It has been a long road, but we are almost home. Amanda and I left Wanganui yesterday and drove up to Auckland, where my brother David manages a complex of 114 apartments in the city CBD.

It was a difficult few days leading up to leaving Wanganui, not only because Amanda is still not well – that will take months – but because of practical matters from packing up her house, to finding a new home for her cat, to saying goodbye to her friends.

The day before we left I had a meeting with leaders at the hospital – the CEO, DON, Chair of the Board and others, to discuss aspects of the hospital’s care for Amanda, including this summary I had written of observations of aspects of managament and clinical care at the hospital: Standards of Care at Whanganui Hospital

I was encouraged by their response, but the hospital has a long history of ‘taking advice on board’ and listening carefully then sailing on unchanged, so it will be interesting to see if there is any real committment to changing the culture and improving levels of service. 

But here we are in Auckland, and the sun is shining. Four more days and we will be in Brisbane, and another three days and we will be home on Kangaroo Island.

An astonishing, excuse filled response from the Wanganui (or Whanganui) Hospital in response to a front page story today in the Wanganui Chronicle about some of their failures in Amanda’s care.

I have just emailed a letter to the editor of the Chronicle as below:

Dear Sir,

I wonder if I might be allowed to address a couple of points arising from your story about my sister Amanda.

I am not surprised that the Hospital would reveal confidential patient information to protect themselves – they had already threatened to do so if we told people what had happened to Amanda. But I am disappointed that Ms Black, the Hospital General Manager, chose to exaggerate or misstate the nature of Amanda’s illness, claiming she was a ‘challenging and complex mental health client,’ as if this provided an excuse for the Hospital’s failure in its duty of care to her.

Amanda is an intelligent, honest and caring woman who holds a professional degree, and is respected by colleagues and clients alike.

In her early thirties she was suddenly struck by crushing feelings of dread, hopelessness and self-loathing. From time to time these feelings were accompanied by an overwhelming urge to harm herself. Despite this, she is a straightforward and easy patient to manage. She has good insight into her illness, is absolutely honest with herself and others, and she wants to be well. If she is at risk, she says so, and will keep saying so until either she gets help, or is so completely rejected that she simply gives up. This is what happened at Te Awhina.

At one point she was told by a senior staff member that she was not at risk, because if she was serious about killing herself she would have done it already, and that there were plenty of ways to do it if she just thought about it more carefully.

As astonishing as that comment from a Te Awhina staff member was, I was even more dismayed by Ms Black’s claim regarding her repeated falls while in the wards, that staff ‘had no reason to believe she was unsteady.’

Amanda’s injuries included a brain injury, a broken neck, another break in her lower spine, and multiple fractures in her pelvis, upon which she was not supposed to put any weight. As if that were not enough to raise doubts about her ability to be steady on her feet, she had already suffered one serious fall while in the Critical Care Unit, a fall that resulted in a deep cut in her head, with so much bruising and swelling that her right eye was completely closed and her sense of vision and balance impaired. If even that was not enough to connect the dots, staff could always have read her notes, where they would, or should, have found comments from orthopedic and physiotherapy staff.

All of Amanda’s current injuries, which as well as those listed above, included a ruptured spleen, lacerated liver, lungs so badly damaged she could not breathe without assistance for two weeks, burns, fractured ribs, cuts and contusions – three separate ACC claims – were incurred while she was in the care of Wanganui Hospital. If Ms Black is serious in her claim that this constitutes ‘very good care, diligent care’ then Good Health Wanganui really does mean ‘God Help Wanganui,’ and residents would be better off taking their seriously ill loved ones to the local vet.

But of course if isn’t good quality care. It’s the Keystone Cops, and the people of Wanganui deserve better.

I wrote a week ago that I expected normal transmissions to resume forthwith. That didn’t happen.

Amanda was then in the Critical Care Unit at Wanganui Hospital. I foolishly imagined that she would be safe there. I was wrong.

She still has multiple major injuries. She has a broken neck and is wearing a brace to stabilise that fracture and prevent spinal damage. She has a fractured pelvis and must not put any weight on  her feet. These would be simple to manage, except that Amanda is also brain injured. This means she sometimes forgets she has these injuries, tries to get up and walk, remove her neck brace, etc. She is also disoriented and suffers vertigo. She must be supervised contantly.

Amanda was in the care of the Wanganui Hopsital when she suffered these injuries, so we hoped that they would take their duty of care for her seriously from that time on.

Last Sunday 22nd Feb she was left unsupervised in the Critical Care Unit. She got out of bed and immediately fell, striking her head on the floor and suffering a deep cut to the right side of her head above the eye. I had only been away from the hospital for about fifteen minutes, and arrived back to find her sitting in bed with a large wound covered with steri- strips, with blood pouring down her face, into her beck brace, and onto pyjamas and sheets. I stood by her bed for over an hour holding a dressing to her wound to stop the bleeding (unsuccessfully), while staff tried to work out what to do. Finally one of the surgical doctors came and sutured the wound.

