Saturday, 21 April 2012

The importance of family support

Fourteen years ago, after working  11 years at mental hospital wards  I started working as a community psychiatric nurse. A month later I had to take my partner to a psychiatrist because he was psychotic. An unexpected  experience.

It started on a Saturday. We decided to wait till tuesday  so we could see the GP we knew. Monday was a bank holiday.Things got worse over the  weekend  and I had no idea where it would end. Although I was familiar with psychosis it was like getting hit by an avalanche in mid summer. We only just met a year and a half earlier.

On tuesday the GP referred us to an office for mental health that same day. We were welcomed very friendly by a  CPN who knew I was a colleague from another hospital. He took us to an office. A few minutes later he introduced us to the psychiatrist who seemed  unpleasantly surprised . His words: “ It is not usual that family comes along unannounced” . Then he shook my hand reluctantly.
That is not the best way to introduce yourself  to a highly stressed person with an adrenaline level way beyond that of the average marathon runner. I can’t imagine a doctor of an emergency room would have said the same if my partner would have had a heart problem or an accident. This was an emergency  as well. A psychiatric one. 

During the visit my partner only told about 40 %  of what had happened - being distracted and paranoid. After some time I added a few things to the conversation but I was being ignored  by the psychiatrist.  And when he finally asked me: “Do you have any idea what psychosis is?“ I was so mad that I answered very calm : “ I have read some about it a while ago”   
He wrote a prescription for an anti-psychotic  and handed us the piece of paper. I asked him to add Biperiden in case of side effects.  I guess he had not expected that because he looked a bit confused. He wrote it down and wanted to say something but I felt too reared for further conversations. I felt like yelling  , throwing things around or burst into tears and I didn’t want to do either one of them. If you come for help the last thing  you need is people who make you feel  worse. A few minutes after we got home the phone rang: the  psychiatrist. He asked me if I could come long next time.  I asked him if he would  have called if I had not been a CPN. Later on we talked and things went better. He learned from the experience. 
And so did I. Although I always had a focus on family support : really knowing the despair, fear and frustration helps to keep it on top of the “to do”- list and encourage others to do so. This was just a bad experience, educational though. Many psychiatrists do an excellent job.

Family support is an important thing in mental health care. Ifcourse there are very dysfunctional families  and some people have caused problems our clients are facing now. No need to deny that and very important to take that into account. But most of them have good intentions and are willing to learn and help.And they usually know their ill family member better than we health professionals do. We shouldn't consider ourselves too important but see family members as team members. 

Psycho-educational family interventions and family support can reduce relapses, readmissions and suicide risk. An important part of our work because it benefits to the welbeing of our patients and a better future for them.

Many family members have felt left alone by mental health care in the past on more than one occasion.Imagine yourself in their shoes and do the best you can to make their next experience a better one.
If family  is visiting a hospital ward make them feel welcome and comfortable. That will make it easier for them to visit more often. For mental health workers a mental hospital ward might be an everyday thing but for visitors it’s often a very  unusual scary place to go , especially the inpredictable crisis wards. If possible give them a quiet place to talk and relax. Encourage family and friends to stay in touch. 
Loneliness is a huge problem for people with mental illness. And it is important to prevent that as much as we can.Giving good information and support to friends and family can make an important difference here.



  1. This is such an echo of my thoughts and experience and it seems to be commonplace... Mental Health nurses do a really thankless task, must be very stressful, but if they did it properly, by including the carers as part of the team, treating the patient holistically, their jobs would become easier and more fulfilling because the carers would do so much more. I was nearly banned from the ward for being intimidating, but it was only because I was continually ignored, abused, lied to, in fear for my wife's safety whilst on the ward due to the carelessness and negligence, I was just not prepared to accept it any longer.
    You are so right, to give the patient the best care and best chance of recovery it is important to involve the carers, engage with them, and consider them a major player on the care team.
    The alternative puts the carer at risk of becoming an in-patient as well, which places extra strain on the staff

  2. I am sorry you had such a bad experience. Very sad because in fact it is not difficult at all to make it a good experience. I hope your comment here will be taken to heart by many inspired mental health workers and I hope they will spread the word and make a difference in the future for others in the same situation. Thank you for your comment :)

  3. I too am v grateful for your post. Sadly, some years ago we lost a family member though suicide whilst of unsound mind. He had been extremely disturbed for a week or so, but we could get no one to believe us, and as he was convinced he was sane, he would not ask for help. We were so relieved when, because he started acting v oddly in a shop, he was sectioned and brought into hospital. Once he was in hospital, however, he became extremely cooperative and lucid with staff, but continued telling us, his family, he could fly etc. No one would believe us when we reported this, a psychiatrist came and assessed him without telling the family, judged him fine, he went home that day & immediately threw himself out of window & died. If they had listened to one family member that could have been prevented. Thank you very much for this post. If professionals take your advice then so much heartbreak could be prevented.

