This Week in Mentalists (86)

I wanted to be at the Glastonbury Festival this week, but I can’t. Hence I shall re-create the experience by watching it on BBC3 while sitting in my own faeces and ripping up £20 notes.

I’m guessing that not many of the mental health blogosphere have gone to Glasto either, because this is a busy TWIM.

My reports on the campaign against the proprosed HPC regulation of psychotherapy have been picked up by Ministry of Truth, an anti-pseudoscience blog. He notes that some of the campaign’s prominent voices have a track record of dubious Freudian explanations for illness.

Where this puts us, and thus far we’ve only just begun to scratch the surface of the campaign against HPC regulation, is firmly on the pseudoscientific wing of psychotherapy, which, in turn, suggests that what may actually be eating at Leader and other, as yet undeclared, ‘professional’ backers of this ‘Coalition’ is not so much a legitimate concern at the possibility of over-regulation or overt bureaucracy but a fear that a move to statutory regulation, underwhich the term ‘psychotherapist’ with protected and, therefore, usable only by HPC registered practitioners may attract unwelcome attention and close scrutiny from advocates of evidence-based medicine in much the same vein as that which has been directed towards ‘alternative therapies’ such as homoeopathy, acupuncture and chiropractic.

Fighting Monsters comments on the use of telecare.

We have fall monitors which can test the pressure on ‘usual’ chairs or beds and alert the appropriate team if there isn’t anyone on that particular chair/bed for a programmed period of time (and it can be set so that the bed monitor is only active between certain hours and the same with the chair monitors).

We have gas detection monitors, C02 monitors, smoke detectors and heat monitors and flood detectors which all report back to a central office in case the person in question is not able to alert anyone.

There are, as I have actually been directly involved in recently, have ‘door monitors’ that can detect if someone ‘wanders’ out of a front door at night.

And probably lots of other types of equipment that I haven’t even begun to explore.

I was surprised at the poor take up because as the article notes, a lot of money has been thrown at the project – it’s certainly been very evident in our local authority. Perhaps the poor take up is related to seeing it as a ‘replacement’ service for home care workers. I’ve never considered that but more of an additional service – a kind of safety net.

The Shrink discusses transfer of care from adult to elderly services.

Do patients like continuity of care? Or is it that folk favour a fresh pair of eyes and a new team looking at things?

There’s been an irritating practice of late, in my corner, that as soon as someone turns 65 years old, they’re referred from their existing working age adult mental health services, to mental health services for older people, and to me. It’s flagrantly outwith our Trust’s graduation policy, they’re all read, shredded and filed carefully in the bin with a succinct letter back to the referrer, but it got me thinking.

Locally, patients we asked favour staying within existing services and didn’t want to move on the basis of age alone.

Happily, 2 local audits of working age adult patients (well, they were called audits, but they were surveys) found that patients feel the same way that I do. If they’ve clinical reasons for being under my care, with stuff that I can do better, I’m keen to snaffle them on over to my corner. If they’ve no reason to transfer care, I’m keen for them to stay with their existing team.

Surely transfer of care on basis of age alone, not clinical need, is flirting dangerously with age discrimination, no?

Not Another Nursing Student is starting placement on an acute ward.

It’s not really that bad, but it’s a pretty mixed bag. If I can keep from getting reported by the Evil Manager then I shouldn’t have any problems with fulfilling my learning outcomes….the rest of the staff seem nice and so are most of the patients….and none of them have tried to kill themselves/each other/me as yet. I’ll elaborate on the bad bits in future posts, when I can work up the energy to be pissed off as opposed to just trying to survive it….

Mentally Interesting: The Secret Life of a Manic Depressive is taking flak from the anti-psychiatry crowd.

I refer to it as an illness because that’s how I think of it. And in my own experience, it feels like an illness. To me, it feels as physical as a descending flu. Its complete disconnection of my actual life (rarely am I “triggered” and often am I depressed in circumstances that don’t call for it, and vice versa) has meant that I think of myself as someone fighting an outside force. I have been aware- some may say too aware- of the likelihood that I might die doing so, and that I find it terrifying.

Because of this, some people would argue that it is a case of me not taking responsibility for myself. Surely if I think of it as an illness outside myself, then I won’t do all those, “lifestyle changes” and I’ll get into the victim role? Well, all long term illnesses require you to live a certain way. In terms of my illness, I do live in a different way that other people my age. More carefully. And I think if I didn’t think of this as an illness I could fight and treat, I would go mad. This growing, shivering jellyfish of a thing is unbearable in itself, and neatening it helps me. I wasn’t always of this opinion. In the past, I was scornful of the idea that people should take medication. Hence the lateness of me getting treatment.

Marine Snow has been binging and purging.

It totally was not worth it! Aside from the whole throwing up blood and pain viewpoint, it’s been a really good reminder of how horrible that feeling is, how much it lowers my mood, and how bad it makes me feel about my body afterwards. Any struggle I might have been having with my thigh circumference or wobbly bits is magnified after a binge. It’s like opening the door up to that mindset, and letting it have a corner of yourself. Like the mousetraps that my Grandmother has scattered around her home, those ED thoughts are so prevalent today. Silently chuntering on in the background, making me feel inferior and lost and sad, but it’s taken me all day to realise that is what is making me feel so miserable. “Blah Fatty Blah Ugly Blah Useless” *SNAP* (ouch) It’s an amazing skill when you learn to listen to those thoughts, rather than act on the bad feelings they bring. For so long I couldn’t actually hear how negative that inner voice was, recently I’ve learnt to tap into it, rather than block it out.