There were no staff to remain with her, so I stayed with Amanda at the hospital that night, all through the next day and the following night. On Tuesday I met with nursing staff and doctors. I had then had two hours sleep in the previous 60 hours. It was agreed that Amanda should be transferred to a surgical ward, and that additional staff would be provided to watch her. I offered to go on a roster to fill in any gaps.

However, when I arrived the next day, it became clear that the expectation was that I would be by Amanda’s bedside from 9am to 9pm every day. She is my sister and I love her. I would do anything for her. But that was not what I had in mind when I offered to ‘fill in the gaps.’

Additional staff were to be provided by Te Awhina, the residential psych unit. I was not happy about this – these were the people who were responsible for Amanda’s care at the time of her original injuries. But there was no option, so I accepted this as a compromise. I made it clear though, that there were three specific staff members I did not want involved in her care. One had a history of drinking before coming on shift, one had, well, let’s just say he was not a safe person to have around young female clients, and the other was known to clients and former staff and as a bully.

The first person to arrive to watch Amanda was one of the people on that list. I stayed with Amanda that night until change of shift and that person left. It was also clear that those staff had no idea why they were there, so I wrote out a list of Amanda’s injuries, and explained specifically that she could not put any weight on her feet, and might have to be restrained from removing her collar. I also had a copy of those instructions placed in her hospital notes.

The next day I repeated my concerns to someone in the hospital I thought could make a difference. I also had repeated arguments with nursing staff, who seemed constantly to be wanting to get Amanda on her feet. I explained each time that the orthopedic staff had said specifically she not to bear any weight on  her feet. It was clear none of the staff had been briefed on her injuires and nursing requirements, and that none of them had read her notes. Many of them argued with me rudely and dismissively, before saying that they would go and check her notes. I could only respond by saying I thought this was a very good idea. I refrained from saying the obvious – that it might be a good plan to read a patient’s notes before attempting to move her around or administer other medical care.

The same staff member from Te Awhina wa again the first to turn up that night. By this time I was approaching exhaustion, and simply could not stay. I went home and had a restless night’s sleep, wondering what I would find the next morning. I was right to be concerned.

When I arrived the following morning, one of the nursing staff was walking Amanda back from the shower. The orthopedic staff had said this would cause damage to her pelvis. This was in her notes. My instructions were in her notes. But this was not the end.

Amanda told me, and this was then confirmed by the nurses, that Te Awhina staff had twice walked her up to the toilet during the night, and left her unattended. The first time she fell from the toilet and landed on her head on the floor (again!). She lay there calling for help, and soiled herself. The second time, she was left alone in the toilet, unable to bear any weight on her feet, with no sense of balance, confused and disoriented from her brain injury and her fall earlier that same night. She could not get her shorts down and wet herself.

When I found out about this I got a wheelchair, wheeled her down to the car park, put her in the car and took her home.

I then rang the hospital and told them I had taken her home. I explained that I could no longer have any faith in the undertakings hospital were contantly giving me, and believed I would be failing in my duty of care to my sister if I left them in her care any longer.

My respite time (provided by trustworthy friends not the hospital) is up. More on this later.

The name for the local health service, including the Wanganui Hospital, is ‘Good Health Wanganui.’  The locals call it ‘God Help Wanganui.’

A Poem for Amanda

Dressings for windows and watches and wounds
I think all my zebras are coming home soon.
I asked my friend Millie the mincer to fix
But she sits on the mantelpiece playing with sticks.
I have to fix, have to fix, have to fix up
The casserole system inside the blue cup.
And please Daddy, please won’t you take me home soon?

My brain is combusted and crumples the moon
The nurses keep playing their pipes out of tune.
The lint on the window sill’s starting to stare.
I am heavy as death, so light I’m not here.
The sheets have gone pickled and prickle my feet
Someone keeps stealing the food that I eat
And please Daddy, please won’t you take me home soon?

The worms in my porridge sing nursery songs.
Who’ll feed the elephant now that I’m gone?
I don’t like the man where the wallpaper bends.
It’s dark where I’m buried here under my friends.
Mustn’t think bad things, they’ll come back and tie me
With eyebrows and pinecones and spiders inside me.
And please Daddy, please won’t you take me home soon?

My arms and my life are all flaked and corrusted
The men in the other place cannot be trusted.
I must be in prison, I know I’ve been bad
The walls are so high, and my friends look so sad
But if you put pineapples back on the wall
I promise I’ll try really hard to be small.
And please Daddy, please won’t you take me home soon?

I am still In Wanganui in New Zealand, still caring for Amanda. But we seem to have settled into a routine now, and I have found a decently quick internet caff, so posting should be back to normal over the next few days.

This is an article I have just written to send to the Wanganui Chronicle. It is about Amanda, but may be of wider interest.

I apologise for the lack of posts over the last few days. Things have been pretty intense here.

Thanks for your support.

