Help Does anyone from the UK know how to get around the mental health act in A&E?

[Average Joe]

I'm asking this because it's likely that I will end up having to go to A&E because of my self-harm. (long story short, I used to blood-let but I plan to return to cutting instead) and I can't cut on a superficial layer anymore, it always has to be extreme.

I was in hospital recently because I blood-let too much and my GP sent me to A&E. I was discharged from hospital on Wednesday I think, returned for a transfusion yesterday but that was just an outpatient day procedure. Before I accepted the transfusion, I tried to hard to leave, I told them "I have capacity, I know the risks and I'm not psychotic".

So I'd love to know for future reference if anyone knows any keywords to say or something that gets them out of A&E?
I usually attend, needing my wounds stitched. I attend willingly, not seeking mental health support, I just attend so I can get my cuts closed as it reduces the risk of infections and scarring.

I'm not allowed to leave even when I am treated, I'm told that because it's of a mental health nature, I have to wait to be assessed by the psych team. To this I always always say "I have capacity, I don't have superpowers nor do I see or hear things, I understand you're concerned as a nurse however I am respectfully declining care from the psych liaison team". This is without fail, met with "If you leave now, the PSNI will be rang to bring you back." (PSNI is Police Service of Northern Ireland)

What do I even do in this situation? I'm not detained yet I'm told that I can't leave or else the police will bring me back.
Do I resort to self-suturing or just use steri strips and hope for the best?

I'm sorry if anyone has experienced a similar situation.

 

[SVEN]

I'm sorry for your predicament, however I greatly doubt that there is any magic formula of words to assist in A & E. They're covering themselves in case something serious occurs after they allow you to leave without evaluation. Just imagine the outcry if a person in your position walked out of Casualty without any psych review and, on the way home, stepped in front of a train or made some other impulsive decision to ctb.
The newspapers and others would crucify the emergency staff who permitted someone who self harmed seriously enough to need medical treatment just to amble out on the basis that they said, "I'm fine, not at all suicidal".

 

[GeminiButter]

You can't leave while they wait for the psych liaison to come and see you, they will send police out to find you if you manage to get out. This is the case regardless of the capacity you have and how 'normal' or well you seem or are. This won't change.

 

[Average Joe]

Thank you both for your replies @SVEN & @GeminiButter .
I do understand their point of view, perhaps I'm wrong in how I think, as I was hoping for a loophole or some sort of magic.

I don't want to make their jobs any more difficult than they already are. And I know it's not their fault. The NHS is under so much strain, and I do appreciate that they do the best they can.

It's just very disheartening when you're sitting for so many hours and nobody even acknowledges you while you're sitting in the observation chair beside the nursing desk. Then someone on drugs comes in giving abuse and shouting, with all the staff around them. I don't blame them either, I'm sure they have their own personal issues.

I don't know what to say, life has just gone downhill massively in the past few months.

Thankyou both for your time.

 

[SVEN]

If the only help I can offer is to try to validate your concern and distress, you've got it and my best wishes.

 

[Average Joe]

If the only help I can offer is to try to validate your concern and distress, you've got it and my best wishes.

Thank you so much my brother/sister.
I hope you are doing okay. I had a laugh when you mentioned Eric Cartman on a different thread/post

 

[GeminiButter]

Thank you both for your replies @SVEN & @GeminiButter .
I do understand their point of view, perhaps I'm wrong in how I think, as I was hoping for a loophole or some sort of magic.

I don't want to make their jobs any more difficult than they already are. And I know it's not their fault. The NHS is under so much strain, and I do appreciate that they do the best they can.

It's just very disheartening when you're sitting for so many hours and nobody even acknowledges you while you're sitting in the observation chair beside the nursing desk. Then someone on drugs comes in giving abuse and shouting, with all the staff around them. I don't blame them either, I'm sure they have their own personal issues.

I don't know what to say, life has just gone downhill massively in the past few months.

Thankyou both for your time.

I'm sorry that you are going through so much pain that trips to a&e keep happening, and that you've got to put up with the bullshit nonsense of medical bureaucracy as well as feeling like shit. I know what you mean about on one hand being annoyed about this and on the other knowing that they are just doing their jobs.

(And I don't live there anymore, but I'm from there too )

 

[6138]

What do I even do in this situation? I'm not detained yet I'm told that I can't leave or else the police will bring me back.
Do I resort to self-suturing or just use steri strips and hope for the best?

