A cure for all our wills

I’ve noticed that every now and again people (mainly charities) pipe up and say “there’s not enough funding in MH services”. I’m guessing that this report will be in a long line of things that say exactly what is needed yet don’t get heeded. (ooh, I think I’ve invented a slogan!) I blogged about this earlier, and have linked to the BBC’s “Have your say” - some of the stories are harrowing to say the least.

I was reading the report and realised that after 10 plus years of being a ’service user’ I still don’t know if my CMHT has a crisis number. Ho hum…

Yesterday I was driving for a living, or attempting to, hardly any of the vehicles in the city were moving, apparantly there was a young man with a few things on his mind standing on a bridge with a desire to end it all. With the chaos that went on the abandond vehicles, beeping, effing and blinding and numerous emergency vehicles, for a split second i felt like i was in an episode of hill street. He’d been on his way to a pyschiatric unit at the time. It was all world wearying stuff.
Today news arrived that the mental health service is ‘failing’
Having grown up during Thatchers years i was a socialist but age knocked that out of me as did the emptiness of most politicians. However there are more and more strikes lately and the privatisation of the NHS by stealth, under a labour government, is ridiculous.
The Campaign for a New Workers Party is becoming more appealing by the day
Thank you for your very informative and entertaining blog

Calm down Malcolm, you will end up having to visit your local acute ward to find a nurse clued up enough to take your BP.
Prior to this I had no real awareness of the Healtcare Commission. They`ll be a public funded quango and therefore extremely unlikely to say “Everything`s fine. Our work is done. And by the way are we entitled to severance pay ?”,
I have done a bit of research though. The Commission has 14 Commissioners, none of whom has a nursing background. I`m not sure why but there`s also a Senior Management Team of 8( possibly the full - timers ). This includes a RGN who specialises in occupational health and safety, stress and ergonomics ( make way Malcolm, my BP is on it`s way up too ) and another one who has a lot of responsibilities elsewhere and can only devote 1 day a week. If token RGN representation is only just perceived as important then it`s hardly any wonder that the other branches of nursing don`t get a look in.
The Commission has 6 offices around the country and also boasts a media office. Interestingly, they are required to report at least annually, rather than on a specific date. Was it a coincidence that they managed to release their report on a slow news day. Perhaps that`s a good thing if it raises awareness. As usual I`m just interested in what the whole thing costs the taxpayer and whether this money would be better diverted to frontline services.
The BBC TV report came out with a lot of statistics claiming 1 in 3, 1 in 4, 1 in 6 suffered with one type of mental illness / disorder or another ( it`s surely only a matter of time before a study claims it`s 1 in 2 ). These figures aren`t repeated in Malcolm`s link so I`m not sure whether the Commission are responsible. The simple fact is though, if there are up to 20,000,000 people with mental health issues then it`s hardly surprising that current services are struggling to cope. You would need a service on every street corner to deal with these type of numbers. Not to mention a very profound debate about how modern living seems to be undermining our collective mental health.
My personal opinion ( quite predictably laced with cynicism ) is that these figures are massively exaggerated. I don`t think they`re helpful either. No one has perfect mental health and we all experience fluctuations. The vast majority of people can deal with this without assistance from services. They will struggle to do so if continually subjected to propoganda telling they`re quite likely to have mental illness and unlikely to prevail unless guided by professionals.
I also had a cursory trawl through the BBC comments. I`m sorry if I`m picking on the psychotherapeutic gurus again ( what am I saying, I`m not sorry at all ) but there were a tremendous number of comments complaining that they hadn`t been able to access psychotherapeutic services but precious few stating that they had accessed these services and found them effective.
Finally, I was never happy with the CPA. It was always likely become submerged in bureaucratic treacle. Why does everyone discharged from hospital have to have follow up within 7 days. Of course, some need and deserve nothing less. For some though a period as an in-patient has given them chance to regain their perspective and develop their own plans for future adavancement. Let them go. There is too much nannying going on.

I also hate the 1 in 4 figure that is constantly bandied about. It counts every vaguely depressed, anxious or disatisfied individual. The real business of mental health services will always be treating people who are genuinely ill (not merely distressed) i.e. those with schizoprenia or manic depression.

Sane reckons it’s 1 in 4 “at some point in our lives” which I also think doesn’t help. I wonder if the discrepancies in figures are based on whatever research model they’ve used, and the most appropriate one is chosen for the story? (sorry if I’m not making much sense, it’s 7am on a Sunday)

I’m inclined to think that (maybe as it’s the BBC) they’re inclined to print the comments that back up their story. I’m a boring sod who reads Have Your Say a lot, and they tend to do this - even changing the actual question to suit the respones sometimes. One of the comments for me sums up the general public’s attitude - saying “I had this, this and this happen, and I managed, why can’t everyone else?” or words to that effect. I can see why there’s so much cynisism in society - and I agree with OldSchoolBaby that the figures are exaggerated - and it doesn’t help attitudes when every sod and his dog is off with “stress” or “depression”.

