Archive | December, 2012

Full circle? Piers Morgan, mental health & gun violence (again)

27 Dec

The amazing power of Twitter to bring diverse people together, engage, educate and – just sometimes – to sow the seeds of change in even the most entrenched views. Here’s a Twitter conversation which ran over the cFull circle Twitter profile photo DEC 2012ourse of 24 hours on the subject of Piers Morgan, gun violence and mental health with tweeter “ahxcjb” (@ahxcjb) (see Twitter profile photo right).

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Sometimes, when someone directs idiotic comments at me, I play with them a little, just to see if they’ll come up with some more. As tweep “ANM” (@Amazonnewsmedia) said:

“Hmmm This is like finding the very source of a ridiculous prejudice. If we could bottle it, or freeze it …”

First there are tweets between @ahxcjb and I (with some commentary from me). I’m afraid I don’t always have the patience to effectively draw out from people what they’re really trying to express when their arguments aren’t coherent. Luckily however other tweeps did a far better job than me.

After my tweets, there is the Twitter gold of other tweeps’ comments when they explore ideas with him in ways I never imagined.

The best part is that, over time, the tweep’s views really did appear to change –  just a little – through the power of different tweeps engaging with him on his own level and educating him about mental health. Utterly fascinating.

Read for yourself and see what you think. (There are quite a lot of tweets so you can see everything and judge for yourself. I may edit later to focus the post more but don’t have time to do so at present.)

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As a tantilising morsel, here is a selection of favourite tweets, to give you a flavour …

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@ahxcjb: @Sectioned_ i’ll ask again, why did you get sectioned? Were you a danger to the public? Clearly you were. Do I want u to have a gun? God no!

@ahxcjb: @ColinGoffin I just don’t take the viewpoints of someone whose been sectioned previously very highly. If you want to – fine. Your lookout.

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@NicClark83: @Sectioned_ I’d be more worried about people like @ahxcjb having a gun. Such ignorance and prejudice is dangerous.

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@ahxcjb: @Dopamine_Diva yes. I have a problem with anyone having a gun that isn’t police (even then, only with in depth vetting) or military.

@Dopamine_Diva: @ahxcjb So do I. But why single out people with mental health problems? Do u know lots of police officers have mental illness too?

@Dopamine_Diva: @ahxcjb 1 in 4 people have a mental illness. 1 in 10 murderers have a mental illness. It’s the healthy people you should watch out for.

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@GetLost_UpYours: @ahxcjb @Sectioned Out of interest, what about people with mh issues owning a car, they might decide to run someone over.

@GetLost_UpYours: @ahxcjb @Sectioned Or what if I learnt a martial art, I could be lethal with my hands then.

@GetLost_UpYours: @ahxcjb @Sectioned_ Just to clarify, I do have mental ill health, I do own air weapons (which could be deadly) and I’m a qualified marksman.

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And finally, here’s a last link to the Storify story.

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UpdateFriday 28th December 2012 – Tweep @ahxcjb disabled his account yesterday, so none of his tweets are available any longer. As @Dopamine_Diva tweeted hilariously:

“So sad he’s disabled the account, I went on the computer today all ready to recruit him to do some anti stigma stuff!”

We’ll probably never know the outcome of the tweet exchange. But maybe, just maybe, the tweep will have a change of heart about mental issues. Fingers crossed.

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Mental health, violence and assessing risk: liability of psychiatrists

24 Dec

Mental health & violence has been all over the media recently. I’d like to be writing about something else, but the subject keeps cropping up.France psychiatrist screenshot

This time, it concerns a psychiatrist in France, Daniele Canarelli, who was given a suspended jail sentence for a murder carried out by her patient, Joel Gaillard. We know very few details of the tragic case, but it has prompted discussions, like the one below, about how mental health professionals should assess and act on perceived risks.

As I tweeted on Sunday:

“How do you balance risk and recovery? How do you know when to detain and when to release? When to encourage and when to warn?”

