One of the biggest challenges so far has been accessing mental health services with someone who not ‘in the system’. J has a long history of mental health problems. She has had a diagnosis of schizophrenia in the past, but due to her inability to engage with services and a precarious housing situation, she had fallen through the gaps. J has been unmedicated, untreated and unsupported for a few years now. As a result of her ‘challenging’ behaviour her tenancy was at risk, and she was very close to losing her flat due to anti-social behaviour.
J has been open about the fact she has mental health problems, however she dislikes the stigma attached to schizophrenia, has had bad experiences of services and medication. It was clear that she was struggling with unwanted thoughts and the actions these provoked so I made enquiries about getting some assistance for J. She was not registered with a GP, so the options were very limited. The first port of call would be to call for an ambulance if she was presenting a risk to herself or others. If she was deemed to be too high risk for paramedics, she would have to be removed by Police officers, who would then escort her to specialist cells in Wakefield. Neither of these options would address J’s ongoing problems, and would be likely to cause her a great deal of distress.
I made further enquiries with the Mental Health crisis team. Again they were unable to help whilst she was unregistered. Even once registered, the crisis team will only respond to a person currently under their care and who is not under the influence of alcohol or other substances. This is further compounded by the fact that they will only visit at a known address and the response time can be up to 4 hours.
So J was again at risk and vulnerable, the one service she needed to access had no duty of care to her and the only other route risked making her feel criminalised for actions beyond her control.
J agreed to register with a local GP, although this took a lot of encouragement. She is wary and sceptical about professional services, so this was a big move for her. I accompanied her to the new patient assessment. She was quite guarded with the GP, but with some prompting it was clear from her mannerisms and speech that she was in some difficulty. A referral was made for a full mental health assessment, a move in the right direction, but this process would also take some time.
Whilst waiting for this referral to be processed and a Community Psychiatric Nurse to be allocated, several incidents occurred which further jeopardized her tenancy. As no up-to-date diagnosis had been made, Kirklees Neighbourhood Housing had little option other than to continue eviction procedures as normal, they needed a diagnosis in black and white before they could consider the situation to be anything other than anti-social behaviour.
All these factors, the threat of eviction, the upcoming Mental Health assessment and past traumatic experiences meant that J was really struggling and her mental health was deteriorating. It took a concerted effort and numerous phone calls to the assessment team before she was flagged up as an urgent referral. It was a relief when I received a phone call from J’s allocated CPN. She had made her first home visit and had immediately admitted J to a psychiatric ward for assessment.
The whole process has taken weeks, during this time J had little support, no-one to advocate for her and little prospect of receiving constructive help. The very service she needed to access was surrounded by barriers, successfully gate keeping support from a person who desperately needed their help.
J has now spent a couple of weeks on the ward. She is making slow progress and is on her way to receiving appropriate support and treatment. This can only be maintained by pulling together a number of different agencies, to ensure that when J returns to the community, she wont be allowed to fall through the gaps again.
Sally, Support Worker, Huddersfield