Mohinder’s story – Reducing stigma in the Sikh community
Kaur talks about caring for her dad, Mohinder, since his mixed dementia diagnosis, and how community awareness needs to be improved.
Sometimes, people with dementia become distressed, frustrated and angry. This may lead to a crisis situation where the person needs to be admitted to a mental health ward for their own safety or the safety of those around them.
Mental health wards (also known as psychiatric wards/units) care for people who are experiencing a mental health crisis. Some just care for older people or those with dementia, while others care for people of all ages with a range of mental health conditions.
People may be admitted to a mental health ward:
- voluntarily/informally – this means they consent to being admitted
- under the Mental Health Act (1983) – often described as ‘being sectioned’ – which means they can be admitted without their consent
The ward staff should provide further information about the person’s individual circumstances and rights while in hospital.
If there are no beds locally or another unit can better meet their needs, the person may be admitted to a ward outside their local area – known as an ‘out of area placement’.
When a person is admitted to a mental health ward, staff will carry out assessments to establish what is causing their mental health crisis and how to help them. This may take a number of days or even weeks, and should include:
- talking to them and their family
- monitoring their behaviour and mood
- reviewing their health and medications
- assessing their ability to care for themselves
If the person cannot explain how they feel, staff will make decisions based on observations of their behaviour and mood.
Many people on mental health wards are prescribed medication – for example, for low mood, anxiety or psychotic symptoms like hallucinations, false beliefs or paranoid thoughts.
The person with dementia may need to try several different medications before they find the most effective one(s). They will usually stay in hospital during this process so staff can monitor them for any improvements in symptoms and/or side effects.
Alongside medications, the person will be supported to take part in purposeful activities and therapies to help ease their distress.
Bear in mind that dementia is a progressive condition, so it will not be possible to relieve all of their symptoms.
Care and treatment decisions are usually made in a multi-disciplinary team (MDT) meeting of the professionals involved in the person’s care. You should be invited to these meetings.
If a person becomes physically unwell, they may need to be transferred to a general hospital. Usually, a member of staff will accompany them and stay with them.
Many people with dementia who are admitted to a mental health ward also have physical health problems, which may be severe. Their care will include making plans for their future – known as advance care planning.
This may involve thinking about what should happen at the end of life, including where they will be cared for and what treatments they should and should not have, for example CPR.
These discussions can be difficult but will help ensure the person gets the best possible care.
Staff are responsible for assisting with personal care on mental health wards. You can help by sharing information on how the person was supported before they came into hospital.
If you have been providing personal care and would like to continue to do this, talk to the staff.
You may notice changes in the person’s care needs, as being in hospital may affect their ability to care for themself – for example, they may find it difficult to manage a shower if they are used to having a bath.
The ward staff can tell you what the person will need while in hospital, such as clothes, toiletries, medication and familiar items to help them feel more comfortable.
Items like glass, sharp objects, and ties/belts/scarves may not be permitted for safety reasons.
Once the person is ready to leave hospital, staff should work with their family and care professionals to plan what care they will need next and where this can best be provided. Often, this will be a care or nursing home.
Be aware that it can take some time to arrange a care package or suitable placement, even once the person is ready to be discharged.
If you have questions or concerns about how the person with dementia is being cared for, speak to the ward manager. If your worries are not resolved, you can contact the hospital’s Patient Advice and Liaison Service (PALS) for help.
How long will my relative stay on the ward?
People with dementia often stay in hospital for months rather than weeks, but everyone’s circumstances will differ.
If the person is admitted under a section of the Mental Health Act (1983), these have particular timeframes: for example, they can be held on Section 2 (for assessment) for up to 28 days, and on Section 3 (for treatment) for up to six months initially. However, these are not definitive, so try not to focus on them too much.
Can the person have visitors?
Speak to the ward staff about visiting arrangements. Most have visiting hours, but some are signed up to John’s Campaign which recognises the importance of flexible visiting for people with dementia.
Some hospitals allow visitors on the ward, while others have designated visiting rooms. Typically, children are not allowed to visit mental health wards, but you can ask if they could see the person in a visiting room or the hospital grounds.
Can the person leave the ward?
This depends on factors like their level of distress and the availability of staff/visitors to accompany them. If the person is allowed to leave the ward – for example to take part in activities in a different area of the hospital or walk around the grounds – they will usually need to be escorted, either by staff or by family or friends.
If the person’s mental health crisis subsides, they may be allowed ‘leave’ from the ward to go home for a few hours or overnight. This is a test of how well they manage outside hospital and is an important step towards discharge.
How can I visit the person if I do not have transport?
Speak to the ward manager or your social worker, as a volunteer driver or hospital transport may be able to help. However, there is no expectation that you visit every day.
If you are unable to visit, ask the ward to help you stay in contact with your relative, for example by phone or video calls.
What if the person needs support with eating and drinking?
Ward staff will support people who need help to eat and drink, so please let them know about the person’s likes, dislikes, routines and dietary needs.
What if the person with dementia is upset, afraid, or looking for me?
Hospital staff are used to working with people in distress. You can help by sharing as much information about the person as possible, including methods that have helped reassure them in the past.
I have been told not to visit for a week while the person settles in – is this right?
There is no evidence that delaying visits from family and friends will help the person settle in, but this advice is still given by some wards.
If you discuss this with staff and they maintain that you cannot visit, contact the hospital’s PALS Team for advice.
Will being in hospital affect the person’s benefits?
Being in hospital will not affect the person’s State Pension, but some other benefits may be affected. For more information, please see the Government’s benefits advice or contact Citizens Advice.
It can be very difficult for families when a loved one is admitted to a mental health ward. Some wards offer support for families or can refer you to local services, or you can speak to your GP about accessing support.
If you need advice on any aspect of dementia, please call the Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or you can also book a phone or virtual appointment with an Admiral Nurse.
Dementia UK resources
- Managing anxiety and depression
- Advance care planning
- The Carer’s Assessment
- Changes in care: a stay in hospital
- Changes in perception and hallucinations
- Coping with distress
- Creating a life story
- Dealing with restlessness
- Delirium
- Financial and legal sources of support
- Keeping safe when you care for someone with dementia
- Lasting power of attorney
- Mental capacity and decision-making
- Recognising the later stages of dementia and moving towards end-of-life care
Other resources
- The Advocacy People – independent mental health advocates
- Gov.uk – benefits
- The Mental Health Act (1983)
- Mind: sectioning – an overview
- NHS: do not attempt CPR (DNACPR) decisions
- NHS: the Mental Capacity Act
- POhWER – independent mental health advocates
- Voiceability – independent mental health advocates
Book an appointment with an Admiral Nurse
Our virtual clinics give you the chance to discuss any questions or concerns with a dementia specialist Admiral Nurse by phone or video call, at a time that suits you.
