Archive | January, 2013

What advice would you give someone recently discharged from psychiatric hospital?

31 Jan

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What advice would you give to a patient who’s recently been discharged from psychiatric hospital? What would you have wanted to know when you first came out? I was asked these questions yesterday evening by someone I’d known for a long time, someone who’d visited me on ward 2 years ago and thought I might be able to help someone who’d come to them in despair.

The woman had recently been discharged from a mental health ward in the hospital where I’d been detained.  She was angry. Her world had falled apart. Her marriage had fallen apart. She was appalled by her treatment on ward. She wanted the hospital to hear what she had to say about her care, to know it was wrong. She wanted to meet with people who would know, through shared experience, what she had been through. Would I meet with her face to face to offer advice and support.

When I got home I sent this series of tweets which sets out my reaction to the question. I’ve also added in the responses of other tweeps, and there’s some good advice in there so take a look. Read the tweets to see my gut reaction at the time, or read on for a slightly edited version (tidied up from yesterday’s stream of consciousness), including my 10 tips.

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Open quotes“Will you meet a woman who’s just been discharged from psychiatric hospital?” I was asked. “She’s so traumatised by the experience.  Her  world has fallen apart. She doesn’t know where to turn. She feels so angry about the experience.” More details were given about her difficult circumstances and how she wanted to make a complaint to the hospital but didn’t know how to do so or where to turn. “Can you meet her?”

“No,” I said. “No, I can’t meet her. I’m still too traumatised myself to take on someone else’s pain. I have to take care of myself first.” Her experience in late 2012 seems similar to mine in 2011. So nothing has changed. The hospital hasn’t changed, despite a programme of improvements to the physical environment. The culture hasn’t changed. Same leaders. Same nurses. Same bullying, abuse and poor care. I don’t want to relive it with someone else who’s suffered in similar ways to me, nearly two years later.

“Did you know,” I said, “that I was discharged requiring treatment for harm inflicted on ward? For mental trauma and a physical injury? That I’m being treated for PTSD from the ward experience? And I’m being treated by a physiotherapist for a restraint injury?” The trauma of being held in seclusion, forcibly treated, repeatedly restrained, yanked around by my arm by a bully nurse, has left scars that still need help to heal. I’m still vulnerable.

“Did you know,” I said, “that, when I raised a sample complaint with the hospital, I was disbelieved and blamed?” Which felt like being assaulted a second time. Making a complaint made me feel worse, not better. Much, much worse. I don’t want to go through that process again with someone else.

“Did you know,” I said, “that I have to measure carefully how I use my brain? To flex & strengthen the mental muscles but be careful to not stress or weaken them. Did you know,” I said, “that, although I tweeted all day about the Mental Health Act report, I’m not going to read it?” It would be too harrowing for me to read about others’ difficult experiences on ward. To read about forced treatment, restraint, seclusion, lack of care as being far too common an experience on ward. I look like I’m coping, but that’s because I’m practised at measuring out my energy so I can hold it together in public when I need to.

So no. No I won’t meet them. No I won’t offer support or comfort. Right now, for me, I want to meet happy people. To smile and laugh. To rest my brain. To enjoy life. To put clear blue water between me and the hospital experience. Having caring responsibilities before contributed to me landing up in hospital before. I can’t take on someone new to care for.
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“But,” I said, “I can give you some advice to pass on. Some things I would have wanted to know when I was discharged. That will still be some help.” Here are the tips I passed on:
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  1. It’s good to have someone on your side. If you’re within 8 weeks of discharge, the ward IMHA should be able to help you make a complaint or get your voice heard. They know the ropes. Even if the ward IMHA can’t help you, your local branch of a mental health charity like Mind, Rethink or Sane may have advocates who can help you be heard.
  2. PALS can also help you if you feel you’ve received poor care on ward.
  3. If you feel like you want to be heard, that’s different from making a complaint. Hospitals will have a procedure to help you be heard, outside of a formal complaints procedure, and that may be a better option for you.
  4. If you’re thinking about making a complaint, what end result do you want to achieve? What do you want to get out of it? Do you want “justice” and, if so, what would that look like to you? Do you want to get an apology? Do you want financial compensation? Do you want a review of procedures? It’s helpful to have an outcome in mind before starting the complaints process, to ensure it’s worthwhile going through it.
  5. If you want to make a complaint, are you up to it at this time? As the saying goes, you cannot break concrete with a feather. Organisations can become defensive in the face of complaints. They can fight back. Is that something you want to deal with now? Weigh up the costs to you of doing so.
  6. If you want to make a complaint, can you achieve the end result you desire by some other means? For instance, you can report poor care or abuse – anonymously or using your name – though the Care Quality Commission. They can send an inspector to the hospital or ward to check on care. That might lead to improved care for others in future.
  7. If what you want is to know that you’re not alone, that there are others who share your difficult experiences, then one place to start is yesterday’s Care Quality Commission annual report on the care of patients under the Mental Health Act (voluntary and sectioned patients, and those under CTOs).
  8. Don’t focus exclusively on the negatives of your hospital experience but make sure you also do positive things. For instance, find out what support services are available in the area which play to your strengths or develop new ones – eg art, creativity, music.
  9. People you’ve met on ward can be a valuable support. They were there with you. They know what it was like. They’ll know what you mean when you talk about what happened. But also mix with people who nurture your sense of funClose quotes and make you smile.
  10. Consider returning to the ward and thanking the staff who helped you, then walking away. Doing this helped one of my ward buddies to draw a line under the experience and move on.

