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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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What you need is a nice little rest …

18 Jan
A Doctor Who yeti fliming on location in Snowdonia in 1967

A Doctor Who yeti fliming on location in Snowdonia in 1967

I remember years ago, when I was travelling round Australia with a friend who began to experience troubling mental health symptoms, going with her to a psychiatric clinic. I recall the kindly nurse, Sister Ooui, taking us to see her colleague, Dr Yeti. And I remember, as my friend went in to the assessment with Dr Yeti, him saying to her, in the most curious accent, “What you need is a nice little rest“. Remembering that phrase, with its comic pronunciation and enunciation, almost in the manner of a Sigmund Freud caricature, still makes me smile.

I’ve been thinking this week that I might need a nice little rest myself. What I’ve been preoccupied with recently is taking a permanent holiday but I thought, what the heck, why not go for a sunny little trip first? Why not walk away from everything and head for somewhere warmer? Perhaps, I’ve been thinking, I’ll feel renewed and reinvigorated and better able to face the challenges ahead (and I do face some tricky ones) after a nice little rest. Or perhaps I’ll just never come back, one way or the other.

Here are some thoughts on why I’ve been feeling this way. (It’s not happy reading.) I may write them up into a blog post at some point. Or I may, as seems to be the case at the moment, find I’m not able to. Tweets ‘R’ Us.

After Dr Yeti took my friend into his office, I recall waiting in the half-lit clinic which seemed to take up a whole floor several floors up in the large hospital building. After a while, I decided to stretch my legs. I wandered round the floor, which was divided into glass-walled rooms. All of a sudden, I noticed a room full of half-finished little baskets. A basket weaving workshop.

I was hit with a jolt of fear. I still remember being stopped in my tracks, standing there, at the sight of those baskets and what it might mean for my friend. Like many people, my only previous knowledge of psychiatric wards or clinics was what I’d seen on that historical US film Cuckoo’s Nest. For some reason, those baskets represented for me all that was worst about psychiatric care as portrayed in that dramatisation. I remember my eyes widening and my pace quickening as I completed the circuit of the floor and reached the exit to find it was … locked.

How had I not noticed? As Sister Yeti had brought us to see Dr Yeti, we’d been let in through double locked doors – a sort of airlock – by another nurse. The realisation rose up in me that there was my friend, being assessed by a psychiatrist, on a locked floor, with a basket weaving workshop.

I cannot tell you the fear I felt for my friend – and how relieved I was when she emerged, shortly afterwards and we were able to leave. We left quickly, my friend somewhat reassured (though not entirely convinced) that she’d just been experiencing the ancient after-effects of previous illicit drug-taking; and me, determined to ‘rescue’ her from a potentially horrible fate as quickly as possible without alarming her too much.

My friend flew back home to England shortly afterwards, but that’s another story. And I did end up on a locked psychiatric ward myself, many years later. But there were no basket weaving workshops.  And it wasn’t a ‘nice little rest’ by any means, which was what I really needed at the time. And that really is another story.

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Some reflections by a retired nurse on asylums old and new

8 Jan

Vintage psychiatric nurse novels 4

 

Earlier this evening, I had a fascinating conversation with a relative who’d trained as a learning disability nurse in the 1960s. She shared her memories as a nurse, visitor and  patient at Coldeast Mental Deficiency Colony, Littlemore Asylum, Digby, Langdon, Tone Vale and other hospitals.She had some interesting observations on the differences between the old asylums and modern psychiatric hospitals.  It was hard to tell if it was pensioner nostalgia or if things really were, on balance, much better in the old asylums. But that was her clear view.

She spoke about the old asylums, on the outskirts of town, each having a home farm where patients would work, have a purpose, be outside and contribute to the life of the institution. Of patients cleaning the wards, nurses helping too, of real hands-on nursing, of vocation, of the matron closely supervising the ward, of strict hygiene standards that meant, for instance, never sitting on a patient’s bed. Of food cooked on the wards, and nurses trained in cooking too in case there was no one else there to do it. Of the value of good routine, of having to boil the needles and bandages, of having to manage patients without drugs, of highly-trained staff.

