This Week in Mentalists (87)

First off, let’s start by announcing that this week’s Tha Winnar of the caption competition is Cellar Door, and by quite a large margin.

And now, on to find what else has been happening in the mental health blogosphere.

Given my not-going-to-Glasto moan from last week, I think I’ll start with a couple of reactions from MH bloggers to Glastonbury.

Aethelred the Unread is not impressed by the TV coverage.

For a start, it bothers me that, even at my advanced age, all of the acts headlining the pyramid stage – Neil Old (did you see what I did there…?), Bruce Springsteen, Blur – were older than I am. It also bothers me that, after the borderline-racist reaction to Jay Z headlining last year, the headliners on all three of the main stages (Pyramid, Other Stage, John Peel Stage) were predominantly white. The TV presenters were banging on, as they always do, about how ‘diverse’ the festival was, and taken as a whole I’m sure it was, but there doesn’t seem that much diversity involved in having Friday and Saturday night both culminate in a performance by an aging rock dinosaur. (To be fair, Springsteen is more of an aging pop-rock dinosaur…)

The more I think about it, the more age seems to be an issue. It’s been traditional for a few years that there should be a kind of ‘heritage’ act on the pyramid stage on the Sunday, but this year pretty much the whole Sunday line-up on that stage were ‘heritage’ acts – Status Quo, Tony Christie, Tom Jones (that’s two cabaret singers on the same bill), Madness, Nick Cave, Blur. It’s pretty hard, with a bill like that, to claim diversity, I think. Especially when the headliners on the Other Stage (The Prodigy) and the John Peel Stage (Echo & The Bunnymen) were bands who have also left their major successes behind them.

Into the System was actually there, but found it difficult coping with depression while at Glastonbury.

I struggled all week though. I couldn’t cope with the crowds at all and felt myself getting anxious whenever I got stuck behind people and couldn’t move freely. Wednesday was so much busier than previous years and it sent me into a tailspin. I am used to a relaxed Wednesday with no one around. It was definitely a busier Glastonbury than the last two years and I couldn’t handle it all. I’m not sure if I just noticed the people more this year though because of everything that’s happened in the past year. I’ve definitely changed. I used to be at my most content at the front of a massive crowd at a gig. This year, I couldn’t cope with the dense crowds at all and opted for standing way back where I could still move a little.

I avoided the main stages wherever possible, only suffering the pyramid stage for Regina Spektor (my glasto highlight), Lily Allen and bits of Tom Jones and Blur. I spent most of my weekend in the Cabaret tent watching comedy, where it was quiet and you could find a nice spot to sit down. I also spent quite a bit of time wandering the green fields and not enough time actually seeing bands.

Fighting Monsters is disappointed by poor practice on an acute ward.

A few random thoughts occurred to me when I arrived on the ward. Firstly that the nursing staff had automatically assumed that this man’s continuing detention in hospital was going to be authorised. I know it can seem a bit pedantic at times but I get a little tetchy when it’s mentioned to me that I’ve ‘come to section Mr X’.

Secondly, that this man asked (and it was noted in the file) for an appeal against his Section 2 about two weeks ago – now it had been probably after the 14 day period for the appeal to be lodged however in this situation he had had to go to the general hospital due to physical health problems – where he had been treated for about 10 days. It’s an interesting point that on his return to the psychiatric ward, he wanted to appeal against the section but the time limit would probably have expired (I am making some guesses here as I don’t know the exact circumstances). I’ll probably look this up when I’m back in the office. Anyway, I’m under no doubt that he wants to appeal now..

Thirdly, he has not yet been allocated in the community team. This is harsh as I think that might have made some difference in the possibility of support in the community.

I’m not sure that he was offered an IMHA (Independent Mental Health Advocate). There was certainly nothing documented and I was met with blank looks when I asked about this. It’s something I can pursue at this point but it really should have been done on admission.

Lake Cocytus reports on a case of a woman with dementia getting down to some red-hot girl-on-girl action.

She was holding hands with other ladies, talking suggestively, then at times cuddling, stroking and kissing them. She and the other ladies all have advanced dementia.

The care home sought advice on how to manage this.

Knowing my foibles, they’d already looked for delirium, considered diet and fluids and constipation, arranged for a district nurse to do bloods to exclude infection and common physical causes for acute on chronic confusion and sussed out and documented what the circumstances of this behaviour were.

A life long heterosexual woman, with an active libido throughout her life, she sought companionship and intimacy with accessible men.

Her dementia cued her in to selecting men through one principle determinant, which of a fashion makes sense. She’d progress amorous overtures to anyone in trousers.

I don’t have a pill to stop that one.

Marine Snow is slowly winning against the anorexia.

Things are changing steadily, and it’s amazing. The past week has been a bit of a struggle in terms of confidence in my body, and I’ll hazard a guess that’s because I’ve been shopping. I’m finally weaning myself away from the last of my “skinny” clothes, and buying new, sensible sized outfits. It’s been tough, for someone who set their self worth on their jeans size for so long. The act of slipping into the category of average, rather than smallest on the rail, has dredged up quite a few feelings of failure, and insecurity. Not looking “Perfect”, or at the very least “a work in progress” is hard graft, a mental battle.

