Crisis admission. Status on Admission: Section 2 MHA.
Patient admitted to the psychiatric intensive care unit because of his deteriorating mental health. Prior to his admission he was cared for in supported sheltered housing with input from the community mental health team. There have been concerns raised by the community team in the past weeks leading up to his admission as to his compliance with his Clozaril and during discussion with the patient he agreed that he had not taken this medication regularly since discharge. He also said that he felt the Clozaril was “useless” and “not helping”. He was unkempt and neglected on admission with evidence of infestation with scabies.
The patient has a long history of schizophrenic type illness. He experiences both visual and auditory disturbances and says he is currently being “plagued” by auditory hallucinations.
The case notes pick up the story approximately seven months to his admission. He is reported as being pleasant and cooperative but still hearing voices on and off but. He says the voices do not trouble him ‘one voice asking one other person to kill him’, one voice telling him very sorry.’
He remains in hospital on a section of the MHA [? Section 3]. The patient is concerned about his section, he feels that he has been in hospital for too long and should now be off section. At appeal the tribunal recommended that he remained compulsorily detained under the MHA until such time as suitable accommodation was available, but could be allowed section 17 leave care of his family.
Reports of boredom and heavy smoking are two recurring themes in the nursing notes. The patient is a very heavy smoker [self reports 60 – 80 cigarettes per day] as a consequence he has shortness of breath and is ‘chesty.’
The story concludes with the patient pleasant and cooperative and awaiting housing.
Profile of Mental Health Case 00-106
Status on Admission Informal:
Admitted via a community based intensive support team. Complaining of paranoid ideas and auditory hallucinations for last 3 days. Auditory hallucinations in the form of male voice telling somebody to kill his friend. He also believed that people are attempting to harm him by putting chemical agents through the vents at his home. He also reports a poor sleep pattern.
The patient is a chain smoker smoking between eighty & one-hundred cigarettes per day which as probably caused his known emphysema.
The case notes pick up the story approximately one month into his admission [day thirty].
He has settled on to the unit and is reported to be pleasant with no management problems. He interacts well with fellow patients and staff spending most of his waking hours in the smoke room or the patio smoking his cigarettes. He believes that if he had accepted his medication he would have been a much better person and being able to get on with his life.
His delusions have been freed for many years and mainly negative around feeling threatened and being spied on by people in the street outside his house. He feels that poisonous gas was being poured through the vent. He takes these ‘threats’ seriously and sleeps with knife under his bed to protect himself from invaders.
He has home leave care of his brother or sister but these do not always go well. He stays on the settee all night fretful that people walking outside will once again put gas through the vents. He also believes that the television at his home is controlling him in some way but is reluctant to elaborate on this.
His auditory hallucinations and paranoia worsen during his hospital stay leading to an increase in his Risperidone. Final reports describe a man who is gradually isolating himself no longer interacting with staff or fellow patients as he used to.
Profile of Mental Health Case 00-107
Crisis Admission. Status Section 2 of the Mental Health Act 1983.
Patient was admitted into the Psychiatric ICU having been assessed there.
Brought to Police Station following incident where the local chapel was defaced with graffiti?-unable to expand upon this due to a flight of ideas however is adamant that he did not deface chapel. The patient is a known diabetic controlled with Metformin and diet. Management of his diabetes poses a problem at the time of admission as he is fasting for ‘religious reasons.’
The records report a patient who has very little insight into his mental health problems he believes that his main problem is his Diabetes Mellitus and insists that this is treated. Management of His Diabetes Mellitus is uncomplicated and causes no problems to him or the staff throughout his stay. He displays grandiose delusions believing that he is the Queens official correspondence. He is reported to have paranoid thoughts/beliefs in the nursing reports, ‘Very suspicious / paranoid, limited interaction. Glazed expression. Kept whispering ‘I’ll sort it ’but the content and nature of his paranoia is not clear. He has a period of being very constipated which might be caused by his drug regime which known to cause constipation.
From the patient’s perspective boredom defines is assessment of his in-patient stay thinks he has been in too long and needs to be discharged. The nursing and medical staff report that the patient is low in mood and gradually but noticeably isolating himself from others with very little spontaneous interaction. The reports of low mood changes to reports of depression as time progresses.
The story concludes with a depressed patient but one whose mood is lightening. He is taking periods of leave care of his family but not coping very well. His mother has recently had a stroke and not in a position to care for him on a full time basis. Occupational Therapy complete an assessment of his house and report a ‘house in a considerable state of disrepair.’