She spoke of parents being persuaded to abandon their ‘mentally retarded’ children, to leave them behind and get on with their lives. Of how wrong that was and of how people could contribute so much to society if they had routine jobs. That seemed her one regret from those times.

She spoke of nurses needing to get at least two years’ experience before they could go on the wards with the more difficult patients. Of how patients would be matched to particular nurses, as some patients could be violent from time to time and you had to know how to relate to them. Of how the experienced staff, strict routine and a pride in their work created a secure and stable environment for patients and staff alike.

And she spoke of how things had started to ‘go down the pan’ in the 1970s when, for the first time, staff could use drugs to ‘keep patients quiet’. Of how younger staff were recruited, how routine slipped, how patients were left to do as they wanted, neglected and ‘drugged up to their eyeballs’. Of seeing the nurses’ pride in their job dwindling, of staff having affairs with each other, of hygiene standards slipping. She’d seen this in residential and nursing homes too: residents drugged to keep them quiet, one perhaps two staff on overnight, and little care.

And then she compared her time working in the old institutions with her recent experience of care in a brand new psychiatric hospital. She said, when she was a patient herself, the staff were ignorant about mental health, and some nurses were ‘really nasty’. Staff congregated in cliques or in the staff room. They didn’t mix – ie care for – patients. At night, nurses would be on their smart phones and would brush her away when she tried to talk to them. Of how the ward phone was kept locked in the nurses’ office, so patients couldn’t contact the outside world except with staff permission. (That’s a recipe for abuse behind closed doors, if ever there was one.)

She spoke of there being no facilities for exercise – and, when she went in, she was used to walking miles. How she got fatter & fatter. That there was a small internal courtyard but she wasn’t allowed in it in case she ‘climbed over the wall’ and escaped. How she was finally, after several weeks, allowed into the courtyard and would then walk round and round and round. How there was a swimming pool and gym elsewhere on the hospital site, but the nurses wouldn’t take her there. How she badly missed activity. How she came out of hospital far more unhealthy than when she went in, physically.

How nursing had become more technical, and nurses had more status now, but had lost the basic hands-on skills. How nurses nowadays had lower hygiene standards and no idea about cross-infection control. How hospitals needed highly-trained staff but how the staff who’d treated her didn’t have sufficient training. How nursing was just a job now, not a vocation.

It was fascinating listening to her experiences as staff, visitor and laterly patient starting in the 1960s and running right through to the present day, and the comparisons she made.

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Related links:

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Do you remember your first time?

16 Nov
My bedspace after one incidence of forced treatment by six people.

My bedspace after one incidence of forced treatment when I was restrained and injected on my bed by six people.

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Open quotes

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Patient: When you’re unwell you need care. And what I got was punishment. So when I was unwell I was extremely stressed and I was anxious. And I was taken by the police from my bedroom, unlawfully as it turned out, erm, from my bedroom into hospital where I was assaulted by patients and staff and I was held down and drugged repeatedly. And nobody came and spoke to me and said this is what’s happening, this is the diagnosis you have, we think you’re experiencing this and this drug will help you. Nobody came and spoke to me. And instead what they did was I would just be on my bed, reading a book, or not reading a book, couldn’t read, I would be on my bed, doing something, minding my own business, and I would turn around and there’d be a team of six people with rubber gloves who would hold me down [Starts to cry], pull my trousers down and drug me. They didn’t tell me what the drug was, they didn’t tell me what the effects were, they didn’t tell me what to expect, they didn’t tell me how long it would last, they didn’t tell me what it was for. Nothing. And they would finish and they would climb off my bed and they would walk away. And I wouldn’t know when they would come back. And they did that, erm, over and over and over and over again over a period of several days. I don’t know what they were giving me and I only found out after I left and saw my medical notes some of the drugs they were giving me. Sometimes they’d make a mistake and they’d give me drugs twice. Even though I went to the counter to get my drugs, take them voluntarily, they would still hold me down and give me other drugs. [In a strong voice, stops crying] So in that context I don’t think medication was helpful. The approach was unhelpful. What that approach does is it makes people afraid to ask for help.

Interviewer: It’s incredibly brutal. Can I go and get you a tissue?