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These are my tips, off the cuff last night. But what advice would you give to someone who’s just been discharged from a psychiatric ward? What would you have wanted to know? Please comment below.

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  •  Storify story of tweets I sent together with responses of others – some great advice in there from other tweeps, so take a look
  • Some tips from Wardipedia (the resource for inpatient psychiatric staff) of things to think about when planning for discharge, but a useful to do list post-discharge too
  • Link to the Care Quality Commission‘s website where you can report poor care or abuse
  • The CQC’s most recent report into the care of patients under the Mental Health Act – voluntary and sectioned patients (and those under CTOs)

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Monitoring the Mental Health Act: the CQC’s annual report

30 Jan

Care Quality Commission logo

Today, the Care Quality Commission (CQC) published its annual review for 2011/2012 of its monitoring of the Mental Health Act. The Mental Health Act covers powers to detain people against their will in psychiatric hospitals, to treat people compulsorily outside hospital and the treatment of people on psychiatric wards voluntarily. CQC inspectors visit hospitals and other venues where the Mental Health Act applies in order to produce these annual reports.CQC infographic

The report covers such areas as:

  • What is the Mental Health Act and how is it used?
  • Are care plans focused on individual needs?
  • Are patients involved their care?
  • Are patients given the opportunity to give consent?
  • Is there a culture of control over patients?

Below are some useful web links from the CQC, mental health charities, the social care sector & the media, together with my Storify of tweets throughout the day using the hashtag #MHAreport, as a helpful one-stop-shop today. If you have any helpful links to add, please tweet me or comment below.

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From the Care Quality Commission:

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Comment from mental health charities:Rethink mental illness logo

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Comment from the social care sector:Community Care logo

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In the press:

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On radio:BBC Radio 5 Live logo

  • Radio 5 Live radio call in: overcrowding on mental health wards puts patients at risk of abuse & neglect, with Victoria Derbyshire (30 January)
  • BBC Radio Norfolk: Chris Goreham at breakfast radio phone-in. Staff are the treatment in mental health services yet 20% cuts planned in Norfolk & Suffolk (from 7 mins 30) (28 January)
  • BBC London: Drivetime with Eddie Nestor. The CQC’s report found overcrowding & containment was prioritised over care (from 16mins) (30 January)

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What does mental illness look like? Panorama & the Great Disability Scam

29 Jan

Panorama - The Great Disability Scam

Last night, BBC One’s Panorama presented a half hour documentary on the government’s Work Programme. This was introduced 18 months ago to help people who’ve been out of work for a long time get back into employment. The focus of the documentary was on how this programme was working for those with disabilities – the “hard to place” candidates. It exposed a culture of paid-by-results private providers cherry picking the easiest to help, parking those considered hard to help and insulting attitudes towards clients who who some staff labelled as LTBs – Lazy Thieving Bastards.

When I watched the programme earlier today, I was shocked by the interview with Mark Gould, diagnosed with anxiety and depression and out of work for several years.Panorama - The Great Disability Scam 3 The interviewer, Samantha Poling (pictured left) appeared to goad him into demonstrating behaviour that would make him “look like” he was mentally ill. It’s not an easy segment of the programme to watch.

