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Just a person

22 Jan

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Just a person.

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I really need a good GP on Team Sectioned

18 May

Good GP lifeline

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After having been shafted twice in one week by the mental health team in my new area (see here and here), now it’s my new GP who’s let me down.

What next? It’s hard to know: for the past 5 years, I’ve had an excellent GP on Team Sectioned to help me manage my health day to day, despite what mental health services threw at me. It’s hard toknow where to turn now it’s been made clear the new GP just wants to bump me back to mental health services rather than have to deal with him himself.

I really need a good GP on Team Sectioned.

 

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Justification

12 Apr

 

It’s been a long day: first I had to explain mental illness to a psychiatrist; then I had to explain mental health cuts to my family. They know. Or they should.

That’s the thing with mental health: you’re always having to explain and justify it in a way you simply don’t have to with physical illness. No cancer doctor would see a new patient without making sure they’d read all the relevant documents first; not so in mental health. No-one would tell a relative that the reason they hadn’t got cancer treatment they needed was because they hadn’t been nice enough to the cancer clinic; not so in mental health. If I had cancer, I’d show up at the clinic and know the doctor would (or should!) have checked the slides and results first; not start from scratch. If I had cancer, family would say how awful it was that cutbacks meant I couldn’t get treatment; not that it must be because of something I’d said or done. It’s bad enough having mental health problems without also having to justify their existence – or your own worthiness to receive help.

Link here.

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What were you doing last 29th February

29 Feb

IMG_0650

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Some reflections.

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A total smoking ban for detained psychiatric patients stinks of coercion

7 Nov

 

Following on from my piece ‘Banned by the BMJ’, below is the article which was to be published in the British Medical Journal on 7th November as part of the ‘Head to Head’ series ahead of the Maudsley debate. I was to put the ‘no’ side of the debate. This piece was written in that context with the medical readership of the British Medical Journal in mind – an audience which had never heard of me and which may have been unfamiliar with many of the materials I reference – and to the BMJ’s word limit.

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I was detained under UK mental health law in 2011. I am a non-smoker.

Arguing that detained patients should be banned completely from smoking is, in essence, arguing that people with mental health problems should not be treated as full human beings but instead as a subset ripe for discrimination.

Everyone, including doctors, makes broad assumptions about psychiatric patients and our ability to make choices and interact with others. When we are locked up, the medical profession assumes it has the moral right to impose lifestyle changes. However, no-one is sectioned for being a smoker: we are sectioned because we’re considered a danger to ourselves or, more rarely, others. Being a smoker is not a healthcare emergency, and a mental health crisis is not the time to impose lifestyle changes.[1]

The ban on smoking inside psychiatric hospitals was introduced a decade ago, a time when people with mental health problems were side-lined far more. The indoor ban had clear aims: to create a safer working environment for staff and to respect the right of non-smoking patients to have a smoke-free surrogate home. The rights of smoking patients were protected by providing access to designated outdoor smoking areas. The aims of the outdoor ban are less clear. For example, the South London and Maudsley NHS Foundation Trust vaguely says that it aims to “create a healthier environment for everyone” and “reduce … inequality.” [2]

A complete ban prevents detained smokers without leave from smoking (or, rather, smoking overtly). It relies on the ward doors being locked. You do not increase patient “equality” by use of force. It is simply a case of “because we can”.

I am very much in favour of making psychiatric wards healthier and bringing about sustainable improvements to patients’ health. When I was fragile and detained, the ward environment was toxic. Food with no fibre, poor sleep hygiene measures, no access to exercise or fresh air, no therapy and nothing to do except sit round eating biscuits and drinking coffee – and avoid being assaulted. I was repeatedly medicated by force. I have since been diagnosed with post-traumatic stress disorder. [3] There was no smoking reduction or cessation help available. There is a great deal of scope for psychiatric hospitals to make wards healthier. [4] [5] [6]

If improving health were the reason for the ban, hospitals would make stopping smoking compulsory for staff too – 24 hours a day, even at home. That, of course won’t happen because staff wouldn’t stand for it. Unlike staff, though, patients can’t vote with their feet.

Behind all this lies a weight of history, law and medical practice which call on the entrenched notion that people with mental health problems need not be considered full human beings. The ability to use force runs through psychiatry like letters through a stick of rock. Coercion is the backbone of psychiatry. Patients experience psychiatric wards as coercive, not therapeutic.[7] [8] I was treated by force. I was locked in seclusion with no water, no food, no access to a toilet and no contact with the outside world, without even my glasses or shoes. Psychiatrists who visit wards do not truly know what goes on behind closed doors. Trusts must make wards better, not more coercive.