Patient: No, no, I come prepared. I always have tissues with me.

Interviewer: Are you okay to …

Patient: Yeah, yeah, I’m fine.

Interviewer: And that was your first experience of medication as well?

Patient: Exactly. I don’t, I don’t take … Well, before this experience, I didn’t take anything. I didn’t take aspirin, I didn’t take paracetamol. I didn’t even drink coffee. You know, I didn’t take any drugs. I had a fear of drugs. I had a fear of needles. I have low blood pressure so if you give me a needle I’ll faint. So if you want to give me a needle I need to be lying down, I need to be calm and then … Whatever. So, Close quoteser. So I’m, you know … Now I know a lot about drugs. [laughs] I know a lot about drugs. Erm, before that, no, that was my, that was my first experience of drugs.

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Do you remember your first time? I do. I remember the first time I was treated by force. I remember it very well. The account above is an unedited segment from the transcript of my February 2012 interview with a researcher. In it, I briefly describe my first time being treated by force. That interview was also the first time I’d been able to speak to anyone in detail about what had actually been done to me in hospital. I knew it would be difficult and emotional, but I forced myself to take that first step in speaking out as part of a research project. It was six months after I’d been discharged from an acute inpatient psychiatric ward but, even so, I was floored for a week by the emotion of the interview.

Then, the following month, I found myself tweeting in bursts, over the course of several hours, about my experience of being treated by force. That was the first time I’d conjured up those images in detail and written them down for others to read. As I tweeted, I shook, cried, felt sick – but kept going. I couldn’t turn it into a full blog post but instead wrote a short one (Treated like an animal) linking to the collated tweets. I hadn’t read them back till just now: I couldn’t. That blog post and collated tweets have since been read thousands of times.

Three months later, in June, mental health charity Mind launched a campaign to end use of face-down restraint on psychiatric wards and that prompted me to write about forced medication again (Restraint – 10 ways it harms psychiatric patients). That post was read even more times than the first, though the toll in writing it was, thankfully, less on me. That was because, this time, I wasn’t conjuring up images of what it was like to be forcibly medicated in order to convey a picture to the public: it was a more considered overview of the topic. Almost a year after discharge, it seemed I’d begun to attain some distance from what was done to me.

Then, in November of that same year, the interview transcript arrived and a mental health charity asked me to write a piece for them about my experience of forced medication for their campaign. I forced myself, again and again, to sit down and bring to mind, in great detail, what it was like, so the reader could envisage themselves there, in the moment, being on the receiving end themselves. It took a heavy toll on me emotionally. Trying to edit it was toughest. Trying to take my raw recollections and shape them into something suitable for a mainstream audience without being overwhelmed by the intensity of the recollections. In the end, I couldn’t submit the written work. (It’s languished on my computer for 2 years, and I’ve only just looked at it. And I’ve only just glanced through the research interview transcript.) What that reinforced for me was that speaking or writing about forced treatment is a part of a healing process for me and something I cannot conjure up to order: it has to naturally arise from me when the time is right. I have a diagnosis of post-traumatic stress disorder as a result of what was done to me in hospital, and that’s just what I’ve got to work with.

It was another four months before I wrote about forced treatment again, in March this year (Forced medication: resistance is futile). I was able to write my first proper blog post describing one aspect of it. Compared to 12 months earlier, I noticed that tweeting about the topic (almost all my blog posts arise from tweets!) had been less overwhelmingly painful and that I’d been able to go back afterwards and edit the tweets into a blog post. It seemed as if I was naturally and instinctively keeping a distance from something that had injured me to the core, gradually circling round it and every now and then being able to touch on the subject. It seemed that, each time, after several months had passed, I was able to return to the subject with a little less terror.

So here I am, 8 months later, over 3 years since I was discharged from hospital, writing about forced treatment again. Circling the subject again, adding a little more depth, noticing that I can now approach it with a little less pain, with fewer flashbacks and  physical responses.

