Tag Archives: discrimination

Mental health and human rights: Why aren’t human rights groups interested in mental health folks?

17 Mar

Healthcare is a human right.

Why aren’t human rights groups interested in the human rights of people with mental health problems, especially when there’s so much for them to get their teeth into? Is it just the same ol’ ignorance and prejudice?

When a human rights story is in the news, you’ll see me banging on about it on twitter and asking where the coverage of the human rights of mental health folks is. I’ll ask why human rights organisations don’t seem interested in this group of people, who can in many cases genuinely be classed as some of society’s most marginalised and vulnerable: sometimes locked up behind closed doors, often out of sight, with little credibilty and subject to state powers to impose forced treatment on people even when they have mental cacpacity. Why don’t we hear about that all day and all night from human rights organisations?

Lancet Psychiatry human rights

This silence from human rights groups is puzzling when mental health issues are receiving more publicity and prominence and where there is so very much for human rights groups to get their teeth into. That leads me to ask all sorts of questions. For instance:

  • The Convention on the Rights of Persons with Disabilities

I’ll ask why human rights organisations don’t seem to be interested in a brand new developing area of rights, namely those under the Convention on the Rights of Persons with Disabilities (CRPD) which has been described as a paradigm shift in disability rights. Don’t they want to get in on the action on this hot new area, rather than sticking doggedly with familiar human rights aspects? Are human rights organisations bound to stay in the familiar niches they’ve carved for themselves, or will they look further afield?

  • United Nations investigation into violations of the rights of disabled people

I’ll ask whether human rights organisation are looking at the fact that the UK is the very first country to be investigated by the United Nations for violations of the human rights of disabled people under the CRPD. Doesn’t that sound like an interesting and important human rights topic?

  • Human rights section to the new Code of Practice to the Mental Health Act

I’ll ask what human rights organisations are doing about the brand new section at the front of the new Code of Practice to the Mental Health Act on … human rights. Isn’t it significant – something of note, something to promite – that the new CoP has at its very beginning a brand new section on human rights? I think so. Is it only me?

  • Care Quality Commission’s new human rights-based approach

Are human rights organisations interested in the human rights-based approach all Care Quality Commission inspectors are to take to inspecting hospitals and other healthcare facilities?

  • Restrictions placed on psychiatric detainees

Do they take an interest in the recent NICE guidance that all NHS hospitals should prevent smoking on their premises, even in the case of detained patients without leave and are there no human rights implications of that blanket policy (spoiler: yes)? And what of the blanket policies of some hospitals to remove patient phones or prohibit them from accessing social media whilst on ward?

  • Routine use of force medication

Forced medication is used on some psychiatric wards as a matter of routine, as a first resort rather than a last resort, even when people have the mental capacity to make medication decisions for themselves. Aren’t the human rights of people subjected to forced medication in psychiatric detention of interest to human rights groups?

  • Voting rights of psychiatric patients

Voting rights are meat and drink for human rights organisations. So why no campaigns or even interest in the voting righs of people with mental health problems?

Mia Vee human rights votin

Why is it? Why don’t human rights groups take an interest in those topics when there’s so much for them to get their teeth into and when mental health is such a hot topic at the moment, often in the news?

Mental health folks don’t seem to get a mention – unless we fall into an existing favoured category such as prisoners, death row inmates or deaths in custody

When I see human rights organisations talking about human rights, I notice time and again that, whilst all sorts of different niche groups and causes are trumpeted, mental health folks just don’t seem to get a mention – unless, that is, we fall into an existing favoured category, such as people in detention in prison or on death row, or deaths in custody. Why is that? And what – given important developments in human rights and current social and political changes giving mental health much more prominence – can be done to get violations of the human rights of mental health folks more of a focus and the enforcement of the human rights of mental health folks made into more of a priority?

Why am I told mental health folks are “too speciailst” when all sorts of other specialist groups are chosen for human rights campaigns?

I’ve tried to follow up with various human rights organisations to find out about the work they do on the human rights of mental health folks. I’ve tried. However, I’ve typically been ignored or, when I do get a response, I’m fobbed off with the line that people with mental health problems are a niche group that’s “too specialised” for them. This doesn’t seem to accord with campaigns run in respect of other “niche groups”, such as refugees, prisoners, LGBT people, trades union members, military personnel. Not at all. And it goes against the premise that human rights are most needed by those people who are most vulnerable – and people with mental health problems can be in very vulnerable postions. It’s niche groups who most need human rights.

Justice Hub human rightsEurorights human rightsHuman rights nicheWhy the seeming lack of interest from human rights organisations? Why are people with mental health problems being marginalised, even by those organisations and individuals who purport to champion society’s most marginalised and vulnerable people? Why – at a time of expanding human rights provisions for people with disabilities including mental health problems, at a time of increasing promimence for mental health issues growth, development and prominence of issues surrounding people with mental health problems – why are human rights organisations not swinging into action and grasping the opportunties available to do good, high profile work and make a real difference to the lives of mental health folks?

Human rights stigma discrimination

Could it be that human rights organisations are simply prey to the same ol’ same ol’ stigma and discrimination that blights the lives of mental health folks every day? Is it a case of priorities and people managing mental health problems just aren’t as important as other groups – even though we make up such a large minority of the population? I’m still trying to find an answer.

I’ll keep on trying. The human rights of people managing mental health conditions are too important to overlook.

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Some human rights organisations
BIHR mental health advocacy guide

BIHR course for mental health workers FEB 2015

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Some human rights laws and conventions

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Some twitter musings on human rights for mental health folks:

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Choice and cuts

24 Feb

Human choice cuts

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My place at the mental health day centre has been cancelled due to council cuts so, instead, I’ve been referred to my GP’s social prescribing service. In other words, I’ll get to meet once with someone who’ll go through a list of activities that are available to the general public in my local area, and then I’ll be left to get on with it. Social prescribing is a really good idea and will provide a valuable service for many people I’m sure. It’s something that hopefully will spread to more areas. But that’s hardly equivalent to a specialist day centre for people diagnosed with serious mental health problems. Not in any way.