I’ve just thought of something - I was feeling a little cynical about the Mental Health Foundation’s campaign for World Mental Health Day - encouraging people to get together with family and friends and cook them a meal (I visualised the paranoid schizophrenic who has lost contact with most people) - maybe they’re targetting the “stress & depression” brigade! *lightbulb goes on*

Ariel, As a ward nurse I`m catering mainly for the schizophrenic and those with bi-polar. The rest of the ward is full of those from outside of our admission criteria and then the disordered. It`s the depressed and those with anxiety problems who are having their noses pushed out. We had an individual in recently who was quite incapacitated by their anxiety, it was rather a shock. We rarely see anyone incapacitated by depression ( 5 years ago we did ). It`s a shame as I`m sure we could help. Most of our admissions are through A and E and screened by risk ahead of diagnosis or need beyond risk. It`s not ideal as it can be manipulated quite easily but you can`t blame the SHO`s. No one wants to do the best suit shuffle in front of the Coroner.
Malcolm, I was hoping that you`d stopped assuming others draw assumptions based on terminology. ( have you read Inspector gadget`s last post, well latest hopefully not last ). You are right ( you occasionally are ) that diagnosis isn`t everything but it can be important. Most people can identify where they want to go. It`s how to get there that`s the tricky part. If you know whereabouts you are to start off with it`s easier. Not everyone wants to go round the houses. Some of us don`t get mileage allowance. Diagnosis should not inevitably mean intervention, you are spot on there ( that`s a first !! )
Dominocat, You are strangely prescient. I am going to post about family /friends and food

Really ? Do you recommend the Manic Depressive fellowship to Schizophrenics ? Would you let it pass if a manic depressive was mistakenly prescribed clozaril ? Of course it has a bearing on your practice. I`ve got fifteen balls to juggle. I need to take short cuts. I have a few interventions up my sleeve which I will deploy depending on diagnosis. If it works I`m lucky, if it doesn`t I have to tailor something for the individual. You may have more balls ( so to speak ) but you only have to juggle one at once ( and I still suspect you have a siesta / meeting between each one ). Providing you keep your bucket to hand you shouldn`t drop anything.
By the way, I deal with all sorts. Acute nurses are a stoical lot who get on with whatever`s dropped in their lap. You don`t hear us squealing like stuck pigs about admission criteria.
Finally, you are stating the obvious when pointing out that we don`t get the full community perspective. When I`m ready for semi - retirement I`ll come and have a look.

Malcolm, you are suffused with the ” I`ve got a caseload, I`ve got a lease car, I`ve got a F Grade, I`m an autonomous practitioner” arrogance of the community type.
Do you mean that your Consultant(s) hasn`t prescribed inappropriately in the last ten years or do you just mean that you haven`t bothered to check.
It gets worse. ” I don`t recommend” !!. I`ve just had the briefest of trawls through the MDF website. There are self help groups, self assessment tools, self management training, altruistic opportunities, fact sheets, books, journals, guides for carers and much much more. ( the same with the NSF or Rethink - I wonder how their donation income has slumped since that masterful name change ? ). Of course, you are now going to retort that you provide all these services but I don`t think you do. Ever thought some people might have a preference for doing it for themselves ?? Could it possibly provide a big fillip to their self esteem / confidence ??.
I should have predicted it. Short cuts would obviously be way beneath a sanctimonious CPN. This is a battle, the more intelligence you have ( including diagnosis ) and the more weapons you have at your disposal the more likely you are to win. Forget bloggers books, you need to read some history.
And finally, butterfingers, put down your bucket and try and get fifteen balls in the air. It was too difficult for you first time round, my friend, and your co-ordination is getting worse with age.

Dominocat, You are strangely prescient. I am going to post about family /friends and food

ha! just so you know, I’ve bagsied the title “food for thought”

You may be a little too idealistic and rather too estranged from your acute roots but you`re a gentleman Malcolm and no one can take that away.
It has its rewards, in spades, but an acute life can be tough. I sail very close to the wind ethically, morally and legally. I have to be adept at begging, borrowing and even re-distributing NHS resources. I have to expedite situations where negotiation would be much more appropriate. I have to be overly robust to send out a message of what is tolerable. I may even have to do things that are mildly detrimental to an individual for the greater good. I am bloodied and bruised only rarely but stink of sweat and faeces a lot more regularly than you might imagine. I cut corners routinely. I could go on. But that is what I have to do to keep the ship on an even keel.
The point is, I shouldn`t have to tell a lot of external influences this as they were once in my shoes. A strange amnesia befalls people who escape the acute environment and they return with disdain in their eyes and limitless unrealistic suggestions for how things should be improved. I am actually shooting at these people but your hairy a**e keeps popping up in my field of fire.
Looking forward to the joint post.
Dominocat, Could you put the intellectual rights to “food for thought” up on Ebay. I want to bid.

My last post WAS sincere but it was also conciliatory and now you`ve wound me up again. Malcolm, I would personally be very pleased if mankind could live by the 5 Commandments which instruct us on how to interact with our peers. I am a raging right winger but if I thought Communism was viable I wouldn`t complain. However, life is not like that. I didn`t create the terms schizophrenic or manic depressive. I don`t see that they are they are derogatory or offensive terms they simply reflect a reality. Now you can either roll your sleeves up and get on with assisting people or you can sit and agonise about whether you might be causing mild offence. In this country there is a monstrous amount of agonising going on, primarily by people who have very little else in their in tray. Meanwhile the numbers of us actually pulling our fingers out and doing something seems to be diminishing.

“It`s not the critic who counts, not the man who points out how the strong man stumbled, or when the doer of deeds could have done better. The credit belongs to the man who is actually in the arena; whose face is marred by dust and sweat and blood; who strives valiantly; who errs and comes short again and again; who knows the great enthusiasms, the great devotions and spends himself in a worthy cause; who at the best, knows in the end the triumph of high achievement; and who at the worst if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory or defeat.”

Theodore Roosevelt ( 1910 ) - praising acute ward nursing staff.

Shamelessly pinched from Frank Chalk ( 2006 )