(I should add that I have very limited knowledge or experience of criminal law or forensic psychiatry but it seems, following my experiences last year, to be something I’m slowing getting to know more about. Not something I’d ever anticipated.)

In the real world, such balancing acts must, I am sure, take place every day: when a police officer decides whether to detain someone under s.136; when an AMHP decides whether to detain someone being assessed in their home; when a psychiatrists decides whether to release a patient from a secure ward; when a mental health professional decides whether to warn the police that their patient may be dangerous.

In this tweet story, three tweeps – a senior police officer, an AMHP and IMHA working in forensic services – discuss this difficult case and its potential ramifications. Inspector Michael Brown (@Mental Health Cop), AMHP “BC” (@444blackcat) and Rob Jamil (@robjamil) (IMHA and trainer working in forensic services) are those 3 people. “BC” could be the person making decisions about detention during a psychiatric assessment in the community. Rob Jamil could be the person helping the patient detained on a criminal ward get his voice heard about his stay on the ward. Inspector Brown could be involved in the investigation of a murder.

The fear expressed by Canarelli’s defence lawyer was that, by placing criminal responsiblity on the shoulders of clinicians in this way, psychiatrists would be forced to take the least risky option. And that the fear of criminal prosecution would weigh against the wishes of the the patient to get on with their life and indeed the benefits to the patient of doing so.

It’s important to bear in mind that this is a case in a different legal system to our own. And that very few murders are committed by people with mental health problems. As consultant psychiatrist Trevor Turner is reported to have said in this Guardian article (which is the subject of this blog post on the use of the phrase “normal people”):

“In the 1950s, there were about 100 murders a year, of which 30-40 were committed by people with mental illnesses at a time when 150,000 people were locked up in asylums. In the 1990s, said Turner, there were about 750 murders a year, but the numbers committed by people with mental illness remained at 30-40, even though the norm was by then care in the community and the asylum population had dropped to about 30,000. The conclusion, said Turner, is that “the rate of murders by normal people has climbed inexorably”.”

There seems no justification in fact for the public’s fear of violence carried out by people with mental health problems. Let’s hope psychiatrists won’t develop an irrational fear too in the wake of this recent French case.

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Jargon buster:

  • AMPH: Approved Mental Health Professional
  • IMHA: Independent Mental Health Advocate
  • Forensic services: services involving crimes and criminals

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Ward round: what is it good for?

23 Dec

Yesterday, ward round suddenly popped into my mind. I don’t know why. Possibly it’s because I’ve recently been asked to complete a “trauma diary”, logging what triggers the flashbacks I get. Since they relate to my time on ward, this means I’m focussing on my ward experience more than I would usually do.

Whatever the reason for ward round being on my mind,  it reminded me of the original concept of the operating theatre: an arena in which the surgeon would theatrically perform for an audience of students and paying spectators.

In this tweet story, I describe my experience of ward round. There are then tweets from others sharing their experiences & suggestions. It’s quite descriptive. And all fairly negative.

Then today, the brilliant Marion Janner of Star Wards (@StarWards) tweeted me to shine a positive light on the issue, as is her way. She said that replacing out-dated ward rounds was top of the list at her new website, Wardipedia (“A world of ward knowledge”). Good news!

Based on her own inpatient experience, Janner is passionate about supporting mental health staff to create a positive and therapeutic environment for psychiatric patients. Her original Star Wards website (“Inspiring inpatient care”) was joined this year by a fantastic new resource for psychiatric staff, Wardipedia. Both provide endless resources & suggestions for free and low cost practical measures for improving the ward experience for staff and patients.

Take a look at this page of the Wardipedia website for an in-depth review of the flaws in the current ward round system and how it can be changed. The experience of Sandwell Park hospital in Hartlepool – which replaced ward rounds in 2006 – is given as a detailed example of how this can work in practice. Ward round can be abolished. And it has been.

As Marion summarised it to me:

Ward rounds throw ward schedules (eg activities) into chaos, distract staff, cause knock-on anger & anxiety among patients. Abolishing ward rounds is cost-free, totally positive way of improving inpatients’ experiences.