That sparked a series of tweets, which I’ve collated here (links below), on the subject of what mental illness looks like, how it is perceived by the public and what that means in terms of access to welfare benefits when you’re unable to work – both in terms of the public’s perception of those who don’t “look” ill, and how Atos conducts Work Capability Assessments of people signed off by their own doctors as currently unfit to work. Panorama - The Great Disability Scam 2

I then commented on the fact that what you look like also forms a component of a psychiatric assessment. The Mental State (or Status) Examination includes observations such as whether you have a bizarre hairstyle or unnatural hair colour. I’ve written and tweeted on this before, in the blog post “You can’t dye your hair red”. I look at the contents of the MSE in more detail in these tweets.

It was interesting that the final segment of Panorama ended with an extended shot of a man in a wheelchair making his way slowly up a sloping street. That, it seems, is how people view disability.

Hope you find my tweets interesting. The best part, of course, is the responses of others. All the links are below.

If you have any comments on the post or the programme, please feel free to add them below. I’ll include new tweets that come in by updating the Storify story.

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Ward newbies: what advice would you give to a patient on a psychiatric ward for the first time?

25 Jan

Welcome to the ward

My stay on a psychiatric ward was a bit of a shocker. No one explained what was happening, why it was happening or what to expect. It seemed there were 1,000 unwritten rules for patients to abide by – or, if they were written down somewhere, they were not communicated to patients. And, as a result, we never knew what was expected or what we’d done wrong.

If only I had had someone to explain how things worked, my stay would have been much more therapeutic. If only staff had communicated with me rather than turning up mob-handed to wordlessly pin me down and inject me with unnamed drugs then disappear. If only staff had taken simple steps like telling me when mealtimes were, rather than waiting for me to spot the trolley being wheeled away from the dining area then saying I was too late to eat. Again. If only I’d been given the ward Welcome Pack on day 1. Rather than day 8.

I know there is great psychiatric inpatient care out there and, even where there isn’t, there are hints and tips that will help inpatients get a more positive experience of their stay on ward.

So, what would your advice be to someone staying on a psychiatric ward for the first time?First day

  • Are you a patient on ward now? What questions do you have? What advice so far has been helpful to you? Perhaps you wonder why your phone charger has been taken. Or why there’s someone watching you and making notes on a clipboard several times an hour. Or how to get hold of tampons and a toothbrush.
  • Have you been an inpatient on a mental health ward before? What would you have liked to know when you first arrived? What tips would you like to have been told? What advice do you have for someone who’s being treated on a psychiatric ward for the first time?
  • Are you a member of staff – a health care assistant, nurse, occupational therapist, cleaner, doctor, advocate? What advice would you give to patients on their first stay on a psychiatric ward that would help them understand the experience and get the most from it?
  • Are you an AMHP or police officer who takes people to psychiatric wards or places of safety? What would you like patients to know?

First day 2As TheSchizoPodcaster (@UKschizophrenic) tweeted last night:

“No one has explained anything yet. […] Do staff watch you all the time when you are sectioned? It is normal for this to happen? I don’t like it at all! Makes me angry!”

Student mental  health nurse Kathryn Finch (@Kat_Finch) tweeted back:

“It’s just to monitor how you are and if there’s improvement or not in how you are. They’re looking after you, try to stay calm. You’ll be on obs for at least the first 24 hours. It all depends on how you’re presenting and the risks they feel are there.”

Hopefully that advice was reassuring and useful. Please let me know – either in the comments below or on Twitter – so we can share the best tips for patients on psychiatric wards for the first time.

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  • My Storify story of tips received by Twitter so far … hopefully more to add!
  • The Code of Practice to the Mental Health Act – guidance to staff on their powers and duties, which can give patients an idea of what to expect
  • The Nice Guidelines on Service User Experience in Adult Mental Health – this is the experience NHS care providers are supposed to provide
  • The Wardipedia website’s tips on welcoming new patients

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Psychiatric wards and social media

18 Jan

Twitter silenced

Yesterday (17 January), there was a fascinating tweet chat about the use of social media on psychiatric inpatient wards, hosted by We Nurses (@WeNurses). Patients, friends, and family, interested people and a wide range of healthcare professionals discussed such topics as the use of social media by psychiatric inpatients and what restrictions, if any, should be placed on patients. It got me thinking about what had happened to me on ward when I was detained. Here’s my personal take on the issue.