As @444blackcat said:

“[Since the centre closed,] a lot [of former attendees] are now sitting at home. At the centre, they felt at ease and didn’t have to explain anything. I get the idea that people should access community resources, but there’s a huge advantage in a safe space where people didn’t stare. We had people who sometimes just wanted to sit in company, but that wasn’t [deemed to be] an intervention promoting recovery.(My punctuation.)
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As @ManchesterMind said:

“So many mental health projects (garden, bread making, football etc) [are] underpinned by giving people somewhere to just ‘be’.”

The problem with withdrawing access to a day centre is that lots of people will just sit at home, stare at the walls & quietly deteriorate. People whose lives had meaning, hope, connection and richness through being able to meet and share and do in a safe space – curtailed. Instead of being able to gradually meet people, gain confidence, get involved, take on volunteer roles, even prepare for or start college, or move into part- of even full-time employment, as some did – zero. Instead of having a place to go whether you’re well or unwell (sometimes very unwell) to do activities or just be – a closed door.

There’s far more to good mental health than welfare benefits, medication and talking therapies – but that’s all we’re left with, now the doors of the day centre are shut to us.  Having that nurturing space to meet and be was a haven from which we could branch out and do other things – and we did! But not any more. What’ll happen now to people who could’ve had art exhibitions, run craft stalls, performed in bands – all arising from the day centre. Nothing. The day centre wasn’t a bunker from which we never emerged: it was a springboard, a platform to reach out into the mainstream. Now gone. The day centre was a hub where we could meet all sorts of people who wouldn’t judge or flinch when we described tough experiences. Now what?

There were so many fantastic activities on offer, but the day centre is so much more than that. There were any number of options to try, and you could try as many as you liked. You could gradually explore different options and maybe try things you hadn’t done since childhood or take up something completely new. It was a chance to explore in a world where your diagnosis or mental health struggles didn’t need to play any part. You could be good at something, rather than focussing on all the things you were bad at or couldn’t do any more or would never have.

Adult education courses and activities in the commuity have their place, but they are in no way equivalent to what’s offered by the day centre. Not at all. Courses, and the space in which they happen, are the vehicle through which all sorts of other valuable interactions and activities take place. Designated learning outcomes for courses delivered in chunks over terms entirely miss the point of all the other things the day centre does. There’s far more to good mental health than going on courses – especially if you’re managing a long-term condition when consistent attendance may not be possible due to periods of ill-health and when attending a course with the general public is in no way the support needed when poorly. Social anxiety, generalised anxiety disorder, depression – hardly conditions that make it easy to organise, motivate & attend courses with the general public. Offering as an alternative stand-alone courses with the general public or people seen in primary care entirely misses the point.

I’m just going to choose* this rather tasty banana bread into slices. *cut

Ouch! I just chose* my finger on this piece of paper. *cut

I love the choice* of that dress on you; it’s so flattering. *cut

Many like to choose from a menu range of options, so we’re giving you more choice*. *cuts

Oh, did I say “choice”? I meant CUTS you fools. Bwa ha ha ha ha!

Seriously, do these corporate bods think we’ve completely lost our senses? Oh, yes, of course, they do: mental patients.

If there’s a service such as a day centre that you value, better prepare for the possibility that the same “choice” might happen to you. Prepare now and you’ll be ready to fight back and challenge the decision. It’s harder to regain access than to stop it being taken away. Apart from rumours, we didn’t know. We weren’t warned. We weren’t asked. And now it’s gone. Don’t let yours be taken away without a fight.

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The politics of mental health: Taskforces and commissions, manifestos and madwash

19 Jan

Manifesto for Better Mental Health

Mind Manifesto at a glanceMental health waiting times

Your vote has value. People with an interest in mental health – whether people with lived experience or carers or professionals – are viewed as one of the many niche markets that political parties will be trying to tempt in the run up to the 2015 general election with the aim of encouraging us to vote for them. So what tempting tidbits have been offered so far?

  • October 2012 – The opposition Labour party launched its mental health taskforce. This was an exciting development, as I wrote at the time. Over two years later, however, and it seems less of a priority. The taskforce was due to report in spring 2014, so shadow mental health minister Luciana Berger told me in April. However, in June I was emailed by the Labour party to say it would be summer, with the report published online giving the public the opportunity to comment and help formulate policy. No report. Other deadlines have passed and still no report.  Apparently it is due to report later today. I don’t know whether that means the public consultation aspect has been dropped.
  • January 2014 – Nick Clegg MP, Liberal Democrat deputy prime minster, launched the coalition government’s mental health action plan (Closing the gap: priorities for essential change in mental health). This sets out the top 25 areas for immediate action to ensure equality for mental health and increase access to the best possible support and treatment. (Here’s Mind on the action plan.)
  • August 2014 – Norman Lamb MP, Liberal Democrat minister for care announced he was establishing a task force into children’s mental health services. We know some of the answers to the questions already. Do we really need to gather more data? Without announcing a plan of action at the same time as announcing a taskforce, announcing a taskforce simply kicks the need to take action into the long grass.
  • September 2014 – Prospective Labour party candidate for London mayor David Lammy MP announced he was launching a London mental health commission. (I haven’t seen any details yet.)
  • October 2014Nick Clegg made mental health a central part of his speech to the Liberal Democrat annual conference. The first ever mental health waiting time standards were announced.
  • November 2014Nick Clegg announces a cross-government taskforce on mental health services. It is to examine how to improve mental health crisis care and services for young people, and the large numbers of people with severe mental health problems who end up in police cells and prisons. The taskforce will be chaired by Nick Clegg and include senior ministers from across the coalition, such as Theresa May (Home Office), Jeremy Hunt (Health) and Vince Cable (Business).

(For earlier government policy documents, see here.)

Are these developments substantial? Or are they merely what I have termed “madwash”?

