Support for Current Patients & Families
You or your loved one has just been admitted to a psychiatric hospital. Perhaps they've been sectioned under the Mental Health Act, the hospital has written a care plan you've not seen or have been prescribed medication that you've never heard of before. What now? FDNH has put together a step-by-step guide below to help ensure that you are actively involved in your care, and the hospital is delivering care in line with national guidance.
1
Stay connected
Patients, stay as closely connected to your outside community as possible, and where safe to do so. Parents or loved ones, keep calling, visiting and sending cards, puzzle books, notes, etc. Keep a line of communication open at all times.
2
What's not okay in hospital?
Inpatient hospitals are so often at risk of becoming closed cultures, where attitudes, actions and unsafe behaviours (by staff, as well as patients) are normalised, and institutional abuse goes unnoticed. Staff, patients and families become desensitised to what is and isn’t okay in a hospital setting, and the likelihood of an abusive environment developing increases. FDNH have put together a guide for patients and families to identify what is and isn’t okay or safe in a hospital environment.
3
Understand what's going on for you, and what you need
There are other ways of understanding mental-ill health, distress and crises outside of a psychiatric view of symptoms, diagnoses and treatment. Sometimes it's not you, or your behaviour, that's 'wrong', but your environment, circumstances or unidentified needs that have led up to you being 'ill'. Take a look at our guide to understand what might be going on for you, so that you have an informed voice to get the right support.
4
Know your rights
· Whether you’re detained under the Mental Health Act or not, you’re entitled to advocacy. You can find a Mental Health Advocacy Service by location here. You can find other types of advocacy here.
· Have you been detained under the Mental Health Act on a Section 3? You’re entitled to Section 117 Aftercare. Rethink Mental Illness have put together a S117 Aftercare Factsheet to explain what you're entitled to, how to get it, and who's responsible for ensuring your S117 Aftercare is put in place.
· Sectioned under the Mental Health Act? You have the right to apply for a Mental Health Act Tribunal.
· Sectioned or not, you’re entitled to Legal Aid, both in terms of rights under the Mental Health Act and your Human Rights. If you’re financially able, you can search for a Mental Health Act or Human Rights solicitor here.
5
Know who's who
Make sure you know who everyone is, including the ward manager, matron, hospital manager, your psychiatrist, social worker, advocate and care coordinator. Keep a list of names, roles and contact details.
6
Document everything
Save, record, download or print all correspondence with the hospital and other teams involved in you or your loved one’s care. Keep it in a file on your computer, or physically. Some agencies (like local authorities) use secure emailing platforms that automatically delete correspondence after a certain amount of time, so make sure you download emails onto your computer.
7
Ask for names
You're on the phone to someone who says they're a nurse or member of staff. They don't say their name, or they only give their first name. They're informing you of a decision they've made, but won't say who made it and why. Ask for their full name (forename and surname). They won't give it to you? Request a reason why in writing.
8
Know the guidance
Knowledge is power.
Request copies of local policies and procedures from the hospital.
Find out what method of restraint the hospital use (e.g. MAPPA, PRICE) and request a copy of the hospital’s restraint policy.
The Restraint Reduction Network are a registered charity that work with various hospitals and care providers to reduce the amount of restrictive practice used in institutional settings. They provide a number of resources that may help you identify where hospitals are breaching human rights.
The Care Act 2014 is a long-read, but provides legislation regarding the duty of local authorities when registered care providers such as Huntercombe/ACG are deemed unable to continue regulated activity by the CQC.
NICE provide guidance for health and social care practitioners, including privately run hospitals like Active Care Group.
9
Ask for copies
Ask for written (printed or emailed) copies of everything; care plans, CPA/MDT minutes, discharge plans, and any correspondence to external authorities involved in your care (Social services, CAMHS/CMHS, GPs, etc). Won't give them to you? Ask for a written response as to why they won't.
10
Plan for discharge
At the moment of admission into a hospital, on a section or not, the hospital team must begin planning for discharge. So often, this does not happen, and patients and their loved ones are discharged back into the community without any support or transition, increasing the likelihood of further mental ill health and hospital readmission.
Discharge planning is deliberately individualised so that the needs of the patient can be met upon transfer back into the community. So? Start pushing for discharge plans to be put in place.
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· Start thinking about what kinds of support/services you might need. Do you need therapy, and can it be provided by the NHS? Do you need a PA funded by Social Care to help with the practicalities of your day-to-day life? What services are available with my Local Authority?
· Be specific. If you have a discharge plan in mind, ensure this is clearly stated and frequently documented. An example might be, ‘I want twice weekly support in my own home from my care coordinator’.
· Make sure you or your loved one is registered with an appropriate GP and under the Local Authority before discharge. Your Local Authority has a duty to carry out a Social Care Needs Assessment if you have a physical or mental health condition that prevents you from carrying out certain tasks and it has a significant impact on your wellbeing; you can find out more here.
· Ask what the discharge criteria is: what is the hospital’s plan in terms of supporting you or your loved one to be discharged? Keep asking and get it in writing.
· Know that referrals to community services and care can be made by the hospital psychiatrist before discharge. If the hospital say they won’t, get a reason in writing and send it to your commissioner, care coordinator, etc.
11
Need to make a complaint?
All inpatient units have a local complaints procedure that you can request to see and follow when making a formal complaint. Usually, external complaints are only considered once a complaint has been made to the organisation/hospital first.
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In FDNH member’s experience, complaints made to the hospital themselves are either not acknowledged, dealt with in the relevant timeframe, or patients and families are met with an inadequate outcome/resolution.
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Our advice? Make a complaint to the hospital and, once you’ve had a response, take it to the next level.
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· Contact the General Medical Council to make a complaint or raise concerns about an individual psychiatrist or doctor. You can also use their search tool to check the registration status of a doctor or psychiatrist (registration is a requirement in order to practice as a doctor in the UK).
· Use the Professional Standards Authority to search regulated and accredited health and care practitioners (who are not medical doctors, i.e; therapist, psychologist, social worker). The search tool will direct you to each ‘register’ (like the BACP) and you can then make complaint about an individual. You can also share your experiences of care to protect the future public.
· The Parliamentary Health Service Ombudsman make final decisions on unresolved complaints about NHS Engalnd and other UK government departments, including private hospitals if funded by the NHS.
· Integrated care boards are responsible for the commissioning of mental health provision and hospitals like Huntercombe/ACG. This article explains what ICBs are, their role, what they do, and their takeover from Clinical Comissioning Groups (CCGs). You can find your local ICS (and make complaints to them) here.
12
Keep breathing
At First Do No Harm, we know how confusing and isolating it is to have to fight for support, either for yourself or you loved one. We also know that one of the hardest things is having no-one who understands what it's like dealing with systems that are supposed to provide, at their most basic, care and compassion.
You're not alone. Family, friend or patient, if you would like to join the FDNH FaceBook Group to get advice and feel heard by a peer-led community, please get in touch.