June 2007

It seems to me the “Mental Health System” fails to recognise that the principal diagnosis of 50% plus of its patients should in fact be the consequent phychologically sane response to damage from one form or another of child abuse. Victims of abuse normally spend seventeen years in the system before they are correctly diagnosed if at all, according to research.

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Alan Johnson has become Minister for Health.

Alan Johnson MP

Personal Homepage

With five minutes of mild Googling I found only a little mention of Alan Johnson and mental health issues. Mention of helping people get back to work.

Quick list of votes follow.

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Oh dear.

He’s angry. Very angry.

Now that I’ve stirred up the hornet’s nest again over at Dr Crippen’s, I think it’s now time to inject a little bit of peace and harmony. A bit of the dove and the olive branch. A bit of ebony and ivory, are side by side in the MDT meeting, oh Lord, why can’t we?

After all, we have a new Prime Minister, and his first act in office has been to boot out Patricia the Hutt, so it’s a time of good cheer.

So, on with the olive branches.
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Thanks you very much to Wife Of A Schizophrenic who has given us all a meme award. As part of the rule I need to link back to the originating site.

Rules are as follows.

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
2. Link to this post so that people can easily find the exact origin of the meme,
3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote (here is an alternative silver version if gold doesn’t fit your blog).

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I’m now just over halfway through my management placement, the 12 week (13 weeks if you include the time off for study days) placement that comes at the end of a nursing degree. Over the course of this period, you’re expected to act less and less like a student and more and more like a staff nurse running the ward.

The one problem with this is that it’s one thing for the ward manager to drop the ward keys into your lap and say, “Here you go. You’re in charge of the ward.” It’s another thing for the people around you to start thinking of you in that way, as the following examples will show:

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I’m just going to harken back to my little spat with Dr Crippen because one of the points I was trying to make has so far gone unanswered.

One of the objections raised in the arguments against advanced nursing roles (nurse specialists, nurse practitioners, consultant nurses) is the claim that these are NHS-only roles. The argument tends to go along the lines of “stick with the NHS and you’ll see a nurse specialist; go private and you’ll see a doctor.” Dr Crippen has made use of this argument.

The NHS lung cancer patient gets his hand patted by the “lung cancer nurse specialist”. The private patient gets Tarceva.…The poor folk can be educated in the comprehensive schools by teaching assistants, and have their health needs catered for by nurse-practitioners and health-care assistants. The rich will continue to pay for public schools and for medical advice from doctors.

Dr Crippen has again makes this point (or at least strongly implies it) since then, in his reactions to the new NICE guidelines on feverish children.

First, some definitions:

HCP: Have you Considered Private healthcare?

So, nurse specialists for the NHS, doctors for the private sector. It’s great rhetoric, but is it actually true? Let’s get the bourbon biscuits out and have a look at the claim.

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A while back, when I was on placement on an elderly ward, I accidentally spilled some alcohol handrub onto my chest, which soaked through my tunic.

When alcohol handrub makes contact with your nipples, the sensation is…interesting.
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I was about to post a further reply to Mental Nurse’s post Diary Of The Demented but my replies get so lengthy I thought I’d be better just creating a new post.

When our old Victorian asylum was starting to wind down, many people were full of optimism, looking forward to waving goodbye to the long, dim, corridors with high ceilings. Farewell to the stains, the smells and the memories of a dubious history. They envisaged a brave new world of shiny purpose built units. These new state of the art environments would benefit and uplift all of us, reducing stress and promoting well being. Oh, everything was going to be so much better.

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In a previous post I introduced you to Professor Whiggy the Consultant Psychiatrist, and Josephine Goebbels, the Mental Health Act Manager.

Josephine Goebbels is currently on something of a mission with regard to Section 58 of the Mental Health Act.

Quick law lesson: Section 58 deals with consent to treatment. If a person has been detained for three months then the Responsible Medical Officer has to fill in Form 38, a Certificate of Capacity to Consent, declaring that the patient is consenting to treatment and has the capacity to do so. If the patient doesn’t consent or doesn’t have the capacity, then a second-opinion appointed doctor (SOAD) is called in to confirm this. The SOAD then completes a Form 39, declaring that the patient should receive the treatment regardless of lack of consent or capacity.

