Black Moon….!

The Black Moon refers to the ‘Egg of Lilith’ which is the source of souls in the Neon Genesis Evangelion. I make mention of this as the nights that I have just done were made up primarily of tortured souls wanting help.

Mad or bad? When we attend jobs with people who are barking at the moon or trying to take their own lives, we try and get them help. Usually this means lots of talking and bags of empathy to steer them towards ‘Mental Health Services’ or the local ‘Crisis Resolution Team’.

Unfortunately most of these patients have taken on board some alcohol or have self harmed in some way or another. This means that the Mental Health Services etc. will not touch them with a barge pole stating that they need to be “assessed in A&E”. In the vast majority of cases this is the last place they need to be taken to.

Obviously if they have injured themselves seriously then they need to be dealt with at A&E but normally all they have done is scratched themselves or had a couple of pints/shots of alcohol. But in my eyes this is a convenient excuse for Mental Health Services to move the problem away from their door and dump them at good old A&E!

Over the years I have seen all the extremes of the ‘Mad and the Bad’ but I know when someone is genuinely desperate for help. And its these people who are being let down. We are in the process of developing a new ‘Care Pathway’ for mental health patients….but it will not work so long as the Mental Health Services play their own rules!

The new Mental Capacity Act (2005 updated to 2007) will set out new guidelines for Ambulance Services to care for people with acute or long term mental health issues. Again this will fail so long as we keep having to take them to A&E.

I still feel a bit shaky from the other night after confronting a woman in her kitchen who had a very large carving knife pointed at her throat. She was in bits! She was really at the end of her reasoning and it took us a long time to convince her to put the knife down. Usually we can switch on the empathy for each job and then switch off as we head for our next one. But this woman touched a nerve in me.

‘There but for the grace of God go I…’ It could have been me standing there in the kitchen with a knife to my throat and I thank God that my life is not too bad. But the thing that got to me the most is the complete lack of care/empathy/understanding/compassion from the Mental Health Services. I don’t want to go into detail as it may breach confidentiality issues but, even though I am not a qualified Mental Health type person, I know that this woman was in need of help from the right people….not in A&E!  

This was one of several mental health incidents that I attended over two nights. The others were not as traumatic but none the less still frustrating with them ending up in A&E.

If any readers are in the Mental Health profession I would value your opinions.



17 Responses to Black Moon….!

  1. AnneDroid says:

    I hope you get some good responses on this interesting topic. It seems to me the world as we have set it up is designed for the mentally well only It also seems to me from the fact that animal charities attract huge amounts of donations but mental health charities are the Cinderella ones, that, for all our scientific progress, we as a society bury our heads in the sand when it comes to mental health. That is to our shame. I suspect it’s because we all know that mental health issues are on a sliding scale and we don’t want to consider the possibility we are on one of those scales. I’m not surprised to read on this and other blogs that the mentally ill fall through cracks in the system. The prison service which employs me has noticed that some of those who fall through the cracks fall into prison cells eventually.


  2. Bendy Girl says:

    I hope you’re feeling better now big bro, that sounds an awful situation to be faced with. Today I saw a young woman in the supermarket, obese and arms covered in what were clearly self harming scars. I’ve seen enough of them on various friends to spot them a mile off. Perhaps what no-one really wants to acknowledge is that there must be a link to the modern lifestyle.
    Those suffering from mental health conditions are set to face increasing problems as the new welfare reform act is bringing in ‘reforms’ which will hit the mentally ill worst of all, and of course that will impact on other agencies, namely you guys, the police and A&E. lil sis

  3. Mark UK says:

    I’m only a First Responder, so I don’t (knowingly) get sent to mental health situations. However, I somesimes do an obbo shift with the real ambulance service, so I have seen some of this at first hand.

    Also, the word “knowingly” is important. I used to have a frequent flyer who had breathing issues as well as mental health ones. On my last visit (some months ago) the patient was NOT in need of assistance with breathing (for which I’d been called), but just needed to vent. The police had also been called, and the paramedic in the FRV didn’t know the patient. He’d hung back until the police arrived. I, in innocence, had gone in.

    The patient was very agitated, and felt she had suffered some kind of injustice from her ex-partner. Her mate was in the room, just nodding in all the right places. I was sympathetic but not just agreeing with everything she said. She was OK with me, but still fairly wound up.

    When the police arrived, one of the officers also knew her. He took a harder line. However, with me doing soft and him doing hard, we managed to calm her down enough to get her to allow herself to be taken in for assessment.

    I found this very tiring, but I also felt that I’d earned my corn that day.

  4. […] Prole wrote an interesting post today onHere’s a quick excerptThis means that the Mental Health Services etc. will not touch them with a barge pole stating that they need to be “assessed in A&E”. In the vast majority of cases this is the last place they need to be taken to. … […]

  5. nickopotamus says:

    I always feel awful getting the NHS out for mental health jobs. It’s a waste of your time, as although you can treat the physical wounds you can’t do anything for the actual cause of the problem, and it’s a waste of the patient’s time as the last place they need to go is stressful busy A&E.

    Unfortunately, the way mental health care works in this country is there is nowhere else – the on call doctors/Crisis team/psychiatrists always refer to the ambulance service if self-harm has been involved, and if there hasn’t been any self harm it’s just brushed off as nothing to worry about.

    I’m glad it’s not just me who’s pissed off and upset by that feeling of helplessness, helplessness enforced by bad management and budgeting of the mental health services 😦

  6. kingmagic says:

    Anne…Lil sis…Mark…Nick….thank you for commenting. I had replied to each of you individually but my wordpress is playing up. So for now I am letting you know that I will reply more fully just as soon as I get this ####### blog to work properly!