    1. Thankyou for telling your story. So many stories go unreported in media, this helps others who have had the same experience where medical professionals may have failed to listen and take action. It hard for people to tell their stories, and I encourage others to tell theirs, that's how we all learn.

  4. I am very sorry for your loss, Anne.That should never have happened
    :( I hope that people who work in the field read your comment and use it to improve mental health care.It's so easy to make a difference and as easy to mess things up.
    Hope this will mean a difference

    1. Thanks. I am particularly grateful for your post as it enabled me to say something about it. After his death I wanted to follow up everything that happened and do exactly what you are talking about - make the health service aware of all the mistakes leading up to his death & how family were ignored. Although there was a post mortem it was only attended by older members of the family, and there was a general shut down of communication. People could not cope with his death & we were told to respect his memory by not talking about it. I had to honour this request as family were hurting so much, but I am so glad that there is somewhere for me to tell this story to, in the hope that it will help prevent future tragedies. I realise that if someone is determined to kill themselves it is difficult for family or professionals to stop them, but he was so extremely disturbed, rather than depressed or self hating, that I feel that he was someone who would have responded to treatment. Anyway, thank you very much again for your work. Thank God there are people like you.

  5. where I live the so called emergency line is unmanned and no-one calls you back! the withdrawal of services is rife there is no help available at all!

  6. I'm sorry to hear that, very bad and sad. Could you file a complaint somewhere?Where are you from?

  7. I see that as a problem again and again, the psychiatrist or therapist is rude or just lousy, and then the person becomes frustrated then do not seek help again. I am so lucky to have good people in my life. I hope your commandments help :)

  8. I received messages from Mental Health workers that the 20 Commandments have been posted in nurses stations in Canada, Africa, USA, Australie,Europa, Asia, South America.Hoping to make small important changes worldwide :)

  9. I'm shocked by the psychiatrist's reaction to you being there. Surely he's had family members attend sessions before? Glad it worked out okay in the end.

  10. Yes it was shocking : when u think you are at your worst and hoping they will help you to make things better and they make it worse. It was awful.I think he didnt even realise what he did.

  11. had YEARS of exactly the same experience as a carer - of a child.
    Family were initially not welcomed, uninformed, excluded and eventually the ill mentally compromised patient was convinced that family were PART of problem.
    Was horrific.
    3 other children also ignored!

  12. I am the Director of an organization called FAME (Family Association for Mental Health Everywhere). I want to thank you for writing about this insight as I'm quite sure it will be helpful to other families. I think that slowly the system has finally begun to understand what role family members can play in support, treatment and advocacy. Again, thank you for the effort and the willingness to share your story. Respectfully, Christine Cooper, Executive Director, FAME

  13. ty nurse with glasses dear u have helped me a lot I have been a patient in many wards all across the states and find people with the right attitude are very helpful, sadly the stigma of MI is so hard to avoid most people don't take what the (sick) person is saying very seriously.suicides talk should always be taken seriously. I love u nurse even though u are a long way away u r part of the solution

  14. I do find it strange that so many professionals have trouble with basic courtesy. Some of them may be exhausted themselves but I would have hoped that those dealing with mental health would be much more aware of their patients reaction to their curtness. I do wonder if they go home and think 'Urgg .. maybe I shouldn't have said that to my patient ... must do better next time' or if they just go to sleep ignorantly blissfull of the damage they have done.

    I also wonder how many times this happens? Historically people haven't made their experiences with doctors public and the confidentiality makes this information impossible to get. Hopefully with people being more connected via the internet pressure will mount on them to up their game a little. My impression is that a lot of people encounter this type of issue at some time during their lives.

    Thanks for writing about this, at least I know that I am not the only one who had to work with this problem. You gave me the courage to post my own similar experiences that I have been sitting on for a while.