Archive | March, 2013

Treated like an animal

24 Mar

Project Nim 2

Today I shared some of my experiences of forced medication, restraint and seclusion from my recent (2011) stay on a psychiatric ward. Hopefully it will be my only stay on a psychiatric ward, because, as you’ll see from these tweets (see the links below), it wasn’t a healing experience. In fact, I’m undergoing treatment for post-traumatic stress disorder as a result of my hospital stay.

The photo above is taken from the documentary, Project Nim, that prompted me to start tweeting this morning. Nim Chimpsky was a chimpanzee taught to sign then sold for medical research. When I watch documentaries with captive animals, it reminds me how ward staff treated me like a creature to be observed, not a person. That’s what happened this morning.

I was tweeting a flood of consciousness, as the images came to my mind. I was sharing what was, for me, a very powerful experience. Holding those images in my mind, tweeting about them, wasn’t easy. I’d never tweeted in that much detail before. I felt sick when I sent these tweets. Bringing back these memories brought back some of the trauma. I was shaking. I was crying. It took me over an hour to send the first tweets.

I wasn’t engaging in a light hearted conversation, garnering opinions, having a chit chat. I wasn’t looking for banter and interaction. I just kept tweeting through the tears.

When I’d finished, I went back and checked the responses of others. I’ve included those in the Storify story as the voices of so many tweeps both mirror and challenge some of my experiences. There isn’t much interaction, because I was too upset.

At the end of the Storify story are comments from two tweeps who say they are psychiatric nurses (I don’t know them). Their comments, sadly, demonstrate one of the reasons my stay on psychiatric ward was so horrible: lack of empathy, lack of understanding and lack of compassion from ward staff. It was a reminder that, for some psychiatric staff, people’s emotional distress is just a day job.

I know there are more compassionate psychiatric staff out there, because I have seen excellent psychiatric care in practice. I’ve just not received it myself.

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When I came out of hospital, I thought I’d be focussing on getting better …

23 Mar

Way out sign

Here are some tweets about the bumpy road I’ve been on since being discharged from hospital. I thought I’d be focussing on getting better.I thought I’d be resting my mind and doing things to nurture myself mentally and physically. Instead, I’ve had to focus on lots of other things.

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How much difference can Time to Change make to how print journalists report mental illness?

19 Mar

Newspapers rolled up

On Monday 18th March, Time to Change held the latest in its series of media education events. This one focussed on print journalists, both tabloid and broadsheet. How much difference can this make to the quality of press reporting where there is a mental health aspect? Take a look at the links below – including the live blog and tweets under the hashtag #TTCmeet media – to see what you think.

At the start of the evening, a film was shown with some valuable advice about reporting mental illness. It’s well worth watching the short (7 mins) film for more fascinating insights put in a straighforward manner. These included the following advice on reporting breaking news stories:

  1. Stick to the facts and don’t speculate that mental health is a factor unless you know it to be 100% true
  2. Interview someone with a mental health problem, to give your audience a realistic view of what it’s like to live with one
  3. Put as much of the subject’s voice in the piece as possible. Use quotes. Let them them tell the story.
  4. Include contextualising facts, since homicides by people with mental health problems are incredibly rare
  5. Seek comment and context by a mental health charity like Mind or Rethink Mental Illness, or a professional body like the Royal College of Psychiatrists
  6. Avoid stereotypes, clichés & sensationalism
  7. Mind your language: misusing mental health diagnoses in the media can be offensive, and can cause misunderstanding
Good advice which, if followed by print journalists, would make stories with a mental health aspect far more relateable to their readers – a quarter of whom, after all, experience mental health problems in any one year – as well as less sensationalist and alarmist. However, as Ian Mayes, Guardian associate editor and former readers’ editor, said in 2008:
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“We stand in relation to some aspects of mental health – particularly in the way we refer to mental illness, in the language that we use and misuse – roughly where we stood in relation to race 20 or 30 years ago. The least we can do is to accept that language used about mental illness is important and reflect this in the practice of our trade.”
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The current state of reporting means there are opportunities available for journalists. What do I mean?
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  • The fact there are so many misconceptions around mental illness means there’s an abundance of great stories waiting to be told.
  • There’s a revolution happening in mental health, which gives the best journalists the chance to make their names in an evolving subject.
The best journalists will break out of the old cliches and start reporting mental health in the new way. Hopefully some of the journalists present at the Time to Change event will be inspired to take on board at least some of the messages receive during the evening and put them into practice in their writing. Of course, the worst journalists will continue reporting mental illness in the same tired old way, using the three bog-standard storylines, namely:
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  1. When a heinous crime is committed, journalists speculate that the perpetrator must have a mental illness. This is sloppy journalism of course, based around an incorrect assumption that “normal” people can’t do terrible things. The opposite is born out by the facts.
  2. When a crime is committed by someone who in the past had a mental health diagnosis or contact with mental health services or treatment for a mental health problem, whether recent or in the far distant past, it’s assumed that mental illness caused that crime. Again, sloppy journalism which confuses correlation and cause.
  3. When a crime is committed by someone who’s been diagnosed or treated for mental illness, this is extrapolated to portray all people with mental illness as potentially dangerous. Again, sloppy journalism which is not born out by the facts.