These feelings are strong, triggering, and upsetting, but above all, these feelings are only transitory. By stopping them dead in their tracks, it seems that they fade pretty quickly. In the changing room, attempting to change my attitude but struggling. Body checking in earnest, the shape in the mirror morphing from slim young woman, to bloated lumpy beast, turning away and taking a deep breath works well. Not comparing my thighs to the mental image which I’ve held for so long, but to something real, like a stepping outside my head for a moment. And realising the body I crave, makes me miserable, tired and no fun to be with. A dead thing, an absent thing, a hollow empty person. Whereas this strong, proud confident REAL person, who glows and smiles and takes interest, is who I want to be.

Not Another Nursing Student notices some plus points about her placement on an acute psychiatric ward.

1. There is a big emphasis on talking to patients. This shouldn’t be such a novelty, but it is. Of course, it helps that we are students and have more time, but every patient gets some dedicated 1:1 time to talk to staff between 1 and 4 times per 8 hour shift.

2. I feel like I’m learning a lot. Admittedly, it’s largely through hiding from the boss, and it’s pretty much entirely self-directed since everyone else is too busy to do much with us. For example, if a patient asks me a question, it’s much easier to go and find the answer myself than it is to try and get the attention of the staff member sat next to me.

3. I like working with people who are acutely ill; it’s an area where you actually get to see real improvement. I’ve seen some very dramatic changes in people, in one case literally overnight. Of course, there’s always a chance that the person will be back again in a month when they stop taking their meds, but still…

4. The rest of the staff seem very friendly, particularly the care assistants, which is a huge plus since they are the ones who know everything. It is never a good idea to get on the wrong side of a care assistant (speaking as an ex HCA) – it will just make your job twenty times harder.

Mentally Interesting: The Secret Life of a Manic Depressive reflects on bulimia.

As it stands, it has been: six weeks since I last took a laxative, and over six months since I purposely shoved my fingers down my throat to re-taste my dinner. I never believed I’d be able to say either. I have gone from someone who used to vomit everything they ate, up to ten times a day, and who used to shovel laxatives down their throat like they were Smarties (albeit Smarties that meant you had to be near a toilet, manhole or enemy’s house at short notice to collapse in crippling pain and then pebbledash the area) to someone who…doesn’t. And still my body refuses to act like a proper body should. I’d fire it if I could.

My eating-disorderliness was rather like the rest of my disorderliness. It was cyclical. There were periods of time in which I didn’t indulge in any aberrant behaviour, other than the usual vicious self loathing that’s part BDD and part habitual. And then there were times in which it was utterly all-consuming. I hated walking back to my desk at work after throwing up my modest lunch. Eyes streaming, and so sure I stank of sick and that everyone knew and were whispering about me. The walk of shame wasn’t a walk. I felt as though I was some sort of archaic, grotesque creature that stomped and was painfully aware of every single heavy, condemnatory step I took.

The Wife of a Schizophrenic is going on a blog hiatus, though it seems to be for positive reasons.

I remember Seaneen saying once that if you feel suicidal try to ride it out for just one month – chances are, you would have changed your mind by then. It’s so true. I’m not saying that I wanted to kill myself and that I’ve been waiting for a month to pass, I’m just saying that 3 weeks ago I would never have imagined I could feel as different as I do today. This is probably the best I have felt in at least 7 years.

In fact, I’m in such a positive place right now that I’m scared of losing it or spoiling it in some way. For the first time since Mr Man’s first admission into hospital, I’m at peace, and I want to stay at peace. For this reason I have decided that I won’t be writing in my blog for the time being. Although I have struggled to update my blog regularly for quite some time now, I never thought I would stop writing it completely. But dwelling on past experiences has not allowed me to let go of the anger I have felt over certain events, and although I desperately wanted to share them with the world, I now feel that it’s time to move on. Of course, never say never. This is perhaps a “See you later” rather than a “Goodbye”.

Writing in the Margins of My Mind has an amusing conversation in the CAMHS waiting room.

I had a very funny encounter today with someone who’s a bit younger than me, and lives quite close. We settled that we knew each other from somewhere but weren’t quite sure where. It turns out she knows my sister, although she did tell me that “I can’t believe you’re her sister when you talk so polite”. She also though my sister must be or have been in care, just from the people she hangs around with and the way she behaves. That’s kind of sad, isn’t it?

’cause I knew where everyone’s offices are and where the water machine was she realised I was a regular, but was completely incredulous that I manage to go in twice a week when she tries to avoid once a fortnight. My favourite comment of the encounter, though?

“It’s funny that you come from a stable home and still have to come here. Were you bullied when you were 3 or something?”

Becoming Hannah has a breakthrough in therapy.