I coined the term “madwash” (inspired by the environmental campaigning term “greenwash”) to describe the window dressing done by an organisation (company, government or other group) to try to give the appearance that mental health matters. Madwash is where an organisation makes a show of sympathising with or of prioritising mental health issues, but this is used to hide a festering nest of ignorance and prejudice, or inactivity around mental health issues. This thin veneer of “madwash” is used draw attention away from lack of meaningful activity, or to distract from practices or policies which, overall, are detrimental to mental health – or which operate in a manner which is opposite to the mental health initiatives announced. Madwash may involve actively making misleading or unsubstantiated claims.

Here are some more musings on mental health taskforces.

On the other hand, we have had several manifestos launched in advance of the election. These include:

Summaries of these manifestos are set out below. What impact will these manifestos have? And what results will the various taskforces and commissions bring? Watch this space to see if they are any more than mere ‘mad wash’.

And finally, everyone loves a taskforce!

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Mind’s manifesto

Take action for better mental health – Our manifesto for the General Election 2015 (June 2014)

What the next government must do in its first 100 days

1. Commit to reducing mental health stigma and discrimination and to supporting the Time to Change campaign to sustain its work.

2. Mandate that the NHS in England offer a full range of evidence based psychological therapies to everyone who needs them within 28 days of requesting a referral.

What the next government must do in its first year

3. Commit to ensuring everybody has safe and speedy access to quality crisis care 24 hours a day, 7 days a week, whatever the circumstances in which they first need help, regardless of where they turn to first.

4. Transform the support offered to people who are out of work because of their mental health and create a system that really helps people to overcome the barriers they face.

What the next government must achieve by the end of its five year term

5. Increase the overall NHS mental health budget by a minimum of 10 per cent in real terms.

6. Develop, consult on, fund and implement a national strategy for wellbeing and resilience.

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The Mental Health Policy Group

Joint manifesto by the Centre for Mental Health, Mental Health Foundation, Mental Health Network, Mind, Rethink Mental Illness and the Royal College of Psychiatrists

A manifesto for better mental health – The Mental Health Policy Group – General Election 2015 (August 2014)

13 commitments are asked for, grouped under the following 6 headings:

  1. Fair funding for mental health – Commit to real terms increases in funding for mental health services for both adults and children in each year of the next Parliament.
  2. Give children a good start in life – Ensure all women have access to mental health support during and after pregnancy. Raise awareness of mental health by putting it on the national curriculum and training teachers and school nurses. Invest in parenting programmes across England.
  3. Improve physical health care for people with mental health problems – Ensure Government targets for smoking reduction apply equally to people with mental health problems. Create a national target to stop people with mental illness dying early, due to preventable physical health problems.
  4. Improve the lives of people with mental health problems – Continue to fund the Time to Change anti stigma campaign. Offer integrated health and employment support to people with mental health conditions who are out of work.
  5. Better access to mental health services – Introduce maximum waiting times for mental health care and support, including psychological therapies. Commit to continued improvements in mental health crisis care, including liaison psychiatry services in all hospitals. Continue to fund liaison and diversion mental health services, working with police and the courts.

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Royal College of Psychiatrists manifesto

Making parity a reality – Six asks for the next government to improve the nation’s mental health (September 2014)

The ‘six asks’ are:

  1. Tackle the mental health beds crisis – Everyone who requires a mental health bed should be able to access one in their local NHS Trust area, unless they need specialist care and treatment.  If specialist care is required, then this should be provided within a reasonable distance of where the patient lives.
  2. Introduce maximum waiting times – No-one should wait longer than 18 weeks to receive treatment for a mental health problem, if the treatment has been recommended by NICE guidelines and the patient’s doctor.
  3. Improve crisis care – Everyone experiencing a mental health crisis, including children and young people, should have safe and speedy access to quality care, 24 hours a day, 7 days a week.  The use of police cells as ‘places of safety’ for children should be eliminated by 2016, and by the end of the next Parliament occur only in exceptional circumstances for adults.
  4. Improve liaison psychiatry services – Every acute hospital should have a liaison psychiatry service which is available seven days a week, for at least 12 hours per day.  This service should be available to patients across all ages. Emergency referrals should be seen within one hour, and urgent referrals within five working hours.
  5. Introduce a minimum unit price for alcohol – A minimum price for alcohol of 50p per unit should be introduced. This will reduce the physical, psychological and social harm associated with problem drinking, and will only have a negligible impact on those who drink in moderation.
  6. Invest in parenting programmes – There should be national investment in evidence-based parenting programmes, in order to improve the life chances of children and the well-being of families.

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The King’s Fund

Transforming mental health – A plan of action for London (September 2014)

The plan, though developed for London, is said to be applicable to the whole country. The key steps identified as being necessary are:
  1. Developing a process of collaborative commissioning to facilitate change
  2. Driving change through collective systems leadership
  3. Ensuring that service users and clinicians are at the core of provision
  4. Using contracting systems to support integration
  5. Building a public health approach to mental wellbeing
  6. Developing pan-London solutions to increase impact
  7. Improving the availability of meaningful outcomes data
  8. Utilising London’s academic infrastructure to disseminate best practice
  9. Creating a new narrative for mental health

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Alliance of Mental Health Research Funders

Prioritising mental health researc – General election manifesto (October 2014)

The Alliance of Mental Health Research Funders is a national coalition of charities working to further research into mental health. They call on all UK political parties to:
  1. Champion mental health research funding in General Election manifestos – The government can redress the current imbalance in publicly funded health research, influence other funders and lead the way in tackling the stigma that hinders mental health research funding.
  2. Seek to remove current blockages to mental health research – We cannot improve mental health and wellbeing without better quality data and information. To unblock research we need better access to high quality data about mental and physical health, improved coordination of data sharing between government departments (for example between Health, Justice and Education) and more mental health knowledge among the wider public service workforce.
  3. Give priority to research that will make the biggest difference to people’s lives – The biggest gaps include research into children’s mental health, prevention and promotion of mental wellbeing and the links between mental and physical health. Setting research priorities should begin with the knowledge andexperience of people with mental health problems.