————————————– 

Just after 5pm on Thursday 29th January, my beloved sister Amanda jumped from a fourth floor fire escape in a building at the Wanganui Hospital.

She broke her spine in two places, fractured ribs and pelvis, tore her liver, ruptured her spleen, and may have permanent brain damage.

A few weeks before, in consultation with her own psychiatrist, she had checked herself into Terror Fina, sorry, Te Awhina. She did this so she could be in a safe and helping place to come off a complex and ineffective mess of medications that had been prescribed to help her cope with depression.

A safe and helping place! What should have been a routine process of care and support for an intelligent and capable young woman turned into a nightmare of….

No, wait. Instead of talking about Terror Fina, let me talk about residential pysch units in general.

Anyone who has seen the film ‘One Flew Over the Cuckoo’s Nest,’ or read the book, would have been horrified by that portrayal of the vindictive, bullying manipulation of people lost in a vicious system and unable to speak for themselves.

Psychiatrists and mental health workers have enormous power over their clients. In my experience, people drawn to those professions are equally divided between those who genuinely wish to help people in distress, and those who see that distress as an opportunity.

In every psych unit there are psychiatrists and other staff who expect instant and unquestioning compliance. Anything else is a challenge to their authority, is taken personally, and considered behaviour which must be punished.

These ‘therapists’ use a variety of techniques to maintain their power over clients who are not appropriately deferential, or if the therapist is male, female clients who do not find them sufficiently attractive. Clients may be told they have a personality disorder. They may be made promises about treatment or other processes which staff have no intention of keeping. Their medication may be increased till they are effectively zombified, they may isolated, belittled, or bullied in other ways.

People who are treated in this way are significantly more likely to self-harm or to commit suicide.

When this happens, the therapist’s first priority will be to come up with a story that casts him in a positive light, while destroying the credibility of the client. The client’s alleged personality disorder will be emphasised, she will be described as erratic, high risk, or ‘treatment resistant.’ It may be claimed that she had a plan, that she self-harmed or committed suicide deliberately to embarrass the therapist. So even after death or serious injury the client’s pain and loneliness and suffering count for nothing. According to the therapist, he is the victim, he is the one who has been inconvenienced. It’s all about him.

The therapist’s behaviour is typical of people who are sociopathic or narcissistic. It is not the client who has a personality disorder.

Let’s imagine that on the morning of the 29th of January a meeting is held at a psych unit somewhere in New Zealand. We need to call this meeting something, so I’ll call it a Malevolently Dysfunctional Team meeting, or MDT for short. Ruling over this particular MDT is a Dr Bastaard. There’s no such person of course.

There is a client at the meeting. She is an intelligent and capable young woman with good insight into her illness. She is also deeply distressed. She has written down her feelings of loss, of abandonment, of confusion and despair. She reads this to the team. She asks for help. None of them respond. Some of the team members smirk at one another. Dr Bastaard, who has been playing with his laptop computer while she speaks, does not look at her or acknowledge her. The meeting continues as if she did not exist.

Is there anyone at the meeting who should be speaking for the client? Perhaps, but they don’t. Is there anyone at the meeting who has a glimmer of care for the client? Perhaps, but any concern for her welfare is less important to them than the approval of their peers. So no one says anything. No one does anything.

These are mental health professionals. They know her feelings and state of mind – she has just told them. They know the impact and likely outcome of such utter rejection. If any harm comes to her after this meeting, it will not be because of an error in professional judgement, or even because of negligence. This is deliberate and culpable malice.

Imagine that during the day, friends who are concerned for the client ring the psych unit to ask that she be cared for, because she has talked about suicide. Their concerns are dismissed. Imagine that another friend waits for an hour in a psychiatrist’s waiting room, so she can tell him that the client is despairing, in danger. Imagine that just before 5pm another friend rings the psych unit to check on the client and to make sure the staff are aware of her state of mind, that she is being watched carefully, only to be told that staff have no idea where she is.

Just after 5pm on Thursday 29th January, my beloved sister Amanda jumped from a fourth floor fire escape in a building at the Wanganui Hospital.

We intend to seek an enquiry into what happened to Amanda. There are lots of different kinds of enquiries. There’s the kind where staff get together and decide that really when all things are considered, they did OK, and issue a statement like this: We’re very sorry your loved one died because we were watching reruns of the Simpsons instead of doing our jobs. But heck, you know, everyone makes mistakes, these things happen sometimes, and it was probably her fault anyway, so please go away and stop bothering us.

We don’t want that kind of enquiry.

We want an enquiry that will make a difference, not just to Amanda, but to the delivery of Mental Health Services, and perhaps even a broader enquiry into the politics and culture of health care in Wanganui.

We have spoken to previous and current Mental Health Care clients and to former staff. We are gathering material to submit to the media, to the Minister for Health, and to ACC.

If you have a story to tell, please email me, Peter (Amanda’s brother) or write to me at 74 Pitt St, Wanganui, NZ.