There is a common myth about mental illness, which goes something like this: ‘unless a person wants to change they cannot be helped’. Like all myths there is a grain of truth in it but it is primarily true only for personal and psychological problems, drug and alcohol related problems and mild degrees of mental illness. So what if your relative is behaving in a really bizarre way, is gravely depressed or suicidal or is causing the family huge anxiety through for example increasing forgetfulness? What if your relative has a diagnosed mental illness and is not taking medication and is deteriorating?
You go to your GP – because your relative will not or cannot go on their own or even with you – or they come but minimise or deny the problem and appear fine when seen. What if your GP says – ‘I’m afraid there’s nothing I can do until your relative asks for help/ seems worse/harms someone or him or herself’. Are they really right – is the system not able to cope? Well the answer, you will be glad to hear is ‘not necessarily so’. The truth is, though many GPS are very knowledgeable about psychiatry, others are not and if you are well informed you will be better able to steer your way through the health service.
Firstly if your relative will not see the GP there is nothing to stop you making an appointment, expressing your concern and asking them to call. If this yields no results for whatever reason you can assert your relative’s right to see a specialist. Most psychiatry in this country is practised in teams and if your GP writes off to his local team, with sufficient information which you can provide, someone will usually send an appointment or, where appropriate, visit.
But what if all this fails? What if things are getting worse by the day and no help is forthcoming. You have heard of people being ‘sectioned’ under the Mental Health Act but no-one is suggesting this. Can you ask for an assessment for this purpose and what happens? Well, although this may seem pretty scary and you may feel as if you are being disloyal, the fact is you are entitled to request an assessment and the route in most places does not necessarily involve your GP, which may be useful to know particularly out of hours.
Mental Health Act Assessments are usually co-ordinated by the NHS and/or Social Services – your local number can be obtained fairly easily – and furthermore there is nearly always an out-of-hours number too. If you request an assessment of your relative, your doctor will often be contacted and involved in the assessment, usually with a doctor who is specially trained in psychiatry. If 2 doctors recommend treatment in hospital then your relative can be taken compulsorily. The application for treatment is made by the Approved Mental Health Professional who will always discuss it with the relative and in the case of a longer treatment section (up to 6 months) cannot proceed if you object.
If this is a first episode it would be more usual for an assessment section (up to 28 days) to be used. In either case both you and your relative have the right of appeal and you can apply for the cessation of the section after 72 hours – if the psychiatrist wants to overrule you the hospital managers have to adjudicate. The section can be lifted earlier or leave can be granted and before discharge a care plan should be made which you should be involved in.