If you’re not familiar with Time to Change or their event that night, here’s some information, followed by all the relevant links. As the Time to Change  website says:

“Time to Change is an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness. These two charities decided to work together, combining their knowledge, skills and expertise, in the biggest attempt yet in England to end the discrimination that surrounds mental health.”

When I first started reading around mental health, I didn’t understand what the word “stigma” meant. And it gets repeated a lot. So I came up with the phrase “negative assumptions” instead, which is pretty straightforward. And discrimination is acting on those negative assumptions.

The Time to Change event aimed to provide:

“a space for journalists to learn more about mental health problems by meeting people with direct experience and hearing their stories, along with some top speakers from the industry.”

It was hosted by Time to Change ambassador Alistair Campbell (writer, communicator and formerly Tony Blair’s press secretary) with celebrity panelists including Denise Welch (presenter of ITV’s Loose Women and former Coronation Street actor), Fiona Phillips (TV presenter and Daily Mirror columnist) and Guardian journalist Mary O’Hara. Media volunteers included Helen Hutchings from Tea and Talking and mental health campaigners Jonathan Benjamin and Erica Camus.

It also aimed to enable journalists to:

  • challenge myths and misconceptions around mental health
  • find out the truth behind the headlines that link mental health with violence
  • join in the debate by asking the panel of experts a question
  • be inspired by the stories of people with experience of mental health problems
  • network with other industry professionals over a glass of wine (the main hook for some attendees no doubt!)

Real stories about mental illness are so much more fascinating than the standard speculation & hyperbole. Hopefully we’ll start to see a gradual improvement in the quality of reporting in Britain’s tabloids and broadsheets when the subject of mental illness comes up.

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Psychiatry, religion & Pope Francis

13 Mar

Pope Francis 13 MAR 2013 (2)

This evening, the new pope, Pope Francis, stepped out onto the balcony overlooking crowds in St Peter’s Square in Rome, having just been elected by the cardinals’ conclave. I can’t claim to know what this means for Catholics, as I am not one. However, I imagine this is a sensitive time for Catholics: on the one hand, it must be a gloriously wonderful time to have a new head of the church; yet on the other it may well be an unsettling time full of hope and possibilities. Perhaps even some of the fundamental certainties people have used as a framework around which they have built their lives will change, with the new pope reportedly viewed as more of a reformer than the previous two. Inevitably there will be change.

Within moments of Pope Francis stepping onto the balcony, this glib comment by London psychiatrist Dr Chris Hilton popped up on twitter:

Extraordinary watching these old men faffing around, dressing up, in the cold, blessing “the entire world” and talking to invisible friend”

I responded:

I wonder if any of your patients who follow your tweets will feel they should keep quiet about their beliefs now.”

Dr Chris replied:

Perhaps – but I doubt it. I’m very open, including w pts, that I find religious faith a peculiar choice – but benefit to some.”

And then me:

“That’s what some patients may find concerning about mentioning faith to a psychiatrist: that it/they are considered peculiar.”

Take a look at this Storify story of our tweets – where we discuss science, religion, belief, choice, proof, male gynaecologists … and ballroom dancing!

There was one key point I didn’t develop in my discussion with Dr Hilton, though it was the reason I responded to his tweet. I couldn’t find the way to frame it within the context of a fast moving tweet conversation. The topic? The hidden coercion in psychiatry the extent of which is, I believe, largely unrecognised by your average jobbing psychiatrist; the treatment by psychiatry of religious belief as a possible symptom of mental illness; and the impact these two have on patients’ willingness to discuss religious beliefs – which can be a core part of someone’s personality, a driving force in their lives, and sometimes the cause of deep distress – with their psychiatrist. (See what I mean about trying to fit that into a tweet?)

I’m sure most psychiatrists view themselves as doctors and healers, as people using science and compassion to bring relief to the sick and suffering. In that context, it can perhaps be hard to see some of the nuances of what it’s like to be on the other side of the desk – to see the power imbalance.

On the other side of the desk, there’s always the power imbalance. There’s the usual power imbalance that occurs in every doctor/patient relationship: you want or need something from the doctor and they are the ones who can provide it to you – or not. The doctor is the one who says yes or no. The doctor is the one into whose sphere of expertise you have entered.

