An AMHP Christmas miracle

By CKMG

I wanted to write about a story which will seem almost unbelievable to most AMHPs and others involved in mental health crisis support at the moment.

Just before Christmas I was on an AMHP shift and was called to do an assessment in A&E where a family had brought their relative due to their bizarre and agitated behaviour. This included the person repeating certain phrases, making threats to kill a close friend without any apparent reason that they could explain; they were highly restless, unable to sit still and had difficulties sleeping. I could see from the records and discussion with the crisis team that the person had experienced similar difficulties at other times in their life and hospital admissions under the Mental Health Act had been required on occasion.

On arrival at A&E, I was able to meet with the person and their family prior to the assessment with the doctors. This enabled me to introduce myself and explain what would happen during the assessment and check any questions they had prior to the doctors joining and things feeling more formal. I was struck by how supportive the family seemed. The person's partner, their sister and son had all come together to be with them. They were holding hands, hugging and offering reassurances to the person. The person was able to tell me about how proud they were of their son and his achievements. They were also able to tell me how much they loved their partner and how sorry they were for causing stress before Christmas. The family and I were able to reassure them that this was not their fault, and we were going to try and help. Tears were shed, and I was able to clarify with the person and the family whether or not they had any questions that they wanted to ask before the assessment commenced. The person was able to tell me how important it was for them to be able to see their family on Christmas Day. We all decided that this could be agreed to, no matter the outcome as, unbeknown to them, I had been informed by the crisis team that should an admission be necessary that a local bed was available.

Following the assessment, the doctors, family and I thought that an admission was necessary and that this was the least restrictive option as a way of providing treatment other than by using the Mental Health Act as the person was assessed as lacking capacity to consent to mental health treatment.

I was able to explain the outcome of the assessment to the person with support from their family. They showed understanding that their family were struggling and again apologised repeatedly. They said that it was very important for them to be able to see them despite being in hospital. We were all able to reassure them that this could easily be facilitated due to the bed being just a few miles from their home and a ward they had been on before.

After a discussion with the doctors, the crisis team and the family, we saw no reason that we couldn't support the person to walk to the ward. I have to say that there was something quite jovial and uplifting about this. The staff member from the crisis team who came to support and lead us down the corridors was known to the person who wished them a happy Christmas. They were able to ask about other crisis team colleagues and also staff who might be working on the ward who they also knew already. This reassured the person, who started singing Christmas tunes whilst holding hands with their son. I may be embellishing some of the facts here and needless to say that the person had not made a miraculous recovery, they were still very repetitive and upset about being admitted to hospital but the way in which they got to the ward was incredibly positive for them and their family (as well as myself!).

On the ward the family were able to settle the person before they left, with reassurances they would be back tomorrow. I was able to give a verbal handover in person to ward staff before I also said my goodbyes to the person who thanked me.

The shock at the feelings that were generated by this assessment was incredible. I felt uplifted. I have to say that this assessment felt like I had done a good job. At no point did I have to explain that the nearest bed would be over 100 miles away or that the family would struggle to visit due to the distance, or that the staff would be complete strangers to them. Nor did I have to tell the family that despite their being unable to continue to offer support, they would need to do so as we could not identify a hospital bed and therefore we’d just have to update them once things changed. Instead, I was able to offer the right care at the right time, something I would want for myself or my own family member should the circumstances arise. This was and is the service that should be on offer every time detention under the Mental Health Act is required.

In summary this assessment showed the benefits for all involved when there is time and resources to be able to do the job properly. There was plenty of time, I was able to meet with the person and family before the full assessment to make things feel less formal and give explanations/ reassurances. The family were lovely and supportive to one another. A local bed was available and staff who knew the person already, adding to the sense of control and familiarity. The person knew where they were and by being able to walk to the ward, this again developed and fostered a sense empowerment and dignity. If I think of the guiding principles of the Mental Health Act, all of them were truly upheld during this assessment. The impact on all involved, but most importantly the person in mental health crisis, was incredible. A true Christmas miracle.

Reflecting upon this assessment, it showed how the little things and the not so little things really make a difference to the person experiencing mental health crisis. If this was the job I did every time, I think I would genuinely feel like I was one of the good ones as opposed to someone that was responsible for sending someone miles from their home and creating further anxiety and stress yet being aware that it is the only option. I hope very much that this scenario can be repeated again. I've been practicing as an AMHP for over five years now and I have never had such a lovely assessment. The end.