to kill him any more.

I think you have to be mindful of what 'progress' actually means to him and to you. The short term is basically he's not going to either kill himself or others. Then it's what treatment, and how effective that might be. This is probably not a short term 'get off the coke and things'll be fine'

I say from some experience with a person who was in no doubt that I had been possessed by a green witch and was conspiring to kill them so I must be stopped at any cost. Which didnt really help my sleep patterns. They, also knew not to tell the people in white coats all the details incase they were a mole.

It's not playing the system as such, more an issue of loose lips sink ships. For the person I knew, anti psychotics were the next phase.


Pot Bellied Fool

2,125 posts

236 months

Monday 27th February 2017
quotequote all
Edwin Strohacker said:
the lads managed a chat with the nursing staff but not a Doctor so not much in the way of a clinical update
The staff wouldn't be able to divulge much to someone not the next of kin anyway but don't be disheartened, speaking to the nursing staff is the most effective thing you can do!

Psychiatric Nurses are - in my experience of marrying one - pretty dedicated folk. Sure there's good ones, bad ones & lazy ones but to stick it you need to have a certain character & actually care.

If you can speak to the Sister/Charge Nurse/Band 6/7 in charge of the ward, that's like speaking to a Sergeant Major, they have a lot of experience, have seen it all and the Doctors listen to what they say about a patient - so your concerns are unlikely to have fallen on deaf ears. The greater problem is the pressure to discharge & free up a bed...

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Monday 27th February 2017
quotequote all
Good stuff - without sounding like a record with a scratch, this is all new to us, so while I'm repeatedly sounding the alarm, the reassurance is pretty welcome.

We've started looking beyond this episode, wondering about the longer term. If you could see this guy's life, you'd be looking on a pretty chaotic picture - we always put it down to his being a jack the lad, living in the moment but in this new context, we're thinking we've had a mate barely coping with life & we never saw it.

Edwin Strohacker

Original Poster:

3,879 posts

85 months

Thursday 2nd March 2017
quotequote all
To tidy this up, they kicked him out on Monday with some pills & a weekly appointment with the shrink. He's still banging on about listening devices, spies & god knows what else. One of the lads gave him a bit of tough love & none of it landed. We've agreed to keep an eye on him at arm's length for a bit, see how it goes. Maybe we should rig up some secret cctv in his flat hehe

Cheers for all the input, it all helped & you lot were bang on the money.