This Week in Mentalists (67)

Happy Valentines Day, you lot!

Time for This Week in Mentalists.

First off, a new addition to my blogroll is…er…a group blog written by mental health nurses. I think we at Mental Nurse are going to have to start wearing gang colours.

Anyway, the Mental Health Nurse Lecturer’s Tea Party is actually very well-written. One of their authors, Tony Barlow, ponders the concept of health promotion.

What about Mental Health promotion? WHO have identified that depression will be the number 1 illness in Europe by 2020 but rarely do I see any health promotion on this issue. The ubiquitous health promotion posters tell me to lose weight, stop drinking, stop smoking, lower my cholesterol, go jogging etc etc but I have never seen a poster saying

‘Hey! Go and chill out!’

And I probably never will. Yes I am well aware that many physical promotion has a knock on effect on mental health but surely we should be promoting factors that are primarily aimed at mental health promotion?

The candle that burns twice as brightly lasts half as long. Personally, I want to enjoy my life rather than extend a miserable one.

Aethelred the Unread comments on the recent House of Lords ruling that failing to prevent suicide breaches their right to life.

In July 2004, Carol Savage left an open acute psychiatric ward, where she was being involuntarily treated for schizophrenia. She walked two miles to a railway station, where she threw herself in front of a train, and died as a result. No-one would deny that this is a tragic situation. Certainly Anna Savage, Carol Savage’s daughter, was greatly upset by her mother’s death. We know this as she tried to sue the local health trust for compensation, because she (Anna Savage, the daughter) had suffered ‘distress, anxiety, vexation, bereavement, loss and damage.’ The case eventually reached the House of Lords last December, where the law lords ruled that the Mental Health Trust had violated Carol Savage’s right to life by failing to put in place restrictions which would have prevented her from killing herself.

The inevitable consequence of this ruling will be to make the Mental Health system even more risk-averse than it already is. Health authorities, terrified at the prospect of watching their already tiny MH budgets eaten up by compensation claims, will put in place systems that recommend the most restrictive treatment and detention policies for all patients. They’ll have to. Under the terms of the HoL decision, anything other than full-scale incarceration of a mental patient presenting a risk of suicide is a ‘violation’ of that person’s right to life.

Speaking of right to life, in the wake of the death of an elderly resident in a care home, Fighting Monsters browses the care home’s inspection report.

As usual, I had a look at the latest inspection report for the residential home, dated May 2008. I am not sure what happened to the twice yearly inspections we used to have. River View achieved a one star rating meaning it is ‘adequate’.

Bear in mind that the same inspection report lists the fees as being between £545 and £818 per week.

A quick glance through the report (pdf link) seems to indicate a lack of social needs being addressed -

Care plans meet residents’ physical needs, they do not address all of people’s social needs and care is not always delivered in a respectful way.

I’ve read a lot of inspection reports in my time, and ‘care is not always delivered in a respectful way’ is actually exceptionally strong by their standards. Definitely worrying. I read on.

During the course of the site visit one member of staff was suspended for inappropriately dealing with a resident.

That has to be remarkable misfortune for there to be an issue at exactly the time the inspector happened to be visiting.

The Shrink questions the role of non-medical consultants.

Senior clinicians, seeing patients, using their clinical expertise whilst also doing enough management stuff to develop their service as they’d wish. Life as a Consultant Psychiatrist is fairly clear.

In fact, mine is very clear. I share my Job Plan and Appraisal with anyone who’s interested. Lots of folk have been curious. Nurses, OT, secretaries, managers. Why not? I’m busy, I do loads, I critique what other people do, it’s only fair that we’re transparent and folk can see what I do. My folder’s a lever arch file full of stats so they can see how many patients I see, what my out-patient activity is, how many home visits I do, how many in-patients I look after, what their length of stay is, what comments (some) and complaints (none, yay!) there’ve been, what my sickness is (still at 0 days over the last year), everything.

I don’t expect everyone to wish to be as open. But I’m surprised at how opaque non-medical Consultants can be.

So, without any rancor, could I pose the question more widely. Rather than existing senior posts, of the non-medical Consultant posts that are high profile (eg the SHA need to agree), what do these posts involve that the non-Consultant posts don’t? What is the raison d’etre behind a Nurse Consultant, Physiotherapist Consultant, Occupational Therapist Consultant or Social Work Consultant?

Marine Snow has a thoughtful post on control and eating disorders.

