This Week in Mentalists (56)

This week we have posts on targets, purging, how not to do restraint and how not to do teamworking. Plus a couple of TV reviews.

Let’s start with reviews of the second episode of the Horizon documentary How Mad Are You. Mentally Interesting: The Secret Life of a Manic Depressive is disappointed that there turned out to be nobody with schizophrenia in the group.

None of them suffered from schizophrenia. Isn’t that lovely? Schizophrenia isn’t hopeless, there are tons of recovered people out there. And if you want to show one mental illness as being non threatening, as having people behind them, for god’s sake, do it with schizophrenia, the most underrepresented and badly perceived mental illness that there is. It affects 1% of the population who are not represented. What a disgraceful cop out. And I also don’t agree with the psychiatrist that said that schizophrenia is the psychiatric equivalent of being diagnosed with cancer. How is that statement helpful or hopeful? Schizophrenia is a severe mental illness, like bipolar disorder, like depression. I would argue that it’s no worse, and no better. It can totally incapacitate some people and that’s true of any mental illness. The only reason it’s “like cancer” is because people make horrifically blinkered statements like that one. It’s like cancer because people perceive it to be the worst.

I do not have schizophrenia, although at one point it was thought that I did because at that time I was suffering from paranoid psychosis. One very brief point. So maybe my saying this is wrong since I have no direct experience of it. But I hate the fatalistic way people talk about schizophrenia. In hushed tones. Who is going to the Stephen Fry of schizophrenia? Who is finally going to come out and talk about openly and prove that it’s not a death sentence?

Aethelred the Unread concurs.

First of all, it drastically undermined the assertion by the narrator that many people diagnosed with schizophrenia go on to live healthy lives. The same thing had been said for all the other conditions, and the presence of a volunteer whose symptoms were not obvious (or, in the case of Dan and his OCD, not entirely debilitating) underlined the fact that this was the case. Because there wasn’t a volunteer who’d been diagnosed with schizophrenia, it was hard not to come away with the impression that this was because the programme-makers hadn’t been able to find someone who met the criteria of appearing to be reasonably ‘normal’.

The second problem is that, unlike every other condition on the list, there was no-one to give a personal account of what it was like to have schizophrenia, and how they’d learned to live with it, and to manage it. That was a shame, because the personal accounts were, I think, one of the best features of the programme, and the part that is most likely to have been useful in breaking down stigma.

Fighting Monsters criticises the targets culture.

Social Work is, for the most part in the UK, funded from the public purse and it’s quite right that we should be subject to a checking and controlling system than ensures we give the taxpayers value for money.

But (you could see the ‘but’ coming, I suspect) the types of data that we are expected to collect can provide a false sense of security in the systems. Some of this has clicked with the press over the weekend. Targets were met in Haringey. That does not mean a quality of service is maintained.

I’m not against all targets, by the way. One which I think has improved the service is the one which is based on time from referral to contact. It means that noone can sit on a ‘waiting list’ not knowing what is happening to them. Even if it is just someone phoning to acknowledge receipt and give a contact telephone number until an assessment has been completed, at least that is better than hearing nothing.

Some though, are less than logical. There is a target relating to how many cases we close. By the way, I was taught never to refer to cases as case but as people. So while I’m writing that in my head, I’m thinking ‘people’ but it just doesn’t seem to flow as well!

Back to the case-closing (I couldn’t really write people-closing..). To me, it is one of the more difficult targets to get my head around. I’ll close when I need to – not based on targets or pressure. It’s probably one of the more damaging targets, I think.

Marine Snow reflects on dental damage due to purging.

My teeth hurt, still, again, always. They’re beyond belief now. I think I may have been hoping that somewhere along the line, they might fall out, and give me an excuse to stop eating altogether.

They also do nothing to help my hope for the future. In fact they depress me so much, that sometimes they alone, are nearly enough to take me to the bridge. I used to have naturally perfect teeth. People always used to comment on them, ask whether I’d had work done on them. It used to annoy Jake no end, he had to spend half his childhood at the orthodontist. I used to constantly be told how nice my smile was. I wonder sometimes when I gave up smiling, it seems like an eternity ago. I am so ashamed of my teeth now, they reflect pretty well what I think of my entire effort at life so far. They need fixing eventually, if I start facing up to things. In the meantime, purgers everywhere, here’s how to NOT end up like me:

Not Another Nursing Student does a semi-fictional account of how not to restrain patients.

A patient is doing something mildly disruptive but not harmful. He or she does it a lot and the usual policy is to ignore them (sorry, disattend. It’s therapeutic. Honest.) and eventually they usually give up. However, because the ward is short staffed and relying on bank staff, this information isn’t passed on. So the patient is challenged. He or she doesn’t stop whatever it is and so staff physically intervene. At this point the patient kicks off and assaults staff. So he or she is restrained on the floor. Every time the patient is allowed up, they start fighting again.

Repeat continuously for eight hours.

This is because the patient is not written up for PRN medication and the seclusion room is unavailable. The decorators are in. Seriously (albeit fictitiously).

Because staffing is so dire there are not enough staff to rotate on the restraint. Muscles are pulled, knees and elbows are bruised, everything hurts. God only knows how the patient is feeling. Or even where they got the energy from in the first place. Must be all the highly nutritious NHS food.

Another one from Mentally Interesting. Did I ever mention that Seaneen is well sexy?

I’ve come out in hives again. Whenever I’ve run myself down with hypomania (and the stress, agitation and restlessness it brings, and I’m doing some writing pieces), these little bastards appear like weeds, accompanied by a rather fetching rash. At least they have the decency to mostly reside on my back away from the judgmental gaze of The World, but it does mean that I keep having to reach around to scratch them and to the untrained eye it looks like I’m scratching my arse. I have a pair of white lace elbow length gloves on which are brilliant for scratching. Makes a noise like, “Chhhch, chhhch”.

I’m also anticipating Yet Another Cold Sore. I like my face herpes for about thirty seconds, when they’re in that slight swelling phase. They make my lips look full and pouty. Then another thirty seconds later they turn into a weeping wound and I forego kisses for a week. It makes me feel like I’m a leper, with bits of dead skin hanging off my mouth.

Please form an orderly queue. I know you want me.

Useless CPN criticises poor teamworking.

Although as a CPN I’m pretty much a ‘lone worker’, I do work as part of a team and there are certain expectations of team members. Such as getting involved in projects, and working towards service improvement.

So how do you deal with the person who refuses point blank to take on an important piece of work? None of us particularly want to do it, but we all recognise it’s value. Every other one of us already has one (or more) projects on the go. We would all muck in, but we just need someone to do the final bit of collation and writing up.

I hope that our Manager brings this up with the person. This is not the only example of their bad attitude, and it’s getting harder and harder to bite my tongue.

The Wife of a Schizophrenic recounts the death of a patient.

It was nearly four years before the truth was finally established, that the patient’s notes were falsified and recorded that she had been checked on – a full half hour after CCTV footage showed her committing suicide elsewhere in the town. She was missing for four hours before anyone noticed. The notes were falsified by the nurse whom I had witnessed on numerous occasions playing computer games in the office. Obviously the nurses were very busy because they were so under-staffed.

It makes me wonder what we would have found out if the case of Mr Man’s attempted suicide on the ward a year earlier was fully investigated. Of course, it never was investigated because… well, he didn’t die did he? So that made everything ok. That’s what I was continually told anyway. I did meet with the Medical Director, to discuss this and other issues, and I was assured that Mr Man had been checked every 15 minutes, so the staff had done all they could to prevent it – it was in his notes so it must be true.