Coping in an approach of crisis

It's sensible for every care plan or programme to include details of what is to happen if a crisis occurs. But in practice, the support systems do not always work as they should and carers may find it difficult to get urgent help, even when their relative is known to local professionals.

Persistence usually helps and all of the actions below are often worth a try...

Ask the GP
GPs can refer someone to a psychiatrist or the local CMHT as well as prescribing medication or arranging for talking treatments. It may be helpful to ask for a 'domiciliary visit' (where the psychiatrist visits your relative at home).

Some GPs will not help unless the patient directly requests it. This can cause problems if your relative is convinced that they are not unwell in spite of having significant symptoms such as hallucinations, which can happen at a time of relapse with conditions like schizophrenia or manic depression. GPs are sometimes described as the gateway to help, but some have insufficient knowledge or understanding of mental illness and are not aware of the need for prompt action.

Telephone NHS Direct (0845 46 47)
This service is available 24 hours a day at local call rates. It should be possible for people who man this line to help you get the help you need for your relative. Ask if you can speak to a nurse responsible for dealing with mental health problems.

Contact the CMHT
This may result in help especially if your relative is already known to the team. But in some areas the local team will only help if the person has been referred by a GP.

Ask to see the CPN
Community psychiatric nurses often work with GP practices or mental health centres and some can be seen on request. They should be familiar with all forms of mental illness and know how to access help. You may find that by asking for help for your own anxiety and stress, you might alert the mental health services to the seriousness of your relative's situation.

Try going to A&E
A&E staff sometimes call the duty psychiatrist to see someone who appears to be having mental health difficulties. This might result in admission. But attending an A&E department can involve a long and stressful wait which many people with mental health problems find intolerable.

Contact the local crisis team
If there is one. Again, the team may not be able to help without a referral from a GP.

Use the Mental Health Act
The Act gives the nearest relative of someone who appears to be mentally ill the right to insist that an ASW assesses the situation, in order to decide whether the person needs to be admitted to hospital for assessment or treatment.

If the ASW and 2 doctors agree that admission is necessary, then the person can be 'sectioned' and taken to hospital, and admitted against their will. Most people would only use this right as a last resort because of the effect which using it might have on the future relationship with their relative.

It is also common for the police to attend when someone is sectioned and occasionally restraint or CS gas may be used. If the ASW decides that admission is not appropriate they must let you know what forms of support will be made available. The right to a mental health assessment by an ASW can be used several times if necessary. Mental Health Act

The police

It's worth remembering that the police can take someone who appears to be mentally disordered to a place of safety for assessment.

Ask for a Community Care Assessment
Local authority Social Service departments have a duty of care to assess anyone who is in need of services (Community Care Act, 1990)

Ask for a second opinion
Try this if your local psychiatrist is refusing help on grounds that your relative has a personality disorder rather than a mental illness and you do not agree with this view. Unfortunately there is no legal right to a second opinion. If you are refused one, Rethink National Advice Service might be able to help. Getting a second opinion

What if there is no response to my requests for help?

Persistence helps. If you are dissatisfied you could threaten to make a formal complaint. All doctors, hospitals and mental health services have a complaints procedure. Some people have found it effective to involve their MP after the crisis has resolved. Complaints

If there is no response to a request for a mental health act assessment from a nearest relative, it maybe possible to threaten 'judicial review'. You will probably need to get advice from Rethink or a solicitor withthe appropriate expertise. here are other circumstances in which a lawyer may also be able to help. Rethink should be able to put youin touch with a legal firm with some knowledge and experience of mental health problems.

How can I recognise an approaching crisis

Sometimes someone with a mental health problem will relapse quite suddenly with little warning - but more often relapse is gradual. Many families come to recognise the signs and symptoms as they develop and do their best to ensure whatever extra support may be needed is available to their relative. Coping in a crisis

Changes in behaviour may be evident through:
sleep disturbances, inability to concentrate, avoiding other people, anxiety or depression, loss of appetite, refusing to leave home, refusing medication

Relapse often follows a particularly stressful event like the loss of a partner or job, while even summer or christmas holidays may involve enough change from day-to-day routine to cause a major problem.