  7. I don’t know if this is something common in the UK, but when I worked as a NYC medic, there were certain hospitals that had a specific psychiatric ER (A&E) that one could take patients to. Of course, this wasn’t always utilized, as more often than not, one still had to go to the regular ER to rule out any medical conditions first. These calls that would come in were tagged as “EDP,” shorthand for “Emotionally Disturbed Person.”

    I haven’t been in the loop for about 9 years, but, I think these psych ER’s still exist. I will have to ask my brother about that………

  8. Louise says:

    I would say that 60% of the calls I’ve been to in the short time I’ve been on the ambulance service were related to Mental Health issues.

    I completely understand your views on finding someone in genuine need of mental health assistance……… A&E is not the place for them.

    The ambulance service and A&E simply do not have the training or resources to do anything contructive for this patients. This is at time extremely frustrating.

    I’d like to direct you to a blog I’ve been pointed to……………. its written from the other side of the fence, the opinions and experiences of a long term mental health patient and her experiences of the UK’s mental health services:

  9. Zac Smith says:

    Some time ago I was the duty Army Officer for a small garrison. One of the soldiers had (what I would describe as) a mental breakdown. While clearly drunk, he was at a level of insanity that was quite disturbing and was clearly a danger to himself and probably others. I rang the police, the Wiltshire Ambulance service, A&E and the local mental health team. The one thing they all agreed with was that I was the best person to deal with him. (Hours spent on Mental Health care training: Nil)

    In the end, I locked him in the cells overnight, despite being fully aware that I was certainly falsely imprisoning him. The abrogation of responsibility by the mental health team really shocked me. Fortunately I had broad shoulders and a cell handy, but the “correct” course of action would have been to release him.

  10. kingmagic says:

    Mr. Nighttime…we need a A/E (ER) for mental health incidents.

    Louise..thanks I will check it out.

    Zac…a difficult call but safety was the first priority. Next would be to get him the help he needed. Hope he sorted himself out. I witnessed a suicide bid whilst I was serving in the forces and the mind set at the time was one of derision and contempt for the soldier who tried (and very nearly) took his own life.

  11. ThereandBack says:

    It is becoming increasingly obvious that the emergency services/A+E etc are as frustrated as Mental Health Service Users when it comes to seeking help and support for [individuals with] MH problems from MH services. The biggest problem at the moment, in my opinion, is that they are reactive rather than proactive. Rather than respond with appropriate services when an indiviudal first presents with MH difficulties they wait and wait and wait until something really serious has occurred and then react, usually by detaining the person under the MH act. When that does happen they all pass the buck, nobody wants to take any responsibility.

    As a mental health service user, seeking support out-of-hours when I have been in crisis is nigh on impossible. Nobody wants to know. The only people who are interested are the emergency services, who I have had very positive experiences with, but are limited in what they can do.

    There’s just a complete lack of resources and a massive shortage of acute beds. MH professionals would argue that ‘crisis teams’ are there to support those as an alternative to being in hospital, but that doesn’t suit everyone. Some people need that place of safety. What gets lost in all of this is that while the patient is slowly deteriorating and everyone (MH Services) is standing around watching, the patient is loosing, possibly, their job, their friends, their independence, their social networks etc and after complete breakdown it is so difficult to rebuild all those things up. Support at an early, e.g. proactive, stage would help preserve all those things and give the individual a much better change of recovery.

    The situation I am in at the moment is completely crazy. I am on the waiting list for an acute bed in my local unit (I have been for two weeks now) after an assessement a fortnight ago and my social worker told me today, that essentially, I have little chance of getting a bed until I deteriorate to the point of needing to be sectioned. It is total madness. An admission now could ‘nip things in the bud’ and prevent further deterioration and actually preserve some of my current life structure, but that seems neither here nor there. The one thing I will say though, in my teams defence, is that they all know that, are all in agreement with me and share my frustrations, but the pen pushers are in charge now.

    Added your blog to my sidebar.

  12. Emma says:

    I don’t know the answer but I do know and appreciate what you are talking about.

    I hope the new act does benefit these people in some way..xx

  13. Stonehead says:

    And from Australia, one of the hazards for paramedics dealing with people who are out of it (for one reason or another).

  14. kingmagic says:

    Thereandback…its good to hear the story from someone with first hand experience. And its strange to hear of the follow up you receive from Mental Health Services. Its still a strange organisation to us.

    Emma…thanks Emma. x

    Stonehead…still in the Ambulance Service in this country we are guilty until proven innocent. Things dont change. Its easier to sack a Paramedic than a nurse/doctor/consultant/member of the public/yoof/hoodie.

  15. Lesley says:

    My partner has bipolar and although the GP has been great, mental health services have been a waste of time. When the crisis team got involved in daily visits, they generally just seemed out of their depth. I think if my partner had been moderately depressed they would have been great, but they just seemed not to know what to do when faced with someone who was severely depressed. They did obvious stuff wrong like asking lots of questions and not leaving enough time for a reply. Someone who is severely depressed thinks more slowly and will thus take longer to reply to a question than someone who is mentally well. But stuff like this meant that she was labelled as unco-operative. Ironically I ended up successfully fighting a threatened section to hospital.

    My partner is now on lithium and be working for the last 2 years with no mental health problems. But I genuinely believe without my help and help of friends my partner could easily have ended up permanently unemployed and with poor mental health

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