When I entered the tweet chat, I recounted an example of being denied access to social media:

Once, when I was in my bedspace on ward, I set up my little camera to record a piece to post to facebook. At that moment, the rapid response team arrived, a crew of 6, to pin me down and inject me. They grabbed my camera and took it away. They said they didn’t want to be filmed restraining & injecting me as some people would use it as porn!!”

It was a shock at the time to have my property confiscated in that way. However, as I learned as time on ward passed, this was representative of the way the ward was managed.

It was only when I tweeted yesterday about this camera incident and then read others’ responses that I realised how bizarre a thing this for staff to have said. And how unjustified it had been to summarily confiscate my camera.

It would be interesting to know if the hospital had a policy around use of social media; or whether it was something they hadn’t thought of at the time and staff were just having to make it up on the hoof. I suspect the latter was the case and that patient access to social media was not considered important.

Patients in yesterdaSocial media graphic 1y’s tweet chat said they found access to social media to be a vital support and a lifeline to keeping in contact with friends and family. Like many of us, they used it in their daily lives before admission, and naturally wanted to continue doing so on ward. In fact, when on ward, keeping contact with the outside world felt more important.

Some healthcare professionals, on the other hand, expressed concern that patients who were vulnerable should not be allowed access to social media in case they breached confidentiality – for instance, by posting about other patients online. It was pointed out that, whilst healthcare professionals had a duty of confidentiality, patients did not. And that a patient should not be have their property confiscated or be deprived of access to social media unless specifically accessed as lacking capacity in that regard.

Quite right too. Just because you are on a psychiatric ward does not mean you suddenly lose all rights to be treated like an adult. Or at least it should not do so. If patients on surgical wards are encouraged to use their iPads and smart phones, why not those on psychiatric wards? As I said during the tweet chat:

It makes me angry that the staff on the ward I was detained thought they ruled the roost & could do whatever they want – eg take our phones. My phone was taken on arrival. I had no way to contact my workplace or friends. I just dropped off the face of the earth. When I got my phone back 4 days later, there were 140 emails – people trying to get in contract with me, wondering where I was.”

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Even prisoners locked up by the police get a phone call home don’t they? Or is that only in TV cop shows? It certainly didn’t apply to me when I was detained on ward. Removing my phone deprived me of my means of communication and isolated me from the outside world in a place which was already shut away from the world.

On ward, there was a big practical problem with accessing social media, or even the outside world. As I tweeted:
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“The only communication with the outside world was a payphone. There wasn’t even a computer on the ward where, let alone access to social media. On another ward, there was a computer. But it wasn’t connected to the internet. And a dongle wouldn’t work (couldn’t work out why). If all you have on ward is a payphone, & you have no money, the only number you can call is 999! And they won’t come out.”
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The isolating restrictions lead to patients becoming inventive to find ways round them. As I tweeted:
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“Luckily, once I got in contact with friends, I was able to smuggle in 2 other phones – then staff were just confiscating a spare one. I smuggled in a laptop, charger & dongle & used it behind the door so nurses couldn’t see. It was them & us environment.”

I also tweeted:

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“My phone was used as a reward: if I was a “good patient”, I got my phone; if I was a “bad patient, it was taken away. No notice. No receipt. Being treated like naughty children was par for the course where I was detained. Staff were our rulers, not our carers.”
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Rather than facilitating access to support through social media, confiscating property was one way some ward staff used to control behaviour. Unfortunately for patients, all the rules were unwritten and never explained to us, so it seemed arbitrary and unpredictable. The best policy was to keep you head down and try not to draw attention to yourself. A week into my detention, I was advised by my solicitor: “comply, cooperate and engage”. Prostrating yourself to staff, he explained, was the only way out and would make the time go easier.
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It seems to me that the overall approach to social media on the ward where I was detained could be summarised in the following tweet:
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In my experience, everything was done to control & silence patients. The answer to any question was always “no”. The cautious approach prevailed. Patients were not put first.”

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To find out about the broader discussion, I’d highly recommend reading the web links below.

