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Many people who care for someone with mental illness will experience difficult times. This may take place when that person’s mental illness is poor and needs additional help. Whether this might be for someone who is not yet diagnosed with a mental illness or for someone who has a long history of mental illness, it can be difficult to get help.
You probably know better than most when someone you care for is getting ill and perhaps when you or they are reaching crisis point.
It is not always easy to get help. There are several reasons for this.
Some professionals will not accept information from you about your relative’s health and ask that the relative come and talk to them themselves. This can often be the case with GPs and is a misunderstanding about the rules on confidentiality.
Sometimes professionals may want to assess the situation themselves. This can often take time and staff are not always immediately available. If a situation is recognised, sometimes there are not the services to deal with the person, for instance, there is often a shortage of psychiatric beds in local hospitals.
It is important when trying to get help for someone with a mental health problem in a crisis situation that you also take into consideration your own health. You will not be as effective if you also become ill.
Professional services are one of the first places you should look for help. They are experienced in assessing people with mental health problems and accessing care and treatment, and if the person you care about is already involved with mental health services, they may already know about some of the difficulties you are having.
The following people and services are worth trying:
The GP can refer someone to a psychiatrist or to the local community mental health team as well as prescribing medication or arranging talking treatments. It may be helpful to ask for a home visit if you live with the person you are worried about.
If you are in crisis during the night, most GPs have a 24 hour ‘out of hours’ telephone number. You will usually not be able to talk to a specific GP so they will not know your circumstances. Because of this you will need to give them a good description of the situation making it clear what you want to happen; for instance, if you want them to come out. Some GPs will not help unless the patient directly requests it. This can cause problems if the person involved is convinced that they are not unwell (sometimes called a lack of insight) or does not want professional intervention. Some GPs are very good but often GPs knowledge of mental illness is limited and they are insufficiently aware of the need for prompt action.
Community psychiatric nurses often work with GP practices or mental health centres and some can be seen on request. They should be familiar with all forms of mental illness and know how to access help.
This may result in help especially if you or the person you are concerned about is already known to the team. In some areas the local team will only help if the person has been referred by the GP.
The crisis team deal with people both known to the mental health services as well as those that are not. As well as crises they act beforehand to prevent a person needing to go into hospital. However, if they do need admission, they can arrange this. They usually aim to see someone within a few hours of referral. Referral can be made by a GP or psychiatrist, but sometimes by a carer or the person themselves. There is often a crisis line where you can talk directly to a member of the team or psychiatric nurse.
Many mental health trusts have an out of hours crisis line. This is usually for use of patients but can be used by carers in times of crisis. Sometimes this is answered by a member of the crisis resolution team but other times is answered by a psychiatric nurse, often in the local psychiatric hospital who can advise you or access additional services.
Take the person you are concerned about to A&E / Casualty
Sometimes A&E staff will be able to call the duty psychiatrist to see someone who is having mental health difficulties. This might result in admission. Going to an A&E department can involve a long wait in sometimes distressing circumstances.
Depending on the circumstances, NHS Direct (0845 4647) may be able to call your GP and emphasise that you are dealing with someone with a psychiatric crisis and request a home visit.
The Mental Health Act (section 13, paragraph 4) gives the nearest relative of someone who is mentally ill the right to insist that an approved social worker (ASW) interviews the person to assess whether they need to be admitted to hospital for further assessment or treatment. The nearest relative is determined by a formula set out in the Act, usually the spouse/same sex partner or older parent or oldest brother or sister).
If the ASW and two doctors agree that admission is necessary, then the person can be 'sectioned' and taken to hospital and admitted without their consent. The police will often be called when someone is sectioned. This is to ensure the safety of everyone involved.
Most people would only use this as a last resort. It could have a negative effect on your future relationship with your relative. However, under certain circumstances it may be the best thing to do and ultimately help your relative. If the ASW decides that admission to hospital is not necessary, s/he must state what other forms of support will be made available. This right to assessment can be used several times if necessary.
Persistence is important in getting help. Try each of the suggestions for help, and in many instances you may need to try them several times. If you are still denied help or the help you receive is inadequate you can threaten to make a formal complaint.
All doctors, hospitals and mental health services have a complaints procedure.
If you require help in making a complaint, contact your local mental health advocate. If there is no response to a request for an assessment from a nearest relative, it may be possible to threaten 'judicial review'. This would be taking the provider of the service (the assessment) to court to determine whether they have carried out their duties to assess your relative.
If you are offered help but you find that the help is insufficient and you are still experiencing a crisis situation due to someone’s mental health problems, it is important that you ask for help again. Take the time to note down why the help that has been offered is insufficient and what you want to happen. Occasionally you may be given unhelpful advice from a professional who might refuse to help arguing that the problems are behavioural or that no help is available until there is more of a crisis.
This page provides a list of useful tips to bear in mind when you are dealing with difficult behaviour in someone you care for. 'Defusion' means verbal and non-verbal ways of reducing tension between you and this person. These tips were developed from practice. The more you try these tips, the better you will become.
If you are concerned that an adult you know might be at risk of being hurt by somebody else, please contact the Safeguarding Adults At Risk Team on 020 8 891 7971. You can find out more information about the procedures which surround protecting adults at risk on the council's website.