For 14 years I have been working with James, who has a diagnosis of severe and enduring mental ill health. He has a support worker paid for by the council as well as a community nurse who gives him his depot injection and monitors his mental health. I have constant interaction with these two professionals but until James became ill I hadn’t dealt with medical professionals.
A few weeks ago James had a cold and had difficulties swallowing so we sent him to the GP, who gave him antibiotics. But James didn’t take his medication, so we monitored this. His cold persisted and two weeks later, when James went for his depot injection, the community nurse noted considerable weight loss. After a home visit from his GP the next day, James was admitted to hospital. But, faced with unfamiliar surroundings, he discharged himself the day after.
When I visited James and his sister, Julie, he was adamant that he wouldn’t go back to hospital but would get better by staying in bed. Julie is deaf and couldn’t hear the frightening gurgling noise James made when he tried to drink. After much persuasion, James returned to hospital where he was diagnosed with cancer.
He was moved to a regional hospital and allocated a Macmillan nurse. I had never before worked with a client who had appeared physically well but was then dying and it helped being able to ring the nurse to discuss medical interventions and aspects of the prognosis.
As there were medical decisions to be made about James, I attended a multidisciplinary meeting with his medical consultant, psychiatric consultant, occupational therapist, radiologist, British Sign Language interpreter, Julie and her husband, and the Macmillan nurse. The community mental health nurse was unable to attend but we discussed James’s needs beforehand. Although I had had no previous contact with the other professionals, it was easy to co-ordinate what we were doing as we all had the same aims.
Before the meeting James’s key nurse told me he was not complying with being fed through a stomach tube and would try to collect glasses of water and sneak food even though he was “nil by mouth”.
The meeting discussed whether James could make informed consent about the best form of treatment. The options were: intensive daily treatment for six weeks, medical intervention, or no intervention. After a long debate the team decided James would not comply with anything except bed rest. Julie requested that the hospice near her house be approached so she could visit her brother. During James’s time in the hospital I would often speak to the ward manager about any queries I had. A further discussion with her led to a referral to the local hospice and we are now awaiting its answer.
James has been one of the most challenging clients I have worked with but we kept him out of psychiatric hospital and residential care by establishing boundaries about what was happening and intensive ways of multidisciplinary working.
Kath Delaney-Wetherill is a community mental health worker for a mental health trust