I'm sorry if anyone has experienced a similar situation.

This should be prefaced with the caveat that nothing I say should be considered "advice".

However, if it was me, I'd walk.

The police may be called, they may bring you back, but then again, they may not.

If you stay, you are much more likely to be locked up.

Dealing with the police is likely to be a lot easier than dealing with the psych staff, you have more rights, and the police need more evidence to detain you. The psych staff can do it with a wink and a smile.

Likewise, if the police come to your house and you're sitting on the couch watching netflix, you've got a good chance of talking your way out of a psych visit. (Suicide? Me?? Are you sure you have the right person officer??)

But if you're already in the A and E for self harm when the psych team arrives, you're just one locked door and a signature away from being locked up, it's a much easier process procedurally.

Psych wards live in the dark, they don't like attention being brought to the abuses within the system. Dragging people from their homes and making a scene makes them look bad, they don't like that. The further you get from the psych ward, the harder it's going to be for them to get you back in there.

 

[Average Joe]

This should be prefaced with the caveat that nothing I say should be considered "advice".

However, if it was me, I'd walk.

The police may be called, they may bring you back, but then again, they may not.

If you stay, you are much more likely to be locked up.

Dealing with the police is likely to be a lot easier than dealing with the psych staff, you have more rights, and the police need more evidence to detain you. The psych staff can do it with a wink and a smile.

Likewise, if the police come to your house and you're sitting on the couch watching netflix, you've got a good chance of talking your way out of a psych visit. (Suicide? Me?? Are you sure you have the right person officer??)

But if you're already in the A and E for self harm when the psych team arrives, you're just one locked door and a signature away from being locked up, it's a much easier process procedurally.

Psych wards live in the dark, they don't like attention being brought to the abuses within the system. Dragging people from their homes and making a scene makes them look bad, they don't like that. The further you get from the psych ward, the harder it's going to be for them to get you back in there.

I understand it's not "advice" but this for me too personally may be the best way to go with things.
I attended A&E again on Tuesday, threatened with the police, all I wanted was some first aid which I got. But I'm not gonna sit and be lectured and gaslit by the psych team.

However I don't plan to attend A&E again, not after the poor treatment I've recieved.

 

[lostintheloop]

In England it's always been optional for me to see psych liaison . Often the drs try to push it but say I have capacity to refuse, I just reassure them I have no further plans to harm myself and i have number for crisis team.
I've found medical staff will be very pushy about me seeing psych but psych are the opposite, they've actually encouraged me not to speak to them when I wanted to, saying I'm better of speaking to community team or that the wait is too long lmao.

 

[Average Joe]

In England it's always been optional for me to see psych liaison . Often the drs try to push it but say I have capacity to refuse, I just reassure them I have no further plans to harm myself and i have number for crisis team.
I've found medical staff will be very pushy about me seeing psych but psych are the opposite, they've actually encouraged me not to speak to them when I wanted to, saying I'm better of speaking to community team or that the wait is too long lmao.

Really? Would you prefer to see the psych liaison team or are you just glad to get out?
I think for me because I presented with mental health issues it's kind of necessary for me to see the psych team. However I have no plan on going back.
I'm gonna treat my wounds at home.

I've lost faith in the psych liaison team but in A&E here, I'm not sure if it's just me but they use the "we're waiting on the psych team" as a way to buy time instead of going down the route of being detained.

 

[GeminiButter]

In England it's always been optional for me to see psych liaison . Often the drs try to push it but say I have capacity to refuse, I just reassure them I have no further plans to harm myself and i have number for crisis team.
I've found medical staff will be very pushy about me seeing psych but psych are the opposite, they've actually encouraged me not to speak to them when I wanted to, saying I'm better of speaking to community team or that the wait is too long lmao.

This is so interesting, I had no idea it was ever optional to see psych liaison lol. Although that's possibly because any time I've been in a&e I've always been in a very bad state. In my recent visit, I found the a&e staff (nurses) were really kind and supportive - in the limited way that they could be - and the psych liaison team were not very helpful and also really upset my sister (who was with me in a&e, and was there the whole time except when I sent her home at night to sleep, and did a lot of advocating for me when I couldn't speak). They basically put it on her, that I could leave if she was able to keep me safe, which was an unfair and impossible thing to ask of her. Anyway. I don't plan to ever have to go back to a&e (years ago I was there after an attempt, and the way they treated me after I told them I had bpd - which was my dx at the time - was traumatising), but it's good to know that this might be the case if I'm ever there in future and I'm not in a state.