And what is new this time I’m writing about forced medication? It’s not a topic I’ve seen discussed much on social media or in the mainstream media. But then, it’s not something I’ve been able (emotionally) to investigate. However, I have been aware (very much at arm’s length) of campaigns to reduce the use of physical and chemical restraint and seclusion related to what’s called “challenging behaviour”. These include Mind’s campaign to end the use of face-down restraint and Mersey Care NHS Trust’s No Force First pilot to create coercion-free psychiatric inpatient wards. I’m also aware of research on conflict and containment in inpatient psychiatric settings which highlights that it’s staff, not patients, who influence how much of each there is likely to be. There may well be research and discussion on forced medication that’s passed me by, and please do let me know if you come across any.

For me, forced medication is very much a separate topic to use of force in situations of danger (to the patient themselves or others) or conflict (such as verbal abuse or violence). Forced medication is about a psychiatrist deciding on a course of treament (medication) and leaving ward staff to get on with administering that. It seems to me there are no controls over use of forced medication, other than the good will of staff and we already know that, when one group of people is given power over another, it may not always be a benevolent dictatorship. Even with the best of intentions, shortcuts can be taken – and using force to medicate someone is the ultimate shortcut – and staff can become aclimatised to routine use of force.

Here, then, are my recommendations for reducing the use of forced medication and thereby the harm it causes:

  1. Collation of national statistics on use of forced treatment – Make it compulsory to record each use of forced medication and to report it nationally. That way, national statistics and a picture of best practice can emerge as the basis for comparisons and for developing evidenced-based interventions. That will necessitate development of standard definitions of forced treatment, particularly since my medical notes record “No restraint employed” in relation to the first incident of forced medication. So, for instance, I would include (but in different categories), where use of force is mentioned to a patient in order to coerce them to take medication “voluntarily”; where the medication “hit squad” attends and stands near a patient to encourage them to take the medication “voluntarily”; and what was done to me (ie the full 6-person take-down). Make use of forced treatment a notifiable process (like a notifiable disease): it’s such an invasive process – state-sanctioned assault on someone at their most vulerable – that there cannot be a justification for treating it in such a slapdash way.
  2. Earning the right to use forced treatment – Make use of forced medication a right which must be earned, each and every time, by exhausting every alternative option beforehand. It may suit some ward staff to go straight for forced medication as a short-cut for ward management purposes. However, patients are people who exist beyond the locked ward and will do so once they are discharged, and forced treatment can have damaging effects in the medium and long term. Forced treatment can cast a long shadow. It should never be a first resort. The Code of Practice to the Mental Health Act sets out strict conditions for use of physical restraint but forced medication is nodded through under the guise of general principles. Clearly that approach is not working, meaning that detailed guidance on the prerequisites for the use of forced medication, in the same way as they are for restraint, are necessary.
  3. Debrief patients after each use of forced treatment – I’ve seen on documentaries (such as ITV’s recent series Broadmoor) that, when a patient is physically restrained and forcibly medicated, afterwards staff meet to discuss and debrief. All the while, the patient – who’s just been subjected to what, at the very least, could be described as a highly intense experience – is left in their bedroom or bed space alone to try to work through their responses. I recall time and again being left face down, underwear and trousers askew, in sheets covered in bootprints on a bed pushed out from the wall, empty antiseptic wipe packets on the floor. I’d be left shocked, terrorised, humiliated, confused, frightened, to clear up my bedspace, somehow get hold of clean sheets and somehow work out how to, well, be on the ward again. Patients need a debrief just as much as staff. Or perhaps more. After all, they are the vulnerable ones, there to be healed, not brutalised. Witness a patient’s pain. Be there to comfort them. Help them work their way through the experience.

I shouldn’t be left, over 3 years after discharge from hospital, still being triggered into flashbacks by obvious reminders like the photograph above or the word “restraint”, let alone such seemingly innocent stimuli as the flicker of fluorescent lights, the hum of air conditioning or traffic cops chasing a motorist on TV. Treatment is supposed to help patients. No patient should ever leave the ward more harmed than when they went in, too scared to ask for help in future and only referring to “that place” in hushed tones. Good psychiatric inpatient wards exist all over the country. Hopefully these three proposals are a helpful addition to dialogue around ridding the psychiatric system of forced medication by learning from those who use it least.

 

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Related web links:

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My previous posts on forced treatment (each containing links):

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On restraint, conflict and containment:

 

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