Josephine Goebbels came into post a few months, and was horrified at the number of Forms 38 and 39 being filled in incorrectly. Hence she has decided that from now, if there’s the slightest thing wrong with any of them, she’s sending them back to be redone.

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7.30 am

I get woken up by two staff. Very smart in their uniforms. I try to pull the covers over my head. It is very bright, the paper thin curtains don’t block the light. One of the staff gently prises the covers from my grip, the other pulls the curtains round the bed. Looking around the bay I can see three other patients still asleep. I shout loudly.

I am stripped naked and placed on a commode next to the bed. One of the staff stands in front of me to prevent me from standing up. The other starts stripping the bed. They chat about Eastenders. Just when they are about to drag me off the commode I start to do the toilet.

Given an all over body wash from a luke warm basin of water with skin dissolving soap. One of the staff holds my wrists when I try to punch the other in the ear. Much shouting. The staff talk to me and tell me what they are doing and why they are doing it. Efficiently they reuse the commode as a seat when washing me.

Eventually they dress me. Guide me to the hallway to let me walk up and down the ward. I try the doors at both ends. Locked as always. I try the office door, locked. I go back to try the exits again.

Other staff cheerily say ‘Good Morning’ and tell me how smart I look in my ancient shirt, faded tracksuit bottoms and cheap deodorant.

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On the 25th anniversary of the Falklands, I’d like to salute all our Veterans, past, present and future; and to apologise for the lousy service they get from the NHS.

Do you realise that more Veterans serving at the time of the Falklands committed suicide afterwards than died in battle?

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Got this from Psychminded, a site that is very fabulous.

People with schizophrenia not on antipsychotics more likely to recover, states research
- patients in US are followed up after 15 years

Personality disorder an invalid “catch-all” label which damages women, says clinical psychologist
- Gillian Proctor attacks “growing prevalence of labeling women with BPD”

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After reading Olanzapine’s recent article about how difficult dealing with death and self harm can be, I remembered an incident that occurred when I was a student. A recently qualified nurse had the misfortune of finding a patient hanged in his room. The whole ward was shocked and the nurse who discovered the bloke was quite understandably deeply traumatized by the incident. The following enquiry did little to alleviate the nurse’s distress. However, colleagues were very sensitive and everyone did whatever they could to offer support. The reason I’m mentioning this is because it is the only time I have ever seen psychiatric nurses being supportive towards a colleague’s psychological problem. Since then, without exception, I have found psychiatric nurses attitudes towards their peers’ so called “weaknesses” quite appalling (and I’m really pleased that I didn’t go mad till after I had left the wards).

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Saw this on the news this morning:

Concern over ‘poor’ dementia care

Some dementia patients are being kept in their wards 24-hours a day for years on end, BBC Scotland has learned.

Original report can be found here:

Services need to get wise to needs of older patients

A report published today, by the Mental Welfare Commission for Scotland, says that hospital based care for patients with severe dementia should be driven by patient need rather than resources. ‘Older and Wiser’ presents findings from unannounced visits to 16 wards that provide long-term nursing care for people with dementia, across Scotland.

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Well, it’s the much loved chicken and egg scenario that we so often encounter… is it the mental illness causing the substance/alcohol abuse, or is it the substance/alcohol causing the mental illness?

Either way, how do we treat them? With difficulty and barriers is the answer!

Unfortunately it has been my experience of late that patients entering the services with dual diagnosis become very political, in terms of whose budget are they going to consume. Hearing many phrases like

‘their primary problem is alcohol, if they didn’t drink they wouldn’t be suicidal’

‘no, no, they wouldn’t be drinking if they weren’t so suicidal and mentally unstable, that needs treating before we can tackle the alcohol’

Meanwhile the poor patient is in the midst of all of this cafuffle being tossed from one to tuther like a frisbee!

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