January 2008

If you ever want a really depressing and upsetting read I suggest a copy of the Victoria Climbie Report. It’s the harrowing and utterly tragic story of how a young girl was slowly tortured to death over a period of months, and how social services, health services and the police could have but did not prevent it. As the report notes,

Victoria was known to no less than two further housing authorities, four social services departments, two child protection teams of the Metropolitan Police Service (MPS), a specialist centre managed by the NSPCC, and she was admitted to two different hospitals because of suspected deliberate harm.

All those agencies involved, and they utterly failed to stop a very gruesome death. Various new policies and legislation have been enacted in response to the Climbie case, but as the report itself notes, to save Victoria’s life, “required nothing more than basic good practice being put into operation. This never happened.”

Is basic good practice being followed now, 8 years on from Victoria’s death? Well…

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The various practices of psychiatry are based on different theories of mind. Psychiatry has been accused by some of being little more than a pseudo science and by others as an instrument of social control. It is true that what previously had been considered a mental illness is not necessarily considered to be such now (homosexuality, sexual promiscuity) and current trends in diagnosing behaviour such as conduct disorder as a mental illness are not without controversy either. The anti psychiatry movement associated with Thomas Szasz held that there was no such thing as mental illness because illness referred to bodily disease and the mind is not part of the body. (Sasz, Thomas 1974) but this extreme view has few adherents today.
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Ok, that was a slight exaggeration, adding a bit of sensationalism, but the above point may come true in the future.

The NMC are currently running a review of pre-registration nursing education.

Questions include:

should nurses be prepared to diploma or degree level?

what proportion of a pre-registration programme should be spent learning in practice?

should shared learning be a requirement?

should there be generalist and/or branch programmes, and if so, what should the branches be?

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But not if the lovers are a psychiatric nurse and her ex-patient. Karen Brock, a CPN, received a rap over the knuckles from the NMC for having a relationship with a former patient/client/service user/survivor/insert phrase of choice here.

The charge relates to a period between December 2003 and October 2004 when Ms Brock was employed as a community psychiatric nurse by Plymouth Teaching Primary Care Trust, a panel in Plymouth heard.

Ms Brock said she only had a social relationship with the man towards the “very very end” of the time he was in her care.

Patrick Kelly, chairman of the hearing, said the panel had determined Ms Brock’s fitness to practice was impaired by reason of misconduct.

He said it amounted to a “breach of trust” between Ms Brock and “vulnerable service user A”.

Is it a crime to fall in love? Can we ever tell where the heart truly leads us?

Bah humbug! We should resist the pull of Cupid’s arrows when they are pointed in the direction of people in our care. The power dynamics alone spell doom for any relationship of this kind. That’s before you consider your professional responsibilities towards the object of your affection. I don’t buy the argument that you can’t help your feelings because actually, yes you can: that’s what the whole of CBT is predicated on isn’t it?

Miss Brock now plans to move into nurse education. Quelle horreur! I don’t think Advanced Seduction Methods are on the curriculum.

I’ve blogged before about Dr Crippen’s ability to find fault in every quarter of the NHS except his own. The latest example, quite frankly, takes the cake.

Quick update: The Shrink relates an encounter in which a patient’s failing physical health is missed by the GP but picked up by the CMHT. This is unfortunate, but it does sometimes happen that one professional misses something that another spots. Just the way it goes, sadly.

Dr Crippen reads The Shrink’s post, and then posts an angry rant of his own accusing The Shrink of making generalisations about GPs. This is not my reading of The Shrink’s post, which strikes me as being about a specific incident, not a general statement about any one sector of healthcare.

Even so, one shouldn’t make generalised insults against entire professional groups, such as, for example…

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As a wise man once wrote, it’s Hammer Time.

Actually, it’s not Hammer Time at all. I have no idea why I mentioned that. Possibly something to do with getting bored at the lack of variation in ways to announce the latest edition of This Week in Mentalists.

As always, nominations for future editions can be e-mailed to zarathustra at mentalnurse dot org dot uk

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Since there’s currently a lively debate going on about ADHD over on NHS Blog Doctor, I think I’ll do a post of my own giving my personal tuppence worth.

Diagnosing ADHD, as the slightly scary Scientology guy who keeps spamming my inbox will tell you, is a pretty controversial business. One thing that’s particularly striking is the difference in prevalence rates between the UK and the US. Over here, ADHD is estimated to affect somewhere between 3 and 7 percent of children. Over in the States, the estimates can go as high as 18%.

(I should have some references for the above, but I’m afraid my mouth was too crammed with bourbon biscuits to jot them down. Sorry.)

So what does that difference tell us? Personally, it tells me that the Americans are rampantly over-diagnosing ADHD, and we’re being (rightly) more cautious.

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Here’s an unusual research paper from the British Medical Journal (PDF file) entitled, Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study.

Yes, it’s a research study undertaken to find out whether or not goths really do cut themselves and attempt suicide more than the rest of us.

And the results?
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Okay, I think the excitement of the past couple of days have calmed down, and I have spent a relaxing afternoon self-flagellating to ensure that I’m as “caring” as certain blogging doctors.

So, on with This Week In Mentalists. To nominate blogs for future editions, e-mail zarathustra at mentalnurse dot org dot uk
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Oops, I did it again.

I’m not going to go further into the ins and outs of that particular argument about why Dr Crippen thinks a certain patient should be admitted to an acute psychiatric ward and I don’t. The argument is over there for all to read and debate.

But I think a few words are now in order regarding Dr Crippen’s writing, and the effect that I think it has on wider debate.
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Here’s a story from the Bad Old Days of the big asylums.

Apparently years ago on a long-stay ward at the Faerie Realm Hospital they used to bring round the tea in ready-mixed jugs of “Regular Tea” (tea, milk and sugar all mixed together) and “Diabetic Tea” (tea, milk and sweetener all mixed together) - because of course, if you’re not diabetic, that automatically means you take sugar in your tea, right?

A new nurse started work on the ward, and was determined to put an end to these archaic and institutional practices.
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Last week or so I recall writing, along with others, about how people should take responsibility for their physical wellbeing to access healthcare.

I now realise that this was the real agenda for us staying fit and healthy.

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Ok, I don’t mean this is “goodbye”.

An article in the Telegraph today caught my eye reporting on suicide in kids. The first thing that I notice, probably displaying my unfortunate mental health cynicism was the expert opinion of;

Dr Dylan Griffiths, an adolescent psychiatrist at the Priory Ticehurst House Hospital, explains that it is often down to the interplay between our internal and external worlds, the point where our internal circuitry is affected by external triggers.

Kind of astute. Suicide occurs where the external real world doesn’t mix well with the inner egocentric world. Or, there’s an incompatibility between life and existing in it.

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Via Mandy Lifeboats Ahoy, I came across this audio lecture (7 minutes, 44 seconds) by psychoanalyst Janet Low, criticising evidence-based practice and cognitive-behaviour therapy.

I feel an urge to reply to Janet Low’s critique, and have my own little rant about psychoanalysis along the way.

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It’s that time of the week again, as we have our weekly linkfest of psychiatric blogging.

To nominate a blog for This Week in Mentalists e-mail zarathustra at mentalnurse dot org dot uk

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