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Here are web links to pages that form the background to the discussion:

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Twental Health Awards for the best in mental health tweeting

13 Jan

TWOM logo batshit crazy smileyThis morning, I was very pleased to learn that I’d won not just one but two Twental Health Awards for the best in mental health tweeting from the World of Mentalists blog. Woo hoo!

The lovely Twitter people had voted for me to win both the Patient Experience tweeter and Subversive tweeter categories. The last time I won two prizes at the same time was at school … which was some time ago! It certainly brought a smile to my face on a crisp sunny winter morning.

I tweet abTwo trophiesout patient experience a lot. I’m very interested in seeing improvements in psychiatric inpatient care –  so that staff love their jobs, the environment is therapeutic and patients recover. Based on my own experience, there’s still some way to go (to say the least).

But I also know that there is excellent mental health inpatient care out there, as well as people who really care about making improvements, and that gives me hope. What an honour that tweeps think my ramblings on patient experience are worthwhile.Subversive

The award for Subersive mental health tweeter left me pleased of course … but a tiny bit puzzled. I’m not quite sure what “subversive tweeter” means, but it sounds pretty cool! Especially for someone who can be quite timid and conservative. Looking at the dictionary definition, amongst other things a subversive is someone who intends to overthrow or undermine the establishment. It seems a lot to live up to!

The best thing about the Twental Health Awards is they contain a whole list of interesting tweeps to check out. They’ve won the hearts and minds (or at least the votes) of mental health tweeps, so they’re well worth a look.

You can see the full list of winners and runners up here, but here are my top 12:

  • Patient experience runner up @PatientOpinion
  • Campaigning winner @Rethink_ and runner up @TimeToChange
  • Informative winner @MarkOneinFour and runner up @MentalHealthCop
  • Helpful winner @VictoriaBetton
  • Nursing winner @nurse_w_glasses
  • Social work winner @Ermintrude2 and runner up @444BlackCat
  • Occupational Therapy winner @ClaireOT
  • Academic joint winners @Neuro_Skeptic and @MentalElf

Congratulations to all the winners and runners up, as well as the nominees. The awards have certainly given me some interesting and informative new tweeps to follow and I hope they do the same for you.

I can also recommend the World of Mentalists blog. As the website says:

“The World of Mentalists is a e-zine of news, commentary and blog digests in the arena of mental health. Our blog digests are known as This Week in Mentalists (TWIM) […] TWIM is a weekly digest of selected writings from blogs across the Madosphere, our affectionate name for the mental health blogosphere. […] A group of volunteer authors take it in turns to write the digests, which enables a wide base of mental health blogs to be reviewed. We cover blogs from professionals and patients alike.”

Well worth reading.

Finally, thank you to the World of Mentalists co-editior Zarathustra (@thus_spake_z) for organising the Twental Health Awards, and to all the lovely tweeps who voted for me.

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Twental Health Awards winner 2013

 

Update smallIn January 2014, I was bowled over to win the following awards in the 2013 World of Mentalists Twental Health Awards:

Twental Health Awards runner up 2014In.

Twental Health Awards winner 2013

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Mental health jargon buster: AMHPs & the Association of Major Holiday Parks

11 Jan

When you first come across the mental health field, there are lots of unfamiliar phrases and acronyms bandied around and you’re left wondering what they mean. If you’ve been in the mental health field for a while, you may be bursting with jargon you want others to know, so they can understand the system better. So – ta dah! – here are my acronym and jargon busters:Image

  • Jargon buster – What on earth does “sectioning” mean anyway? In this section, there are commonly used terms in mental health settings. Please take a look & let me know your favourite jargon so I can add it to the jargon buster. This section really needs help to get it in shape!
  • Acronym buster – An acronym is word formed from the initial letters of other words, such as radar and laser, but also mental health examples like CMHT and AMHP. Does AMHP really stand for the Association of Major Holiday Parks? What’s the Climate Policy Network got to do with CPNs? I  have lots of acronyms already, but I’m sure there are more so please take a look & send me your suggestions.
  • Alternative jargon buster – Here I’ve started a page of silly or ironic definitions, which does need bolstering as it’s light on material at present. Any clever, amusing or ironic definitions are welcome!

Please help me make it more useful by sending your jargon and acronyms – preferable together with their associated definitions!

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