 

[lostintheloop]

Really? Would you prefer to see the psych liaison team or are you just glad to get out?
I think for me because I presented with mental health issues it's kind of necessary for me to see the psych team. However I have no plan on going back.
I'm gonna treat my wounds at home.

I've lost faith in the psych liaison team but in A&E here, I'm not sure if it's just me but they use the "we're waiting on the psych team" as a way to buy time instead of going down the route of being detained.

Glad to get out . In the beginning i used to want to see them but mostly found them useless, just assess and hand a leaflet. At one point i was in a&e a lot (like >50 times in 1 year so they just accepted i just needed stitching and leave) .
When i did see them in past Even when i said i couldnt keep safe they're like well you came for help so you dont want to die you'll be fine. Some of the staff in my local one i find infuriating as they're just so condescending so I avoid them at all costs now . One time they wrote they ended the assessment because I was becoming 'agitated' . I was just struggling to sit still because they talked over me discussing ctb and sh thoughts (which they knew was very hard for me to say as i struggle with verbal communication) to ask me about who in my family cooks xmas dinner

The last time i was in hospital for SH i did see psych liaison and it was different hospital, they were ok but i didn't need them to do anything for me as have support so i just let them do their risk assessment.
Anyway enough rant from me It sounds like you're being sent in circles from your other posts though so sorry it's such a battle to get support . It's so soul destroying being sent from pillar to post when you're trying to get help. I really wish the mh system didn't keep failing so many people

IME , often medical staff seem to genuinely believe psych will help and for psych it's just a tick box .

 

[Average Joe]

This is so interesting, I had no idea it was ever optional to see psych liaison lol. Although that's possibly because any time I've been in a&e I've always been in a very bad state. In my recent visit, I found the a&e staff (nurses) were really kind and supportive - in the limited way that they could be - and the psych liaison team were not very helpful and also really upset my sister (who was with me in a&e, and was there the whole time except when I sent her home at night to sleep, and did a lot of advocating for me when I couldn't speak). They basically put it on her, that I could leave if she was able to keep me safe, which was an unfair and impossible thing to ask of her. Anyway. I don't plan to ever have to go back to a&e (years ago I was there after an attempt, and the way they treated me after I told them I had bpd - which was my dx at the time - was traumatising), but it's good to know that this might be the case if I'm ever there in future and I'm not in a state.

I'm glad that in your recent visit the A&E staff were kind and supportive, I've yet to see that. I've been shown more compassion from an automatic door opening for me.
I am sorry that you've had similar experiences with the so called 'experts'. I agree it's so unfair to put it on family. I remember when I was under 18, the psych team would put it on my mother to keep me safe, which created such a horrible predicament because I don't want to drag family into the mess.

I've seen a video from someone with BPD and she said never tell A&E staff that you have BPD. Can I ask did you get a different diagnosis? Two doctors at my university disagreed with the whole BPD thing and said what I'm suffering from is complex PTSD. I tried telling this to psych team but I think they got a little offended because they were taken back and said "were they psychiatric doctors?" to which I replied, "are you?".

Glad to get out . In the beginning i used to want to see them but mostly found them useless, just assess and hand a leaflet. At one point i was in a&e a lot (like >50 times in 1 year so they just accepted i just needed stitching and leave) .
When i did see them in past Even when i said i couldnt keep safe they're like well you came for help so you dont want to die you'll be fine. Some of the staff in my local one i find infuriating as they're just so condescending so I avoid them at all costs now . One time they wrote they ended the assessment because I was becoming 'agitated' . I was just struggling to sit still because they talked over me discussing ctb and sh thoughts (which they knew was very hard for me to say as i struggle with verbal communication) to ask me about who in my family cooks xmas dinner

The last time i was in hospital for SH i did see psych liaison and it was different hospital, they were ok but i didn't need them to do anything for me as have support so i just let them do their risk assessment.
Anyway enough rant from me It sounds like you're being sent in circles from your other posts though so sorry it's such a battle to get support . It's so soul destroying being sent from pillar to post when you're trying to get help. I really wish the mh system didn't keep failing so many people

IME , often medical staff seem to genuinely believe psych will help and for psych it's just a tick box .

