Chapter 35: Non-medical alternatives for crisis care

Case Study: Non-medical alternatives

Eddy is a 30-year-old man diagnosed by mainstream services with bipolar disorder. He is ambivalent about his diagnosis but does take his prescribed medication. Nevertheless, every few years he has relapses which bring him into hospital, often for six weeks or more at a time. For Eddy, the positive part of having a diagnosis is that his family and his employer have a way of explaining and understanding the times he acts out of character, and this has meant his relationships have stayed strong and he has not lost his job. He does, however, feel that a mental health diagnosis is more broadly stigmatising and he doesn’t always appreciate the value of the medication as it doesn’t seem to prevent relapses and does cause a lot of side effects.

Eddy does not like to be admitted to hospital but he does see the need that he sometimes needs protecting from himself when he is unusually impulsive and disinhibited. He doesn’t, however, think that his local mental health unit is a calm and healing place. Indeed, it is often the opposite – noisy and oppressive, with the staff not having the time to spend in meaningful time with service users. Eddy finds himself moving between periods were he is profoundly anxious and agitated or depressed and bored. He misses his family but is embarrassed when they visit and have to see him in this place. Typically for Eddy, hospital admissions involve being sectioned which also colours his negative view of inpatient care.

Eddy recognises that he often goes through a period of deteriorating mental wellbeing before having to be admitted to hospital. Usually there is a period of his family trying to persuade him to consider going into hospital and him refusing until it all gets too much or he gets that much worse, and then needs longer to recover. For Eddy, if the hospital was a more appealing prospect, he thinks he might be less likely to struggle against going in.

How might the sort of alternatives presented in this chapter be of benefit to someone like Eddy? 

› Possible answer

Eddy’s experiences are not untypical. You might think that all of the alternatives that are discussed in the chapter might be preferable to a sectioned hospital admission. A short-term crisis admission, to perhaps a Soteria facility, might actually prevent a longer term hospital admission and save money in the system, as hospital care is very expensive. A Soteria house would not be cheap to run, but if the aim to only admit people for short-term stays to prevent major breakdowns is achieved, then such places would end up saving precious resources. Arguably, however, even if such alternatives were a substitute for standard inpatient care, they might save money by affording more consensual, less stigmatising admissions and shorter time taken for recovery. They might also offer more appealing employment experiences for nurses keen to practise their relational skills, which are central to these models of care.