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Labour MP David Lammy’s London mental health task force

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Labour’s mental health task force:

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How’s your day been? A Day in the Life

15 Nov

How are you cartoon

How’s your day been? That’s a question you’ve probably asked many times, and been asked a fair few too. It’s part of the normal everyday engagement between people that oils the social wheels. Often it’s not a genuine enquiry in the sense that a detailed response is not expected: instead, it’s a baton being passed, with you expected to pass it back and say, “Fine thanks. How about you?” That “fine” can mask a lot of days that aren’t fine, whether better or worse, but we’re all expected to join in the general cheerleading, pretending to be “fine” too.

For people struggling with mental health problems or managing a long-term mental health condition, how our day has been is probably a bit of a mystery to the general public. This can be a source of assumptions, stereotypes and prejudice, whether that’s the “lazy faker” of depression who just needs to take themselves in hand and go for a brisk walk; or the “dangerous maniac” of schizophrenia who should be monitored and contained for public safety. These prejudices and stereotypes can feed into self-stigma that brings about a sense of isolation.

Our daily lives are also likely to be a bit of a mystery to the professionals who provide our care, whether that’s a therapist an hour a week, 20 minutes with a psychiatrist every 3 months or 10 minutes with a GP every few weeks. What it’s actually like to live with a mental health problem can be pretty uncharted territory unless you’re doing it yourself or living with someone who is. There’s so much more to good mental health, and to good mental health services and support, than the NHS, drugs and talking treatments. People just like me are out there, living our lives, quietly getting on with things day to day, and there’s a new project that aims to capture that reality. It’s called A Day in the Life.Beatles A Day in the Life yellow

A Day in the Life (the mental health project, not the Beatles song) asks people with mental health problems to share what their day has been like – and what has helped or made the day worse – on four set days over a year.

The project aims to shine a light on the everyday lives of people with mental health problems to raise awareness and to help the general public better gain a better understanding: to challenge myths and bust some stigma. It also aims to get people who may never have blogged before writing about how their day went – and perhaps then finding an online voice they never knew they had. There’s guidance on how beginner bloggers can start writing.

But another objective – and the reason the project is funded by Public Health England – is to help policy-makers understand what makes a difference – good or bad – to the lives of people with mental health problems. Although not a scientific study, the project will provide an insight to help influence policy decisions on services provided in future. The online snapshot diaries will also help to highlight emerging themes and suggest future areas for investigation.

I’ve signed up to take part in the project and have already posted my entry for the first day, Friday 7th November. The remaining three days will be in winter, spring and summer 2015.

Follow the project on twitter using hashtag #DayInTheLifeMH and scroll down to find out more about the project and how you can take part.

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Below is my entry for 7th November, which will appear on the Day in the Life website when everyone’s contributions so far – totalling around 370 – go live on Monday 17th.

Please note: I chose to speak very candidly about what I experienced that day, so please read with care if you’ve been affected by suicide, suicidal thoughts or depression – or simply scroll down to the bottom where you’ll find useful links.

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I’m on Twitter – a lot! So, as usual, after turning off my alarm, the first thing I did this morning was to check what tweeps I follow had posted, to catch up on news in the mental health world. Then, returning to bed with breakfast and my pet, as it was the last day to sign up to #ADayintheLifeMH, I sent out a series of tweets to encourage as many people as possible to sign up. The more sign-ups, the more varied a picture of living with mental health problems it will provide.

Next, I checked what had been happening on the #SamaritansRadar hashtag. Samaritans Radar was launched by the Samaritans in October and, ironically, had had a disastrous impact on the Twitter mental health community. Numerous tweeps had contacted the Samaritans by Twitter, email, phone and letter to beg them to take the secret automated surveillance and alert app offline. Experts in various different professions had written about legal and ethical concerns. Mental health experts by experience had blogged about their pain and distress. There was an online petition, an investigation by the Information Commission and even a group proposing legal action against the Samaritans. I was involved in the campaign to have the app taken offline till it could be made safe.

On checking Twitter, it was clear that the outcry was continuing. And the Samaritans had tweeted their followers about A Day in The Life Mental Health!

Next, I tried to work on a blog post about the app. The powerful psychiatric medications I take have an impact on motivation, focus and concentration and, since I’d started taking them, I couldn’t quite connect the dots. It was cripplingly frustrating and is one reason I spend so much time on Twitter: 140 characters just about matches my attention span! Being sedated so your higher functions no longer work properly makes it hard to manage a home and get everyday tasks done, let alone get anywhere near organising your own healthcare in a system that relies on people being pushy. Being a sedated blob doesn’t get you very far and is one reason I haven’t been able to get proper treatment for myself over 3 years since I was discharged from hospital. Here I am, still parked on welfare benefits.

I struggled for a while to try to gather together my thoughts on Radar down on paper, but was unable to do so. I tried to make an overdue phone call, but couldn’t. So I had lunch, then caught the bus to a medical appointment.

Later, as I walked back through a tree-lined park on a beautiful autumn afternoon listening to the radio, I heard a trailer for this evening’s BBC Radio 4 Any Questions saying that one of the topics the panel would discuss was the Assisted Dying Bill. This caused my own “suicide radar” to go off.

Ever since getting notice of eviction from my home so my landlord could sell it (2 months’ notice, out of the blue, after over a decade), I’d been tipped into a deep, debilitating depression. At times, I was utterly tortured by suicidal thoughts. My home had been my security and stability and now I was losing that. And the awful Radar app had thrown a spotlight on suicide, meaning my Twitter feed was full of intellectual suicide talk.

Suicide was being discussed as a fascinating concept, rather than what it was to me and many other mental health folks using twitter: a very real mental pain we were struggling with at that very moment. At times, it seems as if there’s a part of my mind monitoring everything just in case it might be useful in some way in despatching myself – my own “suicide radar”. That’s why the Assisted Suicide Bill caught my attention. Being able to die with dignity alongside friends and family – rather than experience years of unalleviated suffering or go for a secret and uncertain DIY method –  was an option I’d like to have available too.

I’ve had thoughts about suicide in all sorts of places, with all sorts of people and whilst doing all sorts of things. Sometimes I’ll be plagued by all-consuming thoughts of suicide; other times they’d be a background hum, like a reflex response to every turn of events, a mental tic; and sometimes, as today, there’d be calm planning. These thoughts were going through my mind as I walked through the warm autumn afternoon, kicking up piles of fallen leaves. No-one looking at me would have known.

