Why Hammersley Homes is needed: from an A&E doctor:​


As part of our Big Give Campaign this week, where all donations are doubled at no cost to you through the Christmas Challenge, we spoke to a doctor about how people end up in hospital when they reach crisis point with the symptoms of their mental illness.

Working in a busy A&E department, Dr George Madley looks after dozens of patients, including those who are suffering from mental illness and have reached crisis point:

How busy is a typical shift in an A&E department?

Unfortunately, every shift is extremely busy at the moment. There is often no time to catch your breath and obviously we want to see as many patients as possible, and yet we see the waiting times getting worse, especially with the winter approaching. The NHS is under a lot of pressure for many reasons, such as staff shortages, funding and huge volumes of patients needing support. We are almost at breaking point.

How many people do you treat who are suffering from mental illness?

I would estimate 20-30 per cent of people I see on any given shift are suffering with a mental illness, and this number appears to be growing. Depression and anxiety are common, but we are seeing more people with psychotic illnesses ending up in A&E, which is not the best environment for them, especially when they are in need of urgent support.

What kind of issues are resulting in them needing to go to A&E?

The very nature of psychosis is that you don’t tend to seek help, so psychotic episodes are often first noticed by friends, family or neighbours. They can sometimes be reported to the police as having strange or dangerous behaviour, and if the police believe them to be a harm to themselves or others they may bring them to A&E for assessment. Other times, a patient may come in for help and we notice that they have some features of psychosis such as delusions or hallucinations. In terms of how we treat them, we first need to make sure they are safe, which sometimes involves medication to help people relax or calm down. Once they are safe, we need to look into what is causing this change in behaviour. This can be mental illness but equally can be infection, brain injury or intoxication. If we can rule those things out, then we will refer the patient to our colleagues working in mental health services. We then make a collective decision on how to best help them.

If we feel we need to admit them, it can be several days until a bed is available, and until then they have to stay in A&E. During this time their mental well-being can deteriorate further, as A&E can be a scary place for someone in crisis.

Do you see the same people coming in?

Yes, very frequently. Treating psychotic mental illness is extremely difficult – services are overstretched, treatments can take a long time and they come with a lot of side effects. The very nature of these people’s mental illness means they often do not have the right support network around them to prevent them from getting to this crisis point in the first place. This can lead people to relapse, sometimes by not continuing to take medication or by using drugs or alcohol to cope with symptoms and then end up re-presenting to services like A&E.

What experience do you have with those supporting a loved one with a mental illness?

It can be very difficult for the family and loved ones of patients with mental illness. These kinds of illnesses are complex, hard to treat, and present in many different ways that can be hard to understand. The symptoms can take a significant toll on both the patient and their loved ones. As recovery can take a long time, a strong support network is important to give the patient the best chance at managing their symptoms.

Do you think it is preventable?

I don’t think mental illness is completely preventable, not many conditions are, however, there are certainly some things that can help. It’s natural that when you are facing a scary or unknown mental illness that people might turn to unhealthy things to help them to cope, and so we often see patients in a spiral. Additionally, people who are diagnosed with a psychotic illness have often had symptoms for a long time and these can isolate them from friends, family and jobs. This means that when they start their treatment, they might not have people to turn to for help if things start to get worse again. I think we could see a big drop in relapses for people with psychosis if they had better support early on, to help them continue with treatment and avoid other ways of coping. Unfortunately, unless you have a highly dedicated support network, this doesn’t always happen and we realise this can be a huge undertaking for a patient’s family and friends.

The current social services are also not equipped to deal with the needs of these patients – they might be able to provide a roof over your head, but they lack the time or funding to be able to help people cope or to spot someone’s mental health starting to deteriorate. Having a system that offers this would be a huge step in helping people start to live a safe and comfortable life, in the right environment in a supported home. I am certain that this would also start to take the pressure off the NHS at a time when it really needs it.

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