If you work on a ward where ward rounds still take place, this will give you food for thought; and perhaps a basis to suggest modernising the practice. And the same goes for patients and relatives. It’s not just you that finds the current ward round system idiotic and counter-therapeutic. But change is possible and Wardipedia shows the way.

Hopefully one day soon no one will be describing an experience of ward round like the one I described yesterday.

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Happy Christmas Atos!

21 Dec

A collection of tweet stories on the Atos Work Capability Assssment (WCA) process:

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Tuesday 5Updateth February 2013: I was finally able to put my Atos form in the post. Not complete, but as complete as I could make it with the limited help provided. With services at CMHT slashed (eg almost all the support workers have been let go), if you can’t do these things on your own you’re pretty much stuffed.

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Normal people and mad axeman murderers

20 Dec

Retro magnet normal family

Twitter is full of surprises. Whenever I log on, I never know what it’ll turn up. Yesterday, when I went to check what the current crop of “mental health and violence”media stories were doing in the wake of the horrific Newtown school shooting, things took an unexpected turn.

In this case, Twitter threw up an article in the Guardian newspaper, entitled, “Rising fears about ‘mad axeman’ murderers not borne out by statistics”. Supposedly a positive story using statistics to refute the myth that people with mental health problems are the perpetrators of violent crime.

As one tweep said, however:

Only the Guardian could reinforce stereotypes about mental illness in an article designed to undermine them.” (Blakean Warrior-Poet @LosTheSkald)

The problem? The psychiatrist quoted as the basis of the statistics in the article referred to “normal people” as being the group with the greatest increase in murders. “Normal people.” An odd turn of phrase and, I’d hope, a mis-quote.Why Be Happy When You Could Be Normal

However, as presented, the article states that it’s the “normal people” who are committing the murders. So, as one tweep (herself a psychiatrist) pointed out, shouldn’t the rest of us be the ones who get armed for our own self-protection?

See this Storify story for some illuminating and hilarious tweets on this topic.

Here’s an excerpt from the Guardian article:

Open quotesAlthough the level of homicides has risen markedly since the 1950s in Britain, the number of those committed by the mentally ill has remained static … “There is very, very good evidence that there has been no increase in ‘mad axeman’ murders since the 1950s,” said Dr Trevor Turner, a consultant psychiatrist in east London and former vice president of the Royal College of Psychiatrists.

In the 1950s, there were about 100 murders a year, of which 30-40 were committed by people with mental illnesses at a time when 150,000 people were locked up in asylums. In the 1990s, said Turner, there were about 750 murders a year, but the numbers committed by people with mental illness remained at 30-40, even though the normClose quotes was by then care in the community and the asylum population had dropped to about 30,000. The conclusion, said Turner, is that “the rate of murders by normal people has climbed inexorably”.

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Will these tablets turn me into a zombie …?

19 Dec

Dopamine Diva butterfly

Here’s a link to an hilarious conversation I had with Dopamine Diva, who tweets as @Dopamine_Diva and describes herself as, “Mildly eccentric psychiatrist. Not always completely euthymic myself. I like chocolate, knitting and rock music.”

The photo on the left is her Twitter pic.

Dopamine Diva says she’s frequently asked, “Will these tablets turn me into a zombie?” “To which I reply, ‘No. My aim is to get you well and doing the things you want to do. If they make you sleepy, I’ll change them’.

“However I’d prefer to say, ‘Yes. Yes they will. It will be awesome, and we can see if the hospital’s Zombie Plan is any good.'”

Which still makes me laugh every time I read it.

Here’s a link to a Storify story of the original tweets. Well worth reading if you want a belly laugh.

Of course the flip side to the story is that commonly prescribed psychiatric medications like antipsychotics can be highly sedating. That’s why they’re prescribed for insomnia. And (because of their weight gain properties) also for anorexia. And becoming a fat zombie isn’t so funny after all.

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Zombie facts: violent crime and mental health (again)

17 Dec

UpdateThis piece has now been updated following a Twitter conversation with MP Stella Creasy on Sunday 23rd December. I’ve also added at the foot some links to a couple more excellent analyses of the “I am Adam Lanza’s mother” piece. See below.

