Crisis Concordat

TW: contains references to self-harm.  Please proceed only if you are comfortable with the subject matter.

So after my plea for a writing prompt last night, the lovely Jen over at Jenasauruswake (a day to day account of life as a Mum with an acute Mental Illness, and absolutely worth a read) came forward with this idea, which I have spent much of this morning researching.

I have to admit to my ignorance of the expression ‘Crisis Concordat’ although, on reading some articles this morning, I’m more than well aware of the concept.  Much of what I am about to write comes from this webpage, as well as my own, first-hand, experience of the Crisis Concordat (CC) at work.  The theory behind CC is that there is a National Agreement, an understanding, between all Services and Agencies involved (or potentially involved) in the care of someone either in, or approaching, MH Crisis.  It advises that said person is treated efficiently, according to individual needs, and with dignity and respect.  It also says that this person should be treated by the appropriate professionals.  I don’t want to go into the particulars of the CC, because everything is detailed in the link above.

I realise that the effectiveness of the CC is, unfortunately, something of a postcode lottery.  I’ve heard many upsetting stories of some people being held in police cells for want of a bed in a nearby Psychiatric ward.  I’ve heard of people being restrained by Police Officers, and dragged, kicking and screaming, into Accident and Emergency Departments.  I know there are people, detained under the MH Act, transferred to Psychiatric wards miles from home, because no local beds are available.  Does any of this conform to the CC…?  I think not.  Is any of it humane…?  No.  Some of the worst cases are examples of humans being treated as animals…

But I have to be honest and say that, on the whole, where I stay is relatively well-off in terms of Psychiatric care.  My own current situation is such that my parents have met with my care team multiple times, and have been made aware of what to do should I find myself in Crisis.  We have a list of phone numbers on the wall in the kitchen.  Everyone knows it’s there, and everyone knows what it’s for.

My current circumstances mean that I regularly attend A&E with self-inflicted wounds.  I have been treated by aloof Doctors, apathetically suturing wounds.  I sometimes feel lonely and uncared for, but I’ve never been mistreated.  Don’t get me wrong; I’d love for A&E staff to be given training in MH First Aid.  I think it would be great for every A&E department in the country to have a 24-hour Duty Nurse, educated in SH, taught to recognise MH crisis and how to refer patients to the appropriate person.  Someone with whom the patient could engage properly, who knew why people SH, and that it wasn’t a pathetic suicide attempt.  My only gripe about A&E is the odd Nurse who feels it necessary to ask me if I know what day of the week it is, and who won’t take ‘yes’ for an answer, who makes me confirm it.  And (ok, I know I said there was only one, but there is one more…) I think they should, as a matter of procedure, report to the CMHT that I have attended A&E with self-inflicted wounds.  I also think it should be procedure for the CMHT to follow up.  A phone call, or a quick visit to make sure I am safe would be nice.  There are times when I leave A&E unable to process what has happened, feeling lost and vulnerable, and with no concrete follow-up arranged.

There have been occasions when I’ve been distressed enough to warrant referral to Psychiatric Liaison but I’ve never had to wait long for a Nurse to appear.  I’ve always been removed from the A&E cubicle and taken to a private room.  I’ve only ever been formally  assessed a couple of times; as the Psychiatric Liaison Nurses have become more familiar with my situation, they have been a bit more ad hoc about how they treat me.  A chat, a phone call to my CPN…whatever they feel necessary at the time.

So that is, more or less, my experience of the CC at work.  I’ve yet to come across an absolute breach of the CC, and I hope that continues to be the way of things.  But I’m not naïve; I know there are people up and down the country treated abysmally, with no dignity or respect for their basic human rights.  Wouldn’t it be awesome if we could get it adhered to everywhere, irrespective of postcode…?

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