In a bizarre and unprecedented feat of organisation, my university has put up a timetable for the first term of the second year. So, on the 14th November, the university is going to teach me how to give an intramuscular (IM) injection. I assume by this they are going to teach us the correct technique, as opposed to those we have been observing and ignorantly emulating on the wards thus far. But it has got me thinking and possibly even, dare I say it, reflecting…
My first IM was quite unremarkable really, despite shaking so hard I nearly injected my thumb with zuclopenthixol decanoate. The opportunity to do one hadn’t arisen during my first placement, therefore I felt somewhat similar to how I had when I was 16, and positive that I was the only virgin left in my school because everyone else had (allegedly) ‘done the deed’. Embarrassed, impatient and terrified at the same time. It could have been worse though, the other student I was there with hadn’t done any yet either, and won’t now get the chance to before the first placement in second year…on an acute ward.
So, my mentor went through the technique with me, made sure I had read up on what I was doing and administering, then told me to get on with it. Luckily the patient had been having this particular depot for over 20 years, and had had hundreds of terrified students prodding at her buttocks looking for just the right spot to shove a big needle in.
Being a bit of a swot (in the irritating definition, not the strengths/weaknesses analysis twaddle) I had researched my technique, and considered the dorso versus ventrogluteal sites. Of course, when it came to it, I stuck it where my mentor told me to, given that she had never heard of the ventro site and was unlikely to allow her student to just take a (well intentioned) punt at it.
The thing I remember most was how bloody long it took to get the stuff out of the needle and into the backside. I actually had backache when I emerged, blinking, from my crouched position. I was assured that it always takes that long, and the patient very kindly gave me a “twenty out of ten” for my technique. In fact, the experience was very positive. The only concern I had was on hearing that the patient had been admitted to hospital the next morning; I think it’s safe to say I nearly crapped myself, in fact. But I’m reassured that the two things were unrelated, and was just unlucky that my first ever depot patient went into multiple organ failure shortly afterwards. (Last I heard she was shouting abuse at the doctors and singing loudly at 4am, so I imagine discharge is imminent).
I am looking forward to the practical session at uni then, just to see if there was anything I should have done differently. There also appears to be a special section devoted to Risperdal Consta; possibly this is the Trust’s way of ensuring its new nurses don’t accidentally bugger up a £150-a-shot injection.
Now that would be embarrassing 
I gave you a ‘thumbs up’ there Z – mostly for the part where you broadly agree with Mr Ian – so do I.
oops D&DC! (sorry was thinking I was shrink for a minute you were Z)
Ted,
“If we had no drug laws, there would be plenty of space! (in the prisons?) But I agree, some who now spend their time in psychiatry would be correctly (in my opinion) sentenced as criminals.”
And some who have been sentenced as criminals should be spending their time (in my opinion) in psychiatric care. Since the closure of the institutions the police already refer to care in the community as care in custody and to the night shift as the out of hours social work department. Reducing the power of psychiatry to detain people for their own good (?) would only serve to increase the trend of the mentally ill being fed into the criminal justice system which can’t be a good thing either.
Ted, I agree with you that psychiatry’s powers of detention are often inconsistently applied and frequently get in the way of a therapeutic alliance being established between patient and MH worker. I also agree with you that there is often a basic dishonesty in the way powers of detention are applied in psychiatry (voluntary patient to be assessed for sec 5(2) if they try to leave, that sort of thing) but given that many of societies institutions (criminal justice, customs, social services etc) have some limited and some not so limited powers of coercion what is your objection to psychiatry having similar powers in principle. Forget how those powers are exercised in practice for the moment, why do you object so strongly to the principle but appear happy to see that responsibility passed on to other bodies (ie police)?
PS my wife things I am having an affair with you should I have her sectioned? She is clearly mad and a danger to herself.
@ E
“given that many of societies institutions (criminal justice, customs, social services etc) have some limited and some not so limited powers of coercion what is your objection to psychiatry having similar powers in principle”
I must have made this clear already, surely? The objection is that someone who is innocent of all law-breaking and declared legally competent can be detained and drugged indefinitely against his will. This is, by definition, incompatible with a free society. There is another objection which argues that mental illness is a metaphor, and as such psychiatry cannot be a medical discipline. The upshot of this is that justifying psychiatric intervention as a medical treatment is erroneous.
“why do you object so strongly to the principle but appear happy to see that responsibility passed on to other bodies (ie police)?”
When a person breaks the law (assuming it is a good law), they are generally punished by the police etc. Some psychiatric patients have broken the law, and some have not. Those who have not are innocent people, and ought to be free to reject interventions they do not want.
@ dazedandconfused
“please excuse the poor metaphor”
But a doctor hearing someone complaining of headaches has no legal power to detain the person in consultation, so the issue is not about informed consent of possible coercion. My general point in this thread was to say that if coercion is ok, then people ought to be informed that it is a possible outcome of their decision to consult a doctor.
“Similarly, I personally, would not appreciate going to the GP with a minor mental health diagnosis (eg: mild reactive depression) and getting a load of information on my rights under the mental health act”
You can’t go to a GP with a minor mental health diagnosis. The diagnosis is what you receive while you are there. Just because you would like to have that information presented to you does not make it true for everyone else, nor does it mean that such information should not be given.
Edit: Just because you would *not* like to have that information presented to you
Change diagnosis for problem.
If you go to the GP to get an unknown condition diagnosed there is always a chance that it could result in an emergency section being applied. (technically, though unlikely). My headache story:
Patient: I am suffering from headaches Doctor.
Dr: Tell me about them.
Patient: They are caused by the CIA beaming electricity into my head.
So potentially there should be a big sign outside the GPs surgery. “Even if you are not coming in with a mental health problem you may be placed on a section! PS: Brain Tumour leaflets at reception”
“nor does it mean that such information should not be given.”
Nor does it mean it has to be given before it is remotely required.
The objection is that someone who is innocent of all law-breaking and declared legally competent can be detained and drugged indefinitely against his will
This is most definitely the crappiest part of dealing with mental health.
The alternative is to let them roam free and remain at risk to themselves or others.
Do you have a better solution to the risk, Ted?
Ted,
The objection is that someone who is innocent of all law-breaking and declared legally competent can be detained and drugged indefinitely against his will. This is, by definition, incompatible with a free society.
But someone deemed to be suffering from a mental illness of sufficient severity and to be a sufficient risk to themselves or others is not legally competent. Ergo if it is acceptable for the police to detain someone for reasons of law breaking then it is Ok for MH professionals to detain someone for reasons of insanity. (Theirs not ours.)
“There is another objection which argues that mental illness is a metaphor, and as such psychiatry cannot be a medical discipline”
That is sounding dangerously close to the anti psychiatry line and I thought you were not anti psychiatry. Whether we see psychiatry as a metaphor or not is irrelevant. Electrons are a metaphor (ever seen, touched, heard, or smelt an electron, what are they wave or particle?) but that does not stop us making an informed guess what will happen when we flick a light switch. Psychiatry is no less a discipline for also being a metaphor.