Mark’s story
Feedback about poor mental health and available services in Lancashire has been frequently brought to our attention. From feedback received, members of the public have highlighted their concerns over access to mental health support services and their resultant wait times. Members of the public have commented that they have struggled to access support whilst they are waiting for their referral to be processed. Not receiving appropriate support soon enough, can often cause people’s mental health to deteriorate to the point that they reach crisis.
Below is Mark’s story, which details his journey from a mental health ward to a medical ward through A&E.
Mark’s story
Mark is our son, he is 38 years old, and suffers from treatment resistant schizophrenia, characterised by episodes of psychosis and loss of mental capacity. Every time he relapses there is always the risk that he may not recover sufficiently to ever leave hospital so any severe episode of psychosis could be potentially life-changing. As a consequence, it is vitally important to ensure that if Mark’s mental health is poor he is kept safe, and also protected from any unnecessary stress, in order to reduce the likelihood of catastrophic relapse.
Mark was admitted to a secure mental health ward in Blackburn in November and was detained under Section 3 of the Mental Health Act. Acutely unwell in his mental health, and suffering from Strep A infection, he then developed a severe respiratory infection in early December.
DAY 1
With oxygen levels dropping below 90% staff on the mental health ward followed the established procedure and AMBULANCE NUMBER ONE was sent for, to take Mark 200 yards across the hospital car park to A&E. Mark then sat on a chair from 11 o’clock at night until 8.30 the following morning, without being seen; exhausted and distraught he ABSCONDED, running out of A&E with his two mental health nurse minders following in his wake. Lacking full mental capacity, and suffering from pneumonia, Mark was at significant risk in this situation. He does not know Blackburn, and if he had left the hospital grounds he would have been totally lost. It was bitterly cold, and Mark had no coat on. Fortunately, he made his own way back to the mental health ward.
DAY 2
Further monitoring revealed his oxygen levels had dropped still further, and it was clear he was extremely ill and in need of medical care. A SECOND AMBULANCE was sent for, however in spite of very persuasive efforts by the paramedics Mark refused to go with them so they left.
Later that day Mark’s oxygen levels were lower still, and giving serious cause for concern, so a THIRD AMBULANCE was sent for, and at this point staff asked the family to help persuade Mark to attend A&E. Mark eventually agreed to go into the ambulance, and I asked for a copy of his MENTAL HEALTH RISK ASSESSMENT, so it could be given to the medical staff in the main hospital. However, when I offered to give the risk assessment to the medical staff in A&E they gave it back to us, saying ‘they didn’t need it’. There was no piped oxygen in the cubicle, so bottles of oxygen were brought, and Mark was given oxygen.
Blood tests had been ordered on the mental health ward; A&E sent Mark for an X-ray, and we were told he had pneumonia. He would need to be admitted to a medical ward.
DAY 3
Still in A&E, waiting for a bed.
DAYS 4, 5 and 6
Mark was sent to the medical assessment unit (AMU), and this was followed by a transfer to a bed on the Respiratory ward, when one became available.
THE RESPIRATORY WARD
Lacking the mental capacity to make sensible decisions regarding his treatment, Mark refused to have a catheter fitted. Once again, family were sent for in order to help persuade him.
Mark was quite poorly, and while he was on oxygen he was effectively tied to the bed, which was in a ward with other patients. At all times while he was in the medical side of the hospital Mark had two mental health nurses with him.
The problems began when Mark’s oxygen was disconnected. Mark immediately ABSCONDED FROM THE WARD, once again leaving his mental health minders trailing behind him. Mark went to the shop, where he bought a bottle of cough medicine, and promptly drank half of it.
After he had returned to the ward (which he did under his own steam, so once again it was fortunate he did not go further and get lost in Blackburn), Mark asked if he could shave, and so one of the medical nurses gave him a RAZOR. Mark went to the bathroom, so could not be followed by the female mental health nurses, and while there he self-harmed. Blood everywhere.
Later on Mark went to the bathroom again, and self-harmed a second time. Blood everywhere; again. Altogether there were three serious incidents in just one day.
Mark is a big man, and can be aggressive when mentally unwell. On this occasion the only person who was harmed was Mark himself, but in the context of a busy ward with other seriously ill and bed-bound patients alongside, there was the potential for harm to others.
DAY 7
A week since he had left it to go to A&E Mark was deemed sufficiently fit medically to return to his bed in the mental health ward (which had been empty throughout his stay in the medical ward).
It had been hoped that Mark would be well enough in his mental health to be allowed Section 17 leave to spend Christmas Day with his parents. However, his journey through A&E, the AMU and the Respiratory Ward took its toll on his mental health, which (unsurprisingly) deteriorated considerably in the days following his return to the mental health ward. Mark spent Xmas Day in hospital instead of with his family, and it is likely that his mental health admission will be considerably longer than it would otherwise have been.
In 2021 Mark made a similar journey from the mental health ward in Chorley Hospital to the Respiratory Ward in Preston Royal Infirmary, also with pneumonia. On that occasion he spent 7 hours in an ambulance queue outside the hospital, and then two days in A&E before being found a bed. (Note: Chorley Hospital has an A&E Department and ,also a Respiratory Department, but Mark was taken to A&E in Preston in an ambulance because that is the established procedure). On that occasion Mark occupied the medical bed in Preston and also the mental health bed in Chorley for two weeks, and throughout his stay in the medical ward TWO mental health nurses had to be with him 24/7. Surely not the best use of hard-pressed resources.
It is important to say that at all times, the staff working with Mark, both mental health and medical nurses and doctors, were professional and caring. Everyone did their best within the constraints of the established procedures. It seemed to us that it was the system/s that need to change. There were times when Mark was at risk of serious harm.
It is worth considering that the way Mark was managed was cost-intensive, and alternative strategies would not only be better for the patient but also more cost-effective as well.
- I was told by one of the paramedics that patients on the mental health wards ‘used to be able to go straight to a medical ward, but they stopped that three years ago’. The journey through A&E for a person who is already an in-patient on a mental health ward is ridiculous, and needs to be changed.
- If mental health nurses can walk across the car-park to sit with a patient in A&E, then I am sure medical nurses/doctors could walk to the mental health ward to examine a patient. The several days Mark spent in A&E would have been better spent in the safety of a secure mental health ward, with bottles of oxygen sent there if needed instead of being brought to a cubicle in A&E, while he waited for a medical bed.
- Ways need to be found so that a mental health patient does not occupy two beds at the same time, a mental health bed and a medical bed. Although the two Trusts are completely separate, it is not acceptable for one Trust to waste the resources of the other, even if they are not paying for the waste themselves.
- A mentally ill patient who has a record of aggressive behaviour towards others should not be allocated a bed in a crowded ward. If there is a history of absconding, they need to be kept in a secure area. The only way this can be achieved is by allocating a single room with a lockable door.
- Mark is lucky; he has a loving and supporting family. Many mental health patients are not so fortunate, and have no-one to advocate for them. It is important that systems are in place to ensure all mental health patients have access to medical care in a safe and secure environment.
- Medical staff need to be aware that mental health risk assessments are written for a reason.
This case study is anonymous, and names have been changed to protect confidentiality
This is just one of the stories we have heard about the experiences of poor mental health leading to crisis. Healthwatch Lancashire will be launching a project in April to investigate people’s awareness of mental health services in Lancashire and their resultant wait times. We also aim to establish issues faced as a consequence of prolonged wait times. If themes are revealed, recommendations will be formulated and a final project report will be produced to send to decision-makers and NHS Trusts.