Nancy was going on about roundabouts and T-junctions today, and the M25 featured a bit more, apparently I’d come too far down a side road for it to be possible (or safe?) for me to reverse so I had kept going but missed a turning, or gone the wrong way round the roundabout or something, and now I was at a T-junction or a crossroads, and if I wanted I could take left or right or there was always the option of carrying on around the whole M25 back to where I started…. yeah I have no clue either, I think I glazed over completely and was only back in the room when she was laughing to herself about getting a Sat-Nav! The moral of the story I later gathered was that it doesn’t matter if you take a wrong turning, the main thing is you have been travelling, and while you are travelling you are learning.

I’m not sure the thought even occurred to me back then to change direction, I just kept battling on worrying about failing, seems daft now when all I really needed was Rehab Nancy and a road map!

I’m facing something so thrilling and yet equally frightening, after 18 months of learning about who I really am and actually learning what it is I want from my life, I’m about to start making decisions for myself. No more floating along letting other people influence the way I’m driving! I haven’t wasted any time, I’ve been on a journey learning so much about the person I am – all of a sudden the blog title makes a lot more sense! (light bulb moment) It’s one of those funny little quirks of the mind I guess, as if I knew all along what it was I needed and put the template in place for myself without even realising. Natures way of protecting and keeping me alive perhaps? Becoming Hannah wasn’t just a fanciful name for this blog – it’s been a survival tool, and it seems to be working, after all I’m still here and I’m about to embark on the next era – Being Hannah.

Crazy Nurse has a bad reaction to a self-administered diuretic.

I knew something wasn’t right as soon as I began cycling. Everything sounded really far away and my vision was blurry. All I was thinking was ‘just get to work, have a lie down in the staff room and everything will be fine.’ Somewhere en route I must of fainted into the curb because I came round on the pavement in town. I felt like I was struggling for air, it was truly horrible. I lay there for ages, but managed somehow to get up and carry on. About 5 mins after that I knew I was going to faint; so I managed to pull over onto a grass verge. I was in the process of getting off my bike. I came round lying on the grass, my bike kind of on top of me. I was only 5 mins from work by this point. I lay still until my breathing felt better and my heart didn’t feel like it was about to burst out of my skin; then got up and managed to get to work.

I didn’t even lock the bike up because I couldn’t co-ordinate my hands. I was walking through the corridors; and went to go up the stairs but had to stop to catch my breath at the bottom. Someone stopped me to ask if I was okay. I was like “oh, I’m fine, I just need to lie down for a minute or two” they suggested I got the lift, so I backed out of the stairway and was making for the lift. The next thing I remember was waking up and I was being carried like a baby by a matron I didn’t recognise; who put me onto an A+E trolley. They kept shaking me saying “hello? Hello?” and I was like “I’m so sorry, I’m fine”.

Long story short, I had collapased. My ECG was fine, my bloods were fine, my BP was in my boots so I had a couple of litres of fluid and then I was free to go. Needless to say, I neglected to mention the furosemide to them; but that is SO the end of my foray into duretics as a weight loss mechanism.

Victoria Taylor at the Mental Health Nurse Lecturers Tea Party reports the unsurprising news that the smoking ban in psychiatric wards isn’t working.

The Mental Health Foundation report suggests that attempts to ban smoking are simply driving the habit underground. They found that only a minority of wards in England have introduced the ban successfully. 85% of 109 respondents to the survey said the ban, which came into effect in July 2008, had not been implemented effectively. The rise of “secret smoking” has lead to safety concerns: the risk of fire, and also the risk that patients who are very unwell may become aggressive to staff when told they may not smoke.

Members of staff are reportedly unhappy to take on an additional policing role, when they are already faced with the problems of holding people against their will and persuading them to take medication. Some staff members said they felt they had no choice but to break the law and ‘turn a blind eye’ to smoking, especially when patients were acutely unwell, and in units which lack an appropriate outdoor space to allow people to smoke. The ban was also felt to be a drain on resources as staff members were needed to escort patients off the unit to smoke.

Not Another Nursing Student has noticed this too.

Is anyone really surprised by this? I don’t smoke, and would prefer to not be in a situation where I was breathing other peoples smoke. However, I really don’t think forcing people to go without cigarettes (which were still legal, last time I checked) when they are suffering from an acute mental illness is a good idea. I’ve heard the argument that drugs and alcohol are banned on wards, and it’s stupid. Cigarettes aren’t going to get you off your head and make you start throwing up/battering people. An absence of them just might, however (the battering bit, obviously). Either bring back smoking rooms or ensure all wards have available outside space in which smoking is allowed. Or ban smoking altogether, if it’s so evil.

Around 80%* of the conflict on my current ward is caused by smoking inconsistency; staff need to escort patients who don’t have leave out of the building**, and how often do you see spare staff on an acute ward? It’s a pain being a student, as we aren’t allowed to escort patients but our presence makes it look like there are loads of staff, so we’re constantly having to explain that we’re not just being lazy in not taking you out. The upshot is that we have a huge problem with people smoking in their bedrooms and the bathrooms. Depending on which staff are on, it often gets ignored. I was surprised at the comparative tolerance of lighters on the ward, but then I’m looking at everything from a secure unit perspective. Patients are supposed to hand them in, but clearly they aren’t doing so. Whereas, if we suspect someone has a lighter on the secure unit, then it’s rubber glove time.