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How many times is this topic going to come up? Just about daily at present. So here we are, for the next few days at least, getting daily reminders that heinous crime = mental illness, and that mental illness = dangerous and violent.

A simple formula which, Sunday made clear to me, it’s not just the ill-informed (or those who seek to make their careers out of the ill-infomed – see yesterday’s blog post on Piers Morgan) who buy into. It’s intelligent people. It’s people I’ve met. It’s people I’ve admired. It’s people with influence.

First off the mark was David Allen Green, a London lawyer and journalist I follow on Twitter who seemed a sensible and thoughtful chap when I met him. A lot to say for himself on Twitter but then that’s not unique and has gained him a lot of followers (nearly 40,000). He shares interesting content on legal matters and blogs under the name Jack of Kent.

Green roundly endorsed a Huffington Post piece called “I am Adam Lanza’s mother”. He tweeted:

“Outstanding piece on mental health and crime in the US, by a mother”

Adam Lanza is the young man responsible for Friday’s school shoooting in the US. The piece was written by a mother of a 13-year old boy with mental health problems. The mother clearly needs help to manage a situation where she is not coping. But the assumptions, extrapolations and conclusions reached in the article are deeply flawed. (You can read an excellent analysis of the piece in Mark Brown‘s (editor of One in Four magazine) piece for This Week in Mentalists.)

Next was MP Stella Creasy, who I started following only recently after an impressive performance on BBC1’s Question Time. That marked her out as one to watch for the future. She has nearly 24,000 Twitter followers and describes herself as Labour and Co-operative MP for Walthamstow and says that, “Sitting on the sidelines is for Waldorf and Statler”.

Creasy retweeted an endorsement by Mary Ann Siegart of the “I am Adam Lanza’s mother” piece. Seigart, who has over 11,000 Twitter followers, describes herself as a journalist, occasional BBC presenter and chair of the Social Market Foundation. She tweeted:

“Ignore all the horrible disaster porn in today’s papers about the Newtown killings and read this instead. V powerful”

As Inspector Michael Brown (who tweets as MentalHealthCop) said in response:

“This is not ‘very powerful’, it is one if the most irresponsible and outrageous things I think I’ve ever read. It is shameful.”

(Last month, Inspector Brown’s Mental Health Cop police blog was awarded the Mark Hanson digital media award in the Mind Media Awards. The clue is in the name: he knows what he’s talking about when it comes to the subject of the Huffington Post piece, namely mental health and crime.)

I contacted all three on Twitter (see the Storify story for my tweets, those of Green and Siegart, Mental Health Cop and other tweeps). Because … perhaps these intelligent people might be persuaded to think again about the piece they had endorsed? Only Seigart replied, with a chilling comment demonstrating that she really had absorbed the “mental illness = dangerous” formula.

And so this ignorant but apparently seductive piece – which could yet prove to be a hoax – continues to circulate on the internet; continues to be endorsed by people who, presumably, believe they are doing the right thing in highlighting under provision of mental health care. But, all the while, they are in fact reinforcing the stigma and prejudice that exists against those with mental ill health. And that can’t be good. For any of us.

But what can be done? A good question, to which I don’t know the answer. Perhaps all we can do, for now, is to keep doing our little bit to challenge these views whenever we come across them. Even if, like me, that just means sending a tweet or two or writing a short blog piece.

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UpdateOn Sunday 23rd December, Zarathustra (of The World of Mentalists blog) and I had a Twitter conversation with MP Stella Creasy. Afterwards, as Zarathustra said, “I think we may have educated an MP today. #win“. And, since Creasy then retweeted a link to Zarathustra’s blog post analysing the “I am Adam Lanza’s mother” piece, maybe some of her 24,000 Twitter followers will have learned something about mental illness and violent crime too. Check out the conversation here.

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web links 5Here are some excellent commentaries on the “I am Adam Lanza’s mother” piece:

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