Yeah I can understand why you'd be glad to get out. Maybe it was because they had become familiar with you or something.

"i said i couldnt keep safe they're like well you came for help so you dont want to die you'll be fine." I fucking hate that, I've had that one before too. It's like I didn't come to A&E for the fun of it, there's a small part of me that wants to live hence why I'm here. But there's also the other side that wants to end it all and all it takes it just one negative thought for it to snowball into suicide.

They love to use the word agitated, I think it's just a word for them to justify them wiping their hands with the situation. I am sorry to hear that you struggle with verbal communication, I can kind of relate to that but for me it's just trying to put my thoughts into words.

I'm glad that your last visit was more pleasant and that you have the support.
I'll get the support one way or another, whether it's through the system or through the blade that pierces my jugular. Time will tell.

Btw please feel free to continue ranting/venting. I'm just a stranger, I've got no advice but I've got a big heart and time for anyone including you and anyone reading this.

 

[GeminiButter]

I'm glad that in your recent visit the A&E staff were kind and supportive, I've yet to see that. I've been shown more compassion from an automatic door opening for me.
I am sorry that you've had similar experiences with the so called 'experts'. I agree it's so unfair to put it on family. I remember when I was under 18, the psych team would put it on my mother to keep me safe, which created such a horrible predicament because I don't want to drag family into the mess.

I've seen a video from someone with BPD and she said never tell A&E staff that you have BPD. Can I ask did you get a different diagnosis? Two doctors at my university disagreed with the whole BPD thing and said what I'm suffering from is complex PTSD. I tried telling this to psych team but I think they got a little offended because they were taken back and said "were they psychiatric doctors?" to which I replied, "are you?"

Yea that was when I was naive enough and didn't know how stigmatised the condition was, but it didn't take long to learn that. I was glad to see that in my recent inpatient stay, I didn't witness nurses entirely dismiss/judge patients with bpd, and remember one conversation with a nurse when I was trying to do some knitting of her talk to me about risks other patients had (in the context of explaining to me why I was only allowed to do it outside the ward or in the quiet room), and she did this in a way that wasn't breaching anyone's confidentiality but also wasn't judgemental or stigmatising at all, when talking about EUPD. But I know there is so much medical stigma and judgement on patients with that diagnosis.

I got an autism diagnosis in my mid 20s, I was the one who realised I was autistic and spent a lot of time researching and learning about it and got a referral and was diagnosed in the nhs. a few years later when I was getting an adhd diagnosis (privately) I asked the psychiatrist If he thought I had bpd, I'd stopped including it on list of diagnoses but hadn't been able to have a proper conversation about it because the way that it works over here with seeing a psychiatrist. And he told me he didn't think I had it, we talked about it briefly but not for ages (it was at the end of like a 3 hour assessment session).

I've also discovered CPTSD in the last few years and have wondered if I've got that, and have read that it's quite common for lots of neurodivergent people, but I haven't pursued it as a diagnosis anywhere.

 

[6138]

In England it's always been optional for me to see psych liaison . Often the drs try to push it but say I have capacity to refuse, I just reassure them I have no further plans to harm myself and i have number for crisis team.
I've found medical staff will be very pushy about me seeing psych but psych are the opposite, they've actually encouraged me not to speak to them when I wanted to, saying I'm better of speaking to community team or that the wait is too long lmao.

Yeah, I have heard of that kind of thing. I think that... sometimes the staff will imply that you have no choice, when in actual fact you do? Like, they will essentially try to "bluff" you by saying "You HAVE to stay until the psych team sees you, if you leave now we will call the POLICE", when in actual fact most of the time you can just leave, they just don't want you to.

That's kind of what I meant with my post, that you can try to "call their bluff", and you might get away with it.

 

[LetMeOut67]

I'm in northern England.
In March I spent 10 hours in A&E after going at 1am with suicidal feelings.
After about six hours I told them I wanted to leave as the place was packed and there were psychotic people there making noise and one person had an epileptic fit. They said if I left the police would be called. Then at 11.30am after being spoken to for a couple of minutes by a nurse I was told I was free to leave. I wasn't seen by anyone involved with mental health at all.
A complete waste of time.