Back home, I checked Twitter again. At 6pm, the Samaritans tweeted to say that, after 10 days of uproar, the Radar app had been suspended! It was a begrudging statement which did not acknowledge the distress the app had caused, and the so-called apology was an example of how not to apologise. But, nevertheless, the announcement meant that mental health folks could sleep easier in their beds over the weekend. I continue to feel uneasy as to what “suspension” means in practice. Whilst no-one doubts the app was developed with good intensions, the way it was imposed on everyone had damaged trust in the Samaritans.

I spent the evening debating with people on Twitter about Samaritans Radar, listening to Any Questions, then retiring to bed to read Everyday Medical Ethics and Law. It didn’t use to be my sort of book at all, but that was before I was unlawfully arrested, sectioned, held in seclusion and treated by force. Nowadays, chapters on patient autonomy and choice and how they are glibly brushed aside for mental health patients concern me deeply.Close quotes

Sadly, lack of concentration scuppered my attempts to read the book – so it was back to Twitter.

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Stoptober, supporting lifestyle change and preventing detained patients from smoking

14 Oct

   SLAM smoke free

This month is “Stoptober”, the annual campaign encouraging smokers to stop smoking for 28 days during the month of October. It’s an opportunity I heartily recommend people take, if they wish: choosing to stop smoking for 28 days gives you an increased chance of stopping smoking for good, like I did, a decade or so ago. And that would be a good thing, for all sorts of reasons.

On 1st October, South London and Maudsley NHS Trust (SLaM) went “smoke free”. This means that, across its entire site, no-one – staff, patient, visitor – will be permitted to smoke. The ban covers all of its hospital sites, namely the Maudsley Hospital in Southwark, Lambeth Hospital, Bethlem Royal Hospital in Bromley and the Ladywell Unit at Lewisham Hospital. SLaM, whether on ward or – and this is new – outdoors. And here’s the issue I’m highlighting today: that includes a ban on detained patients who do not have leave smoking. People struggling to cope with a mental health crisis and sectioned will now have have no opportunity to go and have a cigarette designated outdoor areas in the grounds, the ‘garden’ of their temporary surrogate home.

I mention SLaM simply because they are one of the only NHS trusts to introduce a total ban and because I’ve chatted with them on twitter about their policy. It’s funny what I randomly stumble across on twitter.

Stoptober SLAM

Stoptober SectionedStoptober SLAM (2)Stoptober Late Fines

I asked SLaM whether it would be requiring staff to be ‘smoke free’ 24 hours a day; or whether detained patients would be permitted to smoke outside of office hours; after all, if a policy is about health, and both staff and patients have the lungs, the same policy should apply.

Stoptober SLAM (3)Stoptober stillicides

“[S]upport[ing] people who smoke to make healthy lifestyle choces and have access to treatment for nicotene dependency” is something I encourage and does not depend on imposing a total ban. However, while staff were to be encouraged to stop smoking, patients were to be forced to do so. I asked whether, to help make wards healthier, would detained patients have access to exercise, healthy food, fresh air? Would harmful practices like forced medication be banned. No response.

Stoptober Sectioned (3)Stoptober Ermintrude

Extending the ban on smoking on NHS premises is NHS policy. The National Institute for Health and Care Excellence (NICE) issued new guidelines last year, updating those from 2008 which banned smoking indoors. SLaM matron Mary Yates contributed to the development of NICE’s national smokefree guidelines which is perhaps why SLaM is one of the early adopters. But what of psychiataric detainees? Somehow, along the way, the rights of mental health patients to make choices about our own lives seem to have been bulldozed by the familiar patronising undertones that infect the whole of mental health services.

“But smoking is harmful! We have a duty to our patients! We must do everything we can to encourage and support patients to make healthy lifestyle choices!” I agree with all of that. However, smoking is not a medical or mental health emergency: it is a bad habit, an unhealthy habit, a poor lifestyle choice, one to be discouraged – and one where people need every opportunity and support to stop or cut down if they choose. Patients with mental health problems die decades before the general population from conditions such as lung cancer, heart disease and stroke. It’s a serious problem and one which needs to be addressed, urgently, diligently and intensely.

Stoptober Pipsterish

However, no one is sectioned for nicotine addiction. No one is in immediate danger of death from being a cigarette smoker. Being a smoker is not a medical emergency. The presenting problem is a mental health crisis. A mental health crisis is not the time to impose lifestyle changes. To seek to impose lifestyle changes at that time is, as Mark Brown put it, “awesome mission creep”.

What is the reason for extending the ban on smoking into the grounds of psychiatric hospitals? The indoors ban introduced a decade ago had clear aims, but what are the aims of the outdoor ban? SLaM says in its page on it’s new ‘smoke free’ policy that its aims are “[t]o create a healthier environment for everyone] and to “reduce … inequality”. Are those aims – vague as they seem – achieved by imposing temporary abstinence on psychiatric detainees? Is there evidence that enforced temporary abstinence provides sustained behaviour change?

Stoptober Sectioned (2)

For instance, do detainees prevented from smoking whilst on ward remain abstinent on discharge – or, say, 6 months post-discharge? We don’t know because, as the NICE guidelines acknowldge, there are huge gaps in the evidence. This is an evidence-free zone. It is a policy based on a toxic combination of public health moralising about smoking and paternalism about people with mental health problems.

And it is a dangerous policy too. Not only is there no evidence that enforced temporary abstinence improves health outcomes post-discharge, there is clear evidence that, in the short-term, bans are potentially dangerous for patients. This is because smoking impacts on the levels of medication patients require. Most inpatient stays are short-term – two to three weeks on average – and, for a short-term stay, stopping smoking suddenly can mean a dangerous rise in in the levels of medication in the bloodstream that will need to be monitored (which does not happen). And, on discharge, any levels of medication established during detention will be impacted on the (likely) resumption of smoking on release.