Where is the evidence that SLaM’s aims will be achieved by temporary enforced abstinence based on dominance, duress and fear? A ward stay is an opportunity to build therapeutic relationships with staff that may continue afterwards in the community and could lead to sustainable smoking reduction or even cessation and reduce healthcare inequalities. In psychiatry, unlike any other medical specialty, engagement with patients and persuasion are relegated to “nice to haves.” If patients can’t go elsewhere for medical advice because they are locked up and the law gives staff the right to use force, there’s no need to hone these skills.

Law and societal changes are moving towards reducing discrimination against people with mental health problems. [9] [10] [11] [12] With this ban, psychiatry is moving against the trend. This is morally indefensible and goes against patients’ rights to be at the centre of decisions about our care and treatment. Medicine shouldn’t be about imposing a doctor-dictated “fix” but helping patients to find to solutions that work in our lives.[13]

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References:

1. Smoking and psychiatric wards – Georgia Rambles blog, Dr Georgia Belam (30 September 2014)

2. Stoptober, supporting lifestyle change and preventing psychiatric patients from smoking – Sectioned UK blog, @Sectioned_ (14 October 2014)

3. Do you remember your first time? – Sectioned UK blog (16 November 2014)

4. A smoking ban for mental health workers in the workplace – Nurse With Glasses blog, @nurse_w_glasses (15 November 2013)

5. SmokingWardipedia, a World of Ward Knowledge, @WardipediaNews

6. How can psychiatric wards become better, healthier places? – Sectioned UK blog (26 October 2015)

7. On the ward – abuse in the mental health system – Schizoaffected3 blog, @schizoaffected (27 June 2015)

8. Coercion in a locked psychiatric ward: Perspectives of patients and staff. (I asked for helps as to how to cite this link properly)

9. Code of Practice to the Mental Health Act 1983Code of Practice to the Mental Health Act 1983 (January 2015) which, for the first time, includes a section on human rights (chapter 3).

10. “The UN Convention on the Rights of Persons with Disabilities (UNCRPD) is the first human rights treaty of the 21st Century. It reaffirms disabled people’s human rights and signals a further major step in disabled people’s journey to becoming full and equal citizens.” Equality & Human Rights Commission on the United Nations Convention on the Rights of People with Disabilities (Ratified by the UK in June 2009)

11. Mental Health (Discrimination) Act 2013Mental Health (Discrimination) Act 2013 (28 February 2013) This Act removed discriminatory mental health legislation affecting MPs, school governors, company directors and would-be jury members.

12. Mental health advocacy and human rights: your guideBritish Institute of Human Rights (2013)

13. What it’s really like to work on a mental health wardIndependent, Dr Sebastian Cook (26 October 2015) 12

 

 

 

140 characters

20 Oct

I’m a tweeter. I tweet a lot. I’m always banging on about one thing or another on twitter – usually myself or about some piece of news that’s randomly floated across my twitter feed and fired me up. There are lots of subjects I tweet about. Here are some of them, in no particular order

  • Section 136, the useful police power to take someone they find in suspected mental health crisis in a public place to somewhere safe for mental health assessment; but which, due to a variety of reasons including lack of NHS “places of safety” (136 suites), especially for children, can mean people end up in police cells for hours or even days. I want the use of police cells to be banned outright to force the NHS to take people the police suspect are in mental health crisis (there would rightly be an outcry if police were expected to take people they suspected had a broken leg to police cells to wait for a doctor to come and assess them) and to limit this power to 6 hours, which is always going to be enough time for the police to drive someone they suspect is in mental health crisis to a healthcare venue and  hand them over to medics.
  • What I’ve called “pill shaming”, which is the underlying anti-psychiatric medication message that pervades mainstream
    Pill shaming bingo card

    Pill shaming buzzword bingo card

    media stories about about mental health written by journalists, commentators and therapists. Varios facets include taking medication is a weakness; all mental distress is psychological and therefore psychological means should be used to overcome it; and so on. There are also th anti-psychiatric medication messages from people who might be called ‘anti-psychiatry’ or ‘critical psychiatry’. This seems largely based on fears from the US insurance-based healthcare system and diagnostic categories, as well as of a USpharmaceutical industry that can market direct to the public, and of course US Scientology. These can be scary and vocal groups who hound people who speak up against stigma and discrimination – the scaremongering and pill-shaming on the #MedicatedandMighty hashtag was a recent example. Stigma about mental health problems stops people from seeking the help they need and harms real people’s lives. Shaming people and making their personal medication choices into some sort of public moral matter does the same. Pill shaming must be challenged. I use the hashtag #pillshaming.