I refuse to let this feel like the end of the world. After all, it’s only an action, isn’t it? Like any other action in it’s simplest sense, throwing up isn’t murdering a kitten, or robbing a bank. If I’d thrown up without premeditation then I doubt I would be giving myself grief for it, beating myself up for getting food poisoning, or being sea sick. So I’m choosing to see it as a great little reminder, that I won’t be going back to Bulimia anytime soon. Life without it is so much better. I’d rather cope with the uncomfortable feelings to start with, than the miserable feelings afterwards. Not to mention the exhaustion and pain physically. I’d been foolish to say “Never again” because you can’t predict what set of circumstances might next lead you to the kitchen cupboard, or to the toilet bowl, but I can hold the memory of this occasion up as a shield, next time the world feels overwhelming.

Schizophrenia – A Carer’s Journal has attended a managers hearing.

A Managers’ Hearing is one of the appeal mechanisms to get out of hospital when detained. It was through one that we – unusually – managed to get Sam out (is it really five years ago now?) to go to France.

Sam was angry because he said his care co-ordinator had lied. He had described again the time when Sam had a serious road accident. It is often used as an example of why Sam is at risk. It was before his first detention in hospital almost ten years ago. Its relevance now seems low – its inclusion just lazy reporting of Sam’s current state. Sam may also be right. He probably got hit by the car because it was a dark night, he was wearing dark clothing and he was drunk. But it gets dragged up again and again because he was seriously injurred. He has done more stupid things and more dangerous ones as a result of his psychosis. If they were emphasised more then Sam might have to reflect rather than turn to anger as a response.

As we talked and explained he calmed and seemed to understand.

We also had to explain that he was unlikely to get out tomorrow – that he needs another strategy – but I think he knows that anyway.

Writing in the Margins of My Mind responds to a news report that a national advisory council has been set up to address the transition from child to adult services.

This does not need a national advisory council, and for that matter it doesn’t need a study or a pilot project. It just needs common sense and compassion. I find this so irksome, because this is one of those things where if people are sensible about it and put some effort in then it’s really not that difficult. Whether it’s a transfer from a paediatrician to an adult team, CAMHS to a CMHT or from a child asthma clinic to adult management, the same principles apply. It should be planned, it should be done in a way which best meets the young person’s needs rather than to satisfy bickering services, and everyone should know what’s going on and why. Careful planning – comprehensive referral letters and meetings between the old and new professionals and the young person will save time and money in the long run, because you don’t get teenagers slipping through the gaps and ending up becoming very ill before anyone notices.

I think the biggest problem probably does arise from resource and target-related bickering between services – the question of whose responsibility the teenager is and who is funded to treat them. That, of course, needs to be dealt with on a national level. But on the local and individual level, all it takes is common sense. Young people growing up and moving on isn’t a once in a career event for health professionals – it happens constantly! Transition arrangements should be smooth and well practiced, and considered just as important a part of the treatment as anything else, particularly in mental health care where there’s such a risk of deterioration if the person ends up feeling abandoned or lost in the system.

Becoming Hannah is on a Condition Management Programme.

I had my second CMP session today, and Rehab Nancy was on top form. She came to the conclusion that I am incredibly intelligent, very beautiful and great things will happen for me. Now can you imagine carrying a little pint sized Nancy around in your handbag?

” hmmm I’m feeling a bit down, might just go home via the offy and drink myself to sleep tonight…”
….. then out pops Nancy!
“You are sooo beautiful Hannah, you are soooo clever and full of potential, I see a promising future ahead of you!”

Bloody perfect! Instead of the offy, you’re sailing into Debenhams and buying yourself a sexy new dress and heading out on the town! All the while listening to the dulcet cooing tones of Nancy in your ear!

So not only did we establish how bloody brilliant I am today, we also decided that I am wasted in the construction industry, so it’s goodbye yellow Hi-Vis jacket and hello -
…… umm, well we haven’t worked out who I’m saying hello to yet, but that will come…. I’m hoping Nancy will have that covered next week!

Meanwhile, Serotonin is doing CBT

Anyway I have to write down more evidence in the thought charts regarding what goes on in my head. There is definitely a link between responsibility and perceived consquences and my levels of anxiety. I do struggle at times in the sessions, because my mind does go blank, but Jan is great and is very understanding . Mind you, I did have a go at her because she has come out with “you have had a lot of CBT in the past….”, although she agreed that the past CBT was geared towards very basic maintenance techniques in dealing with depression and anxiety. Plus at the time I also really didn’t have an awareness of how OCD and the thoughts that go with it affect me.

Samantha Chapman joins the Mental Health Nurse Lecturers Tea Party, having made the crossover from nursing to lecturing. I can hear OSB’s blood starting to boil.

Now I have entered a world where the language and terms used are strange and new. Three weeks into the job I have met with Moodle, Eyelit, Talislist and Uceel, tools I am to become familiar with as they become part of my daily teaching. There is plenty to keep any lecturer busy, with moderation, invigilation, interviews, marking, quality meetings, boards of study and Rolex. There are students to visit on placement, tutorial meetings and personal students to support. There are pathways to co-ordinate, modules to run and classes to teach. In addition, lecturers will want to commit some of their time and interests in research, publication of work, design and creation of new teaching systems. For me, effective time and diary management is essential if I want to contribute fully to my role.

Considering the amount of work expected of the lecturer is it also important to allow time for ongoing involvement in clinical practice. How much time can I realistically commit? Is clinical practice the only way to stay fresh and ahead with clinical issues and skills? Is it essential and do students notice a difference to the quality of their learning experience? Having recently come from clinical practice, I am more concerned with the long term effects if clinical experience is not maintained. Is there cause for concern?