Smoking is just about the worst thing anyone can do to their body apart from, say, sticking their head into a giant mincer & pressing the on-button. I am a non-smoker and wish everyoe else was too. I wish smoking had never been invented. It breaks my heart when friends smoke (and makes me turn up my nose and back away from the smell); I want them to be around, not die prematurely early from smoking-related disease. That’s why I want all the help in the world made available to people with mental health problems who wish to stop smoking. But I don’t for one second think that unevidenced temporary enforced abstinence should be any part of the solution. There’s a difference between saying “Smoking is harmful” (which clearly it is, and has a disproportionately large impact on people with mental health problems) and saying “This new policy is the most best & effective way to reduce that harm” – which clearly it isn’t, because there’s no evidence base.

Stoptober pesserine

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  • Here I’ll put links to all the patient consultations I come across *taps fingers* *checks watch* *waits*

Secrets from the modern day asylum

20 Aug
Actor Ray Winstone in episode 1 of ITV's new series Secrets from the Asylum

Actor Ray Winstone in episode 1 of ITV’s new series Secrets from the Asylum

 

This evening, episode 1 of ITV’s new family history series Secrets from the Asylum aired. It delves into the murky world of dreaded Victorian lunatic asylums through the eyes of celebrities who make emotional discoveries about relatives incarcerated in the distant past. With a doom-laden commentory and spooky music, viewers were invited to be shocked that people with senile dementia were condemned as lunatics, to gasp at disturbing treatments like chaining or hosing with cold water (“treatments which now seem crazy themselves”) and to shake their heads at “sickening attitudes towards the mentally ill”.

I’ve often said that one of life’s cruel ironies is that, whilst nowadays we condemn with obvious horror what was done in the name of mental health care in the past, we don’t recognise the horror of some of what is being done now, today, in modern psychiatric hospitals. What is going on now – behind locked doors, out of sight, to the country’s most vulnerable people, sometimes by the most brutal of “carers” – goes unremarked. I’ve said before that, in the future, we will look back at some of today’s practice of mental health care with horror, just as we now look back  in horror on the lunatic asylum. How long will it be before we do that? And why can’t the general public see it now?

Because it is happening now. This minute, as I write this piece, as you read it, horrors of commission and omission, of things done and not done, are taking place in the name of mental health care. And yet the damage they cause – the lack of job satisfaction of good staff, the lives half-lived through inadequate treatment and support and even the lives cut short – go largely unremarked. It’s a secret from the modern day asylum, because no one is looking.

Only this morning, government minister Norman Lamb announced he was establishing a new mental health task force to look at the state of children and young people’s mental health care. Some of the papers ran the story. There was an excellent feature on the morning news. But, by lunchtime, it seems it had all been forgotten. What – if not hundreds of sick children detained in police cells for want of treatment of hospital beds, of sick children bussed from hospital to hospital, hundreds of miles from their parents – what could make the wider public see the utter inhumanity of the way in which people with mental health problems are treated today? If even sick children won’t make the public – and hence politicians – sit up and reach into their back pockes for some serious money and some serious thought how those in need of help can best be supported, then what hope is there, really for things to improve in mental health services in this country?

So today, the day that Norman Lamb announced that children’s mental health services were “in the dark ages”, ITV launches a new two-part series, Secrets from the Asylum. We gawp at the outdated practices of the old lunatic asylums. We gasp at the people locked away without proper treatment. We shake our heads in judgment at the barbaric treatments in days gone by.

And yet, it wasn’t until very recently that there were any effective treatments for mental distress and mental illness. Those running the old Victorian asylums had, in a way, an excuse. They did the best they could. In the words of the title to episode 1 , those trying to help people with mental health problems in the past had the “best intentions”. Nowadays, we don’t have that excuse.

Nowadays, there are treatments, help and support that can make a real difference to people’s lives. And yet … they are not employed. And, worst still, sometimes – in fact, far too often – practices that we know – through logic, humanity and research studies – are actively harmful to people are employed instead.

Why is that? It’s hard to explain. In large part it will be down to the resources allocated to NHS mental health care: with few staff on wards and paperwork to complete, there isn’t enough time to spend building therapeutic alliances with patients. There isn’t enough time to show the care and compassion, kindness and support so vital to helping people in mental health crisis. With wards that are badly designed and ill-equipped (as was the one on which I was detained), staff will be struggling from the outset.

But, also, it seems that there is something to do with the training of mental health professionals that creates a barrier, preventing staff from recognising human suffering. On ward, it seemed to me that the priority of even well-meaning staff was ward management. “Order and control took precedence over care,” said the commetator in episode 1: it seems that nothing has changed.

I speak as someone who was so traumatised by my experience of inpatient psychiatric care that I came out with the gift of PTSD (post-traumatic stress injury). Tonight’s episode refers to people in the past – before the advent of Victorian asylums – being chained, caged and beaten: I have been “chained” by means of the chemical cosh, a cocktail of drugs intended to quell me; I have been “caged” by being held in seclusion; I have been “beaten” by staff who assaulted me (in the criminal sense) and many more who physically restrained me, six at a time, for forced treatment and by patients from whom the staff did not protect me. Based on my experience of modern day inpatient psychiatric care, it doesn’t seem to me that there’s any obvious reason for us to pick over the bones of history and gloat about how far we’ve come.

And how is it such practices are allowed to continue, without a public outcry? Several powerful reasons. One is that there is still an enormous stigma to mental health problems. There is a shame to having been treated in a psychiatric hospital. It’s not something people speak out about readily. Another reason is that psychiatric patients lack almost any credibility. In an NHS system which we know is hard for even staff to raise concerns about and which has, it seems, a culture of closing ranks and covering up, what hope for patients’ complaints to be dealt with? And of course these things go on behind closed doors, out of sight. No one sees apart from those incarcerated in the strange world of the psychiatric ward, whether they are staff or patients.

It isn’t just me who thinks that some of what goes on on inpatient psychiatric wards is wrong. Here are a couple of examples from this week:

  • Here is a conversation that took place a couple of days ago when a psychiatrist, a psychiatric nurse and I discussed our experiences of physical restraint and bullying on mental health wards. The strong impression is that what I experienced is the norm, rather than the exception, which is heartbreaking.
  • Here is a post by Skye, the Secret Schizophrenic, about an upsetting incident that happened to her on ward recently. It illustrates how what happens on wards now can confound humanity and logic.
  • Here are some tweets on the hashtag #secretsfromtheasylum comparing modern day practices with those in Victorian asylums and questioning whether it really all is in the past.