I have a strong suspicion that I only ventured into therapy for Bulimia, to get control over my eating, and then if I’m brutally honest, my plan was always to cut back and lose weight again. That desire waxed and waned, as did my awareness of it, but yes that probably was my long term objective. It was again about control. I craved control over eating and food and weight. I craved control over how others perceived me, and how I perceived myself. By “theorising” everything, I remained aloof and in control of my emotions. The concept of being ill never even touched the raw bit inside, the bit that loathed how out of control my binging was.

Mostly people attach the concept of control to the weight and food issue with ED’s. As I begin to recover, I notice just how important control is to me, in everything. It is pivotal for sustaining my ED, and certainly hikes up the anxiety levels to fever pitch. I’m sure the experts would have a lovely flow chart for that, but again it’s common sense in my mind.

Lack of control = anxiety (everything seems complicated and too much)
Deal with anxiety = order and routine (reduce the choices reduce the anxiety and feel safe)
**BUT LIFE IS NOT ORDERED, IT IS UNPREDICTABLE**
Routine is threatened = social withdrawal (avoid the nasty chaos)
Social withdrawal = depression and anxiety (loneliness and self criticism)
Depression and anxiety = more dependence on order and routine and feeling safe.

More vicious circles here, don’t ya think?

Mentally Interesting: The Secret Life of a Manic Depressive has another of her increasing forays into Proper Journalism with an article on the BBC Ouch website on bipolar disorder and sexuality.

During manic episodes I am bountiful, beautiful, charming, amazing, glossy haired, white of teeth and dressed in clothes that a Barbie would consider too revealing. This is because one of the key symptoms of mania is hypersexuality (scientifically termed as: ‘hitting on anything that moves’).

Sadly, this often includes people other than my boyfriend. He’s there, and he loves me, but it’s not enough. I know that the riotous sexuality within me can’t be contained; in fact, how dare he ask that it be? So I share it amongst … everyone. This is usually followed by apologies from my boyfriend to those who are involved, and screaming protests from me as I’m dragged away and bundled into the nearest taxi.

But hey, that’s totally sexy. Passion is attractive, isn’t it? As is passionately trying to make love to someone who is still pretty angry at you. But it’s okay, it’s not one-sided. I’m pretty angry at him, too. Here I am, a sex goddess, and he doesn’t seem to appreciate it. All he seems interested in doing is getting me to take little white pills. He says they’ll make me calm down. What a waste.

Following the furore over Action for Children’s autism advert, The New Republic highlights a much better way to do these things.

This is the latest video from the National Autistic Society in the UK. It demonstrates how to raise the serious issues that affect, and sometimes the unpalatable reality of life for, autistics, without having the world’s leading autism experts and thousands of people howling with outrage.

This sets the standard that the Action For Children, Monster Dan ads, so spectacularly failed to attain.

Are you listening Polly?

Writing in the Margins of My Mind is getting an unusual effect from Citalopram.

When I first started citalopram, there was a definite and immediate lift in my mood. It lasted a few days, and then it was gone, without a trace. A few weeks ago when my dose was increased, there was a similar definite and immediate lift in my mood. It was hard to describe, because I was quite intensely sad about my friend leaving, but I could appreciate that it was a “normal” kind of sadness, and there was a clear lift in the usual dark and depressed stuff that doesn’t feel so normal. This time, it last two weeks, and then I crashed. It was a pretty big crash this time, and I very much was not safe. I’m still feeling precarious.

I saw my psychiatrist today, and she is simply puzzled. She’s never seen anyone react like this to citalopram (or any other SSRI) before. The definite lift (that doesn’t seem as likely to be coincidental now it’s happened twice) would seem to indicate that somewhere along the way it’s hitting the right neurotransmitter, and should be a good med for me. But then why do I crash? It doesn’t fit with the mechanism of action for SSRIs, from what I understand. It’s also really annoying and a little bit soul destroying, seeing as a get a hint of what the benefits could be, and then it’s taken away from me. Psych’s in two minds as to what to do, because that apparent benefit means it might well be worth increasing the dose as far as possible and see if we can get a sustained effect, but at the same time she’s eying me up with her risk assessment matrix because the kind of crash I had last week is A Big Risk. She’s planning to talk to the other Consultants about it and maybe contact the drug company to see if there’s been reports of this kind of thing before. I am a clinical anomaly!