Tag Archives: NHS

“Safe” staffing on mental health wards

5 Feb

Some thoughts on “safe” staffing and what this mean on psychiatric inpatient wards.

 

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

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On restraint, conflict and containment:

 

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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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