  • The “headclutcher”, those standard pictures trotted out by picture editors whenever there’s a mental health story and
    'Head clutcher' montags

    ‘Head clutcher’ montags

    which consist of someone in lonely isolation, typically with their head in their hands. I was tickled pink to be part of the development of Time to Change’s brilliant new (and still developing) free online library of pictures for use in mental health stories, Get the Picture (#GetThePicture). It’s a welcome development and something that can be pointed to whenever a head clutcher picture is used. I tweet on the hashtag #headclutcher.

  • Halloween, when all the stereotypes about people with mental health problems being unpredictable and potentially violent that float around in the general public and media, as well as scary representations of what psychiatric hospitals are like, suddenly turn into a seasonal industry, Ridiculing and demonising people with serious health conditions for fun and profit isn’t about ‘offence’, it’s about harm – the real harm that is caused to real people’s lives every day. It’s a pretty despicable practice, but one thing I do notice since the big #AsylumNo campaign challenging Thorpe Park’s scary mental patient horror maze Asylum 2 years ago is that now businesses respond more quickly, and generally favourably. The challenges still need to be made, but there seem to be fewer, as well as fewer people who then want to put their resources into defending this discrimination in this way. Good news – but no cause for complacency.
  • Human rights, which mental health folks sorely need, but which seem too often to be ignored entirely by human rights organisations – that is,  unless we fall into one of their existing favoured categories like people in detention. There’s enormous scope for use of human rights arguments for people with mental health problems, whether that’s use of force or voting rights or taking away people’s phones on inpatient wards or the new Code of Practice to the Mental Health Act, even if most human rights organisations aren’t interested. I’m a big fan of human rights.
  • Use of forced medication, restraint and seclusion in psychiatric wards and how in some places this has become routine, a first line of attack rather than a final line of defence. So far as I know, the only nationally-collated and reported statistics in mental health are the annual report on deaths and self-harm – purely physical measures in supposedly mental health care. I want use of any form of coercion to be nationally collated and reported annually so that pictures of best practice can emerge and so we can know where places of bad practice exist.
  • Stigma, stigma, stigma – the negative assumptions about people with mental health problems that come up again and again.
  • Use of terms related to mental illness as metaphor, as insult, to emphasise disapproval – “crazy”, “fruitloop”, “loon”. Use of mental health terms this way reinforces negative associations and harms real people.
  • The difficulties in accessing good, timely mental health care. My own experience if of toxic coercive ‘care’ in hospital followed by neglect in the community. Parking me on welfare benefits and meds without any other form of help and support has simply compounded problems which, with proper help and support, could and should have seen me back in work within months. It’s a false economy. Here I am, over four years out of hospital, still waiting for treatment and support which cutbacks to historically under-funded services make less likely to be forthcoming as every day passes.

I’m always talking about these subjects on twitter. It suits my short attention span and lack of concentration and focus and the fact I have no editor to help me polish my rambling thoughts into something more ordered and punchy. Sometimes (rarely) when I have time I save my twitter conversations in Storify. Sometimes (more rarely) when I have time I stick a link to a Storify story on this blog, with the intention (rarely achieved) of writing it up into a blog later. Sometimes I write a blog piece and (even more rarely) I’m able to publish it. But mostly, mostly my writing is on twitter. That’s where my work is. That’s where my scattered thoughts are. There are a lot of them. But they don’t often make it onto this blog.

I find twitter suits me. I don’t see the 140 characters as a limit but a discipline, a spur to be succinct, an enabler of freedom that only requires me to keep focus till the end of the sentence. And in any case there’s no rule that I can only tweet once: I treat a tweet as a sentence in a paragraph, often linking tweets to make that more explicit. There’s no reason complex thoughts and concepts can’t be expressed on twitter, even if, as in my case, there isn’t any planning beforehand.

I get invitations to write for this journal or that publisher, to take part in this debate or that consultation, but twitter’s where I’m most at home. Writing in more than 140 characters can be a struggle.

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A bowl of porridge waiting for Goldilocks – Another day, another assessment, and still no closer to receiving help

24 Jun

My thoughts from this evening, in the face of yet another assessment tomorrow – A bowl of porridge, waiting for Goldilocks

Thoughts from December 2012 – Mental health – I’m a bowl of porridge

And from November 2013 – Waiting for therapy: two and a half years on

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