Added to that, in psychiatry, there is the fact that a psychiatrist can – if they believe you to be a danger to yourself or others – detain you against your will. A psychiatrist can – regardless of whether or not you have mental capacity – treat you against your will. That is the backdrop to psychiatry. That is a fact that’s always there. Unlike consulting other doctors, you can’t just go elsewhere if you don’t like what they say. You can be stopped. You can be detained. You can be treated by force. I have to say, that power imbalance is always at the back of my mind. I don’t think it’s there in the minds of psychiatrists – hence I term it hidden coercion.  Religion and psychiatry - Psychiatric Times

And, as psychiatrist Dr Simon Dein wrote in 2010:

“Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has been viewed to result in emotional instability.”

Or, as Dr Hilton tweeted, “peculiar”.

Religious belief can also be viewed as a symptom of mental disorder. When I was on ward, I found many people took strength from faith and religious beliefs. Perhaps it’s something to do with finding yourself at the bottom of the heap with nowhere else to turn. Talking about faith or religion, though, is going to be one of those things that gets noted down on the clipboard: “talking about religion – query delusional?”

Tonight’s coverage on Channel 4 of the new pope’s first speech demonstrated another point from my conversation with Dr Hilton: the effects of lack of understanding of the subject matter. Channel 4 had shipped their star reporter, Jon Snow, over to the Vatican. Snow reported the election of the new pope as if it were the appointment of a new chief executive taking over a large and ailing corporation. His commentary even talked over Pope Francis. How different would the reporting have been if a Catholic or someone with religious belief had delivered it instead? How much more insight would we have gained from someone with a better understanding?

A more subtle point, then, is that lack of knowledge around faith and religious belief can lead to a lack of understanding of the patient. If your psychiatrist views your religious beliefs as akin to a passion for ballroom dancing, will they really be able to understand how troubled you are by a religious matter, without seeing it as a symptom of mental illness? Would you feel able to raise it with your psychiatrist knowing he viewed religious belief as “peculiar”?

In the context of coercion, in the context of religious belief being seen as a possible symptom of mental illness or at best akin to believing in Father Christmas, how willing are psychiatric patients to raise such matters with their psychiatrists?  As I said to Dr Hilton at the start of our twitter conversation:

I wonder if any of your patients who follow your tweets will feel they should keep quiet about their beliefs now.”

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Nicola Edgington – the IPCC & the police response

5 Mar

IPCC logo

Edgington - Sally Hodkin

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On Monday 4th March, Nicola Edgington was sentenced in court for the murder of Sally Hodkin (top) and the attempted murder of Kerry Clark (below left) in October 2011. At the same time, the Independent Police Complaints Commission (IPCC) published its report into the police contact with Edgington.

Edgington - Kerry Clark

Below I have collated links to all the relevant reports & media stories I’ve come across in the past couple of days. I’ve also included a link to Storify stories of my tweets on the topic, as well as a debate with Inspector Michael Brown on expanding the role of police in relation to people experiencing mental distress.

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Issues which arose from the case and media coverage include:

  • Whether there is a link between a borderline personality disorder diagnosis and violence (the jury convicted Edgington of murder, finding her criminally responsible not mentally ill)
  • Whether there is a link between a schizophrenia diagnosis and violence (the defence had argued that Edgington was experiencing psychotic symptoms at the time of the attacks)
  • What role mental healthcare providers can play in predicting and preventing rare but heinous violent crimes being committed by people with whom they have had contact or are currently treating

No report has been published into Edgington’s social or mental health care (Edgington was under the care of Oxleas mental health trust at the relevant time) and none are expected for some time (possibly years). Little or no comment has been made so far by the major mental health charities. These factors – combined with others such as a media appetite for the drama of violent crime, conflict and apportioning blame; and the spectre of the dangerous “mental patient” – resulted in media coverage focused heavily on the potential culpability of the police. For instance, the following issues have been raised:

  • Whether police should play an increased role in the management of people with mental health problems
  • Whether all those with whom police come in contact who they suspect are experiencing mental distress should be PNC checked
  • Whether police powers to arrest people in a public place if they think they are in a mental health crisis – under s136 of the Mental Health Act 1983 – should be extended to private dwellings

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This is another extremely rare but tragic violent attack where the link between mental illness, violence and crime  seems reinforced in the minds of the public and media. I’ve written a number of times on this topic. Not because I have an interest in violent crime. Far from it. But it seems the only time mental illness is reported in the media is when a dramatic heinous crime is committed. If the stigma and discrimination against people experiencing mental distress or with a history of mental illness are to be reduced, the myths linking mental illness with unpredictable and violent behaviour must continue to be challenged.

Take a look at the links below and see what you think.

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My Storify stories

  • Nicola Edgington, the police & the IPCC (4th March) – First there are my tweets; then a debate with Insp Michael Brown (@MentalHealthCop) on the topic of extending police powers in relation to people experiencing mental distress; then comments from other tweeps.
  • Mental health and violent crime (5th March) – Just because someone who commits a heinous crime once had a mental health diagnosis or treatment does NOT make it a “mental health murder”.

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Police response

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Law

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Mental health & social care commentators

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Media coverage (4th March unless otherwise stated)

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