I do know people who have had excellent experiences of psychiatric inpatient care that has transformed their lives for the better. It gives me hope. It should be the norm. Especially now that we there are effective treatments available to help people recover from  or manage mental health problems.

What is the hook? What is it that makes people want to watch programmes like Secrets from the Asylum but not care about the way mental health patients of today are neglected and mistreated? And how can some aspect of that be harnessed to our benefit, so that the lessons of the past are learned? Those are questions I wish I had the answer to but don’t.

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“He’s a psycho” – Professor Adrian Furnham on the importance of cleansing the workplace of undesirables

19 Jun
Harry Enfield as Kevin the Teenager (PA)

Harry Enfield as Kevin the Teenager (PA)

 

Have you seen this? Rachel Hobbs of mental health charity Rethink Mental Illness asked me this afternoon. She was referring to the charity’s response to a piece in the Sunday Times headed “I’m sorry, he’s not a differently gifted worker – he’s a psycho”. I’d just arrived home so hadn’t but, sadly, I had already seen the piece that prompted the rebuttal – and been shocked to the core.

The Sunday Times piece to which Rethink had issued a response advises employers of the necessity of screening job applicants and employees to weed out undesirable ones. The author writes:

“There are three important questions. The first is how you spot these people at selection so you can reject them … The second is, given that they have already been appointed, how to manage them … Sometimes it is a matter of damage limitation …  The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.”

Putting aside for one moment the reference to “maladaptive personalities” and the telltale use of “these people” (a clue that we’re about to experience a group of people being made “other”), this all seems fair enough. After all, what employer wants to end up lumbered with rogues or duffers, or people who are simply not suited to the post being filled?

In any recruitment process, whether to fill a new role or replace a departing employee, some sort of selection process is inevitable. Indeed it is welcome, since it will give both prospective employer and employee the opportunity to see whether post and candidate are a good fit. I’ve read plenty of books and done courses including interview techniques, networking, career development and workplace psychology. I’ve undertaken interviews and assessments. It’s an interesting field and one that can bear fruit for employers and employees.

So what’s the problem? The problem is that the premise of the piece is – regardless of the role to be filled – people fall into two categories: they are either desirable or undesirable in the workplace, and the “unemployables” are to be hunted down and excluded. “These people” are to be avoided at all costs. “These people” have “maladaptive personalities”.

“These people”, according to the piece, fall into 5 categories, namely people who exhibit what is classified as antagonism,  disinhibition (Harry Enfield’s Kevin the Teenager – pictured above – is the illustration the author provides for this category), detachment, negative affect or psychoticism (bear with me – this isn’t made up). Each, as described in the piece, has a clear link to mental health problems.

Reading the piece, I had several strong immediate reactions – to the extent I sat down and wrote out my thoughts (then, unhelpfully, lost the piece of paper; perhaps there should be a sixth category of “unemployables”, the abstent-minded).

First, I took away the message that (based on the characteristics of the people described in the 5 categories, some of which I share) I was most definitely not wanted in the workplace. I was not wanted in the workplace and there were armies of workplace psychologists devising tests designed to make jolly sure I wouldn’t be able to sneak in undetected.

It felt as if, when I finally feel able to re-enter the competitive employment market and, were I ever to make it through to a job selection process, there would be a head to head battle. On one side would be the selectors, trying to expose my “maladaptive personality”; and, on the other, me, desperately trying to keep my deficiencies and undesirable characteristics under wraps. Then, in the unlikely event I was able to pull the wool over their eyes and win on that occasion, I would always be at risk of exposure and therefore dismissal. And, even if I started a job mentally healthy but then (for whatever reason – even if it was because too much work was loaded onto me at work, causing unnecessary stress) I became unwell, my employer wouldn’t seek to support me, a valuable employee, through that illness – but instead try to get me out.

I was reminded of the recent disappointment of prospective cabin crew Megan Cox. Notoriously, her offer of a dream job with Emirates Air was withdrawn when she disclosed a past history of depressive illness. In Megan’s case, it was clear that the prospective employer had based their decision on generalisations about depressive illness rather than the individual under consideration. Perhaps they were administering a standardised workplace psychological assessment which sought to weed out the undesirables. Megan Cox was deemed undesirable by Emirates Air. Lucky escape for them that they were able to spot her during the recruitment process. The piece made clear that, similarly, I would be weeded out.

Second, the contents made me want to send the piece to all those people involved in making decisions about the social security support of people who, like me, are managing disabilities, to show them the high barriers we have in getting into employment. Only today, it was reported that Employment and Support Allowance and the Work Programme were costing more than the predecessor welfare benefit Income Support and were getting fewer disabled people back into work. Is it any wonder that a system based around the notion that disabled people are out of work because of a lack of motivation (and incentives – or, rather, penalties) to seek work will fail when the actual barrier is the attitudes of employers – fed by pieces such as these – towards people with disabilities?

Third, having assumed at first glance that the piece was written by a generalist journalist to meet a deadline, I was gobsmacked to find it was written by a professor of psychology. A renowned academic – Professor Adrian Furnham – of a renowned institution – University College London – was the author. It simply did not compute.

So then  I did a little reading around the subject on the internet. I discovered that Furnham hadn’t made up terms like “dark traits” or “psychoticism”. No: they were legitimate. These terms came from last year’s new version of the US psychiatric manual (DSM5) and from workplace psychology (for the past couple of years).  The meat of the piece seemed to be almost a cut and paste from ideas that would be familiar to people who’d studied the field: nothing new, surprising or out of the ordinary. This wasn’t some rogue piece by a lazy journalist in a hurry: it reflected current thinking in (US) workplace psychology. That was hard to swallow.

