I won’t go into details, but here is the scenario – when the health service, and the divide between mental and physical health goes wrong.
An older man, say in his 80s has deteriorating memory, changes to his personality, perhaps his sleep-wake cycle is reversed.
His family have been helping him at home for the past six months, but, finding it more and more difficult they decide to transfer him to a care home for respite, at their own expense.
Four weeks after transfer to the care home his behaviour, let’s call him Nigel, to make this more personal, has deteriorated. He isn’t sleeping. He refuses to wash and on one occasion he punched another resident.
The GP is called who calls the psychiatrist.
GP: ‘We believe Nigel has Vascular Dementia, the care home staff are struggling to support him, despite all their best person-centred interventions – diversion, distraction, relaxation, he is becoming more anxious, more distressed. We can’t cope.’
Psychiatrist: ‘This man doesn’t have a diagnosis of dementia, he hasn’t been through the memory clinic, he has red legs, I don’t feel this is a psychiatric issue – it is medical; send him to A&E’
24 hours later, Nigel is admitted to a ward, let’s call it ‘Merlin Ward’ at the local acute hospital, he is seen by the physician who checks Nigel over and feels that there isn’t anything majorly wrong with him other than his 88 years and several long-term health conditions; perhaps, diabetes, heart disease and asthma.
‘We need to get Nigel home, although he can’t go back to the care home as they said they can’t cope and he can’t go home as his family can’t cope… What do we do? Let’s wait for the social workers to sort him.’
72 hours after admission Nigel has become distressed. Anxious and fearful, he wants to leave the hospital, he can’t understand why we won’t let him go, he feels we are trying to harm him, poison him, deprive him of his liberty.
The next day Nigel has smashed a computer, a window and punched a member of the nursing staff. Nigel is not a bad man, he isn’t violent, he is distressed, terrified.
The staff do their best to calm him. He throws a plate against the wall. It smashes.
We try to administer medicines, overt and covert, Nigel refuses.
Eventually, for his own safety, we sedate Nigel. He becomes tranquillised.
The hospital staff are distressed, his family are distraught.
‘We can’t look after Nigel, we feel he needs to be sectioned – for his own safety,’ Says the hospital doctor, sad, feeling defeated, inadequate.
Another twelve hours pass.
The psychiatrist arrives, mental health social worker in tow.
This man is not psychiatrically ill – he is medically ill, he should stay here. You are doing a great job. After all, his CRP – a test for infection, inflammation and innumerable other conditions is slightly high, his blood count low and kidneys sluggish.
‘We are not trained or equipped to support this man,’ says the matron.
‘I’m sorry – the law is the law, he is medically ill; it’s not his psyche.’
The psychiatrist departs, the social worker leaves the building.
The nurses are left with a ward full of older people, frail and vulnerable, they call security, guys in stab-jackets with thickset necks; they sit sweating in the corner.
Everyone feels disappointed, let-down, exasperated.
Nigel is still zonked from the sedation from earlier.
The computer monitor, still smashed, the broken crockery has been swept away.
This doesn’t seem right.
This doesn’t seem person-centred.
Not holistic, or collaborative.
What do we do? Where do we go?
This is a failure of the system, a failure of standards, inadequacy of care and lack of love – it is not considering what is best for the person, it is playing organisational games where the patient is piggy in the middle and no one goes home satisfied.
Nigel remains locked in the ward. Asleep.
This is a fictionalised account.
Nigel is not a real patient.
There is no Merlin Ward.
There are psychiatric teams who see the medical/psychiatric dualism of modern medicine as an impassable obstacle.