However, on reading the piece again, there were some flaws (whether of the author or in the editing) which meant it was skewed to paint a worse picture than US workplace psychology actually seems to do. Thank goodness. For instance, the professor conflates the DSM5’s “maladaptive personality traits” (undesirable characteristics) with “maladaptive personalities” (undesirable people). To confuse a trait with a person is a big leap – and a damaging one for the people on the receiving end of the “undesirables” label. Furnham also conflates mental illness (with references to “disorders” and “pathology”) with personality disorders (he lists the 3 DSM5 clusters) and personality traits. Thankfully, therefore, the piece isn’t an accurate representation of the current state of play. In fact, it’s a bit of a mess.

In addition – as is common with fear-mongering pieces – the particular damage “these people” could do in the workplace is left vague; but the fact that they will cause damage is made plain.

The trouble is, however, that anyone not familiar with the nuances in the field (and that might be your average Sunday Times reader) would easily be expected to come away with the very clear message that people with mental health problems – yes, people like me – should be excluded from the workplace at all costs. And that is a damaging message.

Which leads me to my fourth thought on the topic: I wonder (and I don’t know) whether the piece might breach disability discrimination laws.

Furnham argues for keeping “these people” – people with “maladaptive personalities”, people whose symptoms which, as described, fall within mental health diagnoses such as anxiety, depression and schizophrenia – out of the workplace. My understanding is that, where a condition impacts on someone’s health for 12 months or longer, that counts as a disability and is protected by law. In other words, discriminating against someone in these circumstances counts as disability discrimination.

I’m trying hard to see how advising employers on how to avoid employing or get rid of people with disabilities is any different to advising employers to not employ black people or gay people or women. Whether or not it amounts to disability discrimination, it’s clear it is not good to advocate discrimination in the workplace.

Rethink Mental Illness has been in contact with the author and are hoping to have a piece – written with other mental health charities – published in this weekend’s Sunday Times. Rethink reports that Furnham and colleagues were surprised at the reaction to the piece and believe it has been misinterpreted. It seems to me there is a clear opportunity for a dialogue, and for largely commercially-focused workplace psychologists to gain a greater understanding of the crossover between their work and mental illness and the role they can play in the negative stereotypes.

Until employers are willing to consider job candidates or existing employees as individuals rather than categories based on assumption, the prejudices and assumptions of employers will impact on people managing mental health problems like a form of modern straight jacket.

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Update smallThe Sunday Times published a letter from Rethink Mental Illness and others on Sunday 22nd; and the following day Furnham wrote to explain, apologise and request that the article be withdrawn. Constructive engagement and a willingness to engage produced a positive result.

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Here’s the full text of the piece written by Adrian Furnham and published in the Sunday Times on 17th June under the heading “I’m sorry, he’s not a differently gifted worker – he’s a psycho”:

Open quotesTWO things account for the success of a popular personality test: extensive marketing and the reassuring message you get with your results. Whatever profile you have, or type you are, “it’s OK”. We have different gifts. We can’t all be the same. Everyone is fine. Celebrate your quirkiness.

The message makes it easy for consultants and trainers. Researchers, however, know that one of the best predictors of success at work is (raw) intelligence, along with emotional stability and adjustment. But too many in the selection business are afraid of using well-proven tests to assess these factors for fear of having to deliver feedback such as: “Sorry you were unsuccessful in your application: the reason is that you are too dim and too neurotic.”

However, the message of “we are all OK” is not true. There are people with a distinctly unhealthy personality. There are many words for this. Some talk of “dark-side” traits, others of “abnormal” traits. And for more than 20 years, clinicians have talked about the maladaptive personality.

Researchers have recently tried to spell out traits that are most clearly manifest in the maladaptive personality. There are five of them.

Antagonism
This is defined as manifesting behaviours that put people at odds with others. It has components such as manipulativeness, deceitfulness, self-centredness, entitlement, superiority, attention-seeking and callousness.

Antagonistic people put everyone’s back up. They are selfish, self-centred and bad team players. The clever and attractive ones are the worst, because they use their skills and advantages to get what they want, come hell or high water.

Disinhibition
Defined as manifesting behaviours that lead to immediate gratification with no thought of the past or future. It has components such as irresponsibility (no honouring of obligations or commitments), impulsivity, sloppiness, distractability and risk-taking.

Think Kevin the Teenager. It can mean enjoying shocking others with unacceptable language, outlandish clothing or poor manners. This may be amusing in the playground but hardly acceptable in any form in the workplace.

Detachment
This is defined as showing behaviours associated with social avoidance and lack of emotion. It has various components, such as a preference for being alone, an inability to experience pleasure, depressivity and mild paranoia.

These are the cold fish of the commercial world. They seem uninterested in nearly everything and certainly the people around them. Some seem frightened by others, most just not interested in being part of a team.

Negative affect
This is defined as experiencing anxiety, depression, guilt, shame, anger and worry. It has components such as intense and unstable emotions, anxiety, constricted emotional expression, persistent anger and irritability, and submissiveness.

These are the neurotics of the world. They can be very tiring to engage with and highly unpredictable because of their mood swings. The glass is always empty, and they seem always on edge.

Psychoticism
This is about displaying odd, unusual and bizarre behaviours. It includes having many peculiar beliefs and experiences (telekinesis, hallucination-like events), eccentricity and odd thought processes. Some may see such people as creative, others as in need of therapy.

Psychiatrists have grouped those with personality disorders into three similar clusters: dramatic, emotional and erratic types; odd and eccentric types; and anxious and fearful types.

There are three important questions. The first is how you spot these people at selection so you can reject them. This is easier with some disorders than others. It is virtually impossible to spot the psychopath or the obsessive-compulsive person at an interview. Clearly, you need to question those who have worked with them in the past to get some sense of their pathology, which many are skilled at hiding.

The second is, given that they have already been appointed, how to manage them. There is, alas, no simple method that converts the antagonist into a warm, open, honest individual or the disinhibited worker into a careful, serious and dutiful employee. Sometimes it is a matter of damage limitation.

The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.

Adrian Furnham is professor of psychology at University College London and co-author of High Potential: How to Spot, Manage and Develop Talented People at Work (Bloomsbury) Close quotes

 

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