This Week in Mentalists (98)

Thanks to Mental for doing TWIM for me last week. It enabled me to take time off for a very relaxing ritual slaughter. Great Dagon has been placated for another year, my supply of virgins blood has been topped up, and I even got a nice tan due to standing in front of the Furnace of Purification. Cthulhu ftagn.

Anyways, here is what’s been happening among mental health bloggers this week.

Marine Snow has found a novel way to address her self-identity issues. Live-Action Role Play.

Role play gives me the opportunity to face situations that scare the crap out of me in real life, but in a safe environment. I’m terrible and a real coward about dating, but my Character? She’s confident and out-going and tactile. She’s sexy without being afraid of it, and confident in her sexuality whilst sober. Me? I jump at loud noises, or even moderate noises, and even the tiniest raised voice has my heart pounding and my legs turning to jelly. I’m usually scared of my own shadow, convinced I’m about to get punched/stabbed/mugged, but my character? She lives for a fight. She’s a brave warrior. Adrenaline is her drug of choice. My character is not afraid to speak her mind, though not afraid to hold her tongue either.

And the maddest thing? I never feel fat as my character. I eat what is put before me, and am grateful for it. I rarely think of calories or wobbly flesh. I walk with my head up.

Fighting Monsters doesn’t like depriving people of choice. This is probably a good thing. There are certain jobs that are best done by people who aren’t comfortable doing it.

Last week, I felt very autocratic – particularly in my dealings with one individual. It is easy for me to justify by telling myself that he doesn’t have capacity and the choices that I made on his behalf (via an IMCA (Independent Mental Capacity Advocate) are in his ‘best interests’ – but when I stop for a moment in the flurry of work as it arrives at my desk – and realise that I am, in fact, dictating where someone will be living for possibly the rest of their life – it fills me with discomfort.

This isn’t why I wanted to do this job.

I am often faced with this feeling when I carry out Mental Health Act Assessments. I am responsible for making a decision about someone’s compulsory detention in hospital. Of course, for those assessments to take place, the people are very unwell. Sometimes acutely, sometimes chronically. Often the process is distressing and it never involves choice. Occasionally, and I can count the times on the finger of one hand in the past year, we might be able to think about and consider community alternatives – but usually those choices have been explored to the point of expediency by the time the assessment roles around.

Sometimes when I am faced with my own choices, I become increasingly thankful that I have the liberty and wherewithal to be in a position to make these choices.

Choice is a fundamental aspect of our humanity. I see people who lose this on a day to day basis and I see my role in the loss of this choice.

Lake Cocytus discusses benzodiazepines.

One lady has anxiety which necessitated hospital in-patient care over many months, she relocated to my corner a few years ago to be near to family and now is on oxazepam 5mg as required. The tablets are 10mg, so it’s half a tablet a time. The dose range in older adults is 10mg to 20mg, 3 or 4 times a day. 30mg to 80mg a day, then (which is what she was taking when we first met). She now takes 5mg a couple times a week. At such a tiny dose there’s no risk of pharmacological dependence, no problems of side effects. Okay okay, it’s homeopathy in all but name, yet for her it’s invaluable. She finds that when she’s anxious she can take half a tablet, she’s in control, it’s a key tool for her in her toolbox as part of her anxiety management. Developing an internal locus of control, patient choice, an empowered patient, person centred care, frame it how you will. For her, being able to have a bottle of tablets with just one tablet used up each week is incredibly effective in enabling her to manage her mood state and functional level.

Another lady’s had a major adjustment disorder and is currently taking diazepam 2mg half to one tablet once a day. Again, a dose that doesn’t cause pharmacological dependence (or side effects for her) but a dose which gives her feelings of relief that she finds necessary to help her cope. And cope she does, now managing activities of daily living that six months ago eluded her. Sure, her CBT and SNRI and twice weekly CPN input are far more meaningful than a sniff of diazepam, but for her the choice of taking a dose (or not) when she wishes is a choice that she feels she needs, a choice that puts her back in control, a choice that enables her to feel she’s better equipped to cope.

Other than these two patients, every other prescription for a benzodiazepine since April has been purely as an aid in the management of dementia care. It’s not used a lot, at all. We’ve specialist teams to support care in my corner so if there’re problems then the team looks at causes and understanding and interventions, I look at physical comorbidity and concurrent medication, our commonest intervention is stopping drugs not starting them.

Not Another Nursing Student has been threatened with a fitness to practise hearing.

Turns out, my tutor didn’t check his emails and is accusing me of not replying to a previous email relating to attendence at uni. See also this post.

Because he didn’t check his emails, he was threatening to initiate fitness to practice procedures against me.

Luckily, being the cynical and paranoid person I am, and being fully aware of how useless the uni is, I had saved my previous correspondance and CC’d various other departments in when I initially replied. So it was sorted quickly and I got a full and frank apology for being undeservedly accused of misconduct I was grudgingly informed that I did not need to attend the scheduled meeting.

After which, I was able to finally stop cursing and return my heart to it’s rightful place, although it took another hour to stop the palpitations.

Mentally Interesting: The Secret Life of a Manic Depressive has a guest article on BBC Ouch on whether mental illness is a “proper” disability.

One night at the pub, I was emptying my pockets looking for my keys when it fell out. It lives in a distinctive orange wallet and has the words ‘FREEDOM PASS’ emblazoned across it. An acquaintance picked it up for me and cocked an eyebrow. “How come you get one of these?” he asked. I cocked an eyebrow right back.

“Because I’m disabled”, I responded. With a barely concealed smirk, he replied, in the laborious tone of disbelief, “But you’re not disabled”. And, although my social worker, the Department of Work and Pensions and Islington council, beg to differ, a part of me agreed.

Disability is defined as, “a physical or mental impairment that substantially limits one or more major life activities”.
London skyline
Having a mental illness does “substantially limit” my life. There are times in which I barely function on any meaningful level. No one would look at me and guess that sometimes I need help bathing myself, or that there are times I can’t cook a meal. But I do, and there are.

And yet, even though I’m speaking to you from Britain’s best disability website (oh yes), I feel like a total fraud. I felt like a fraud when I was filling in my Disability Living allowance forms, I felt like a fraud when I was staring blankly ahead for the passport photo I needed to get my Freedom Pass and I felt like a fraud when I retorted to my friend. I just have a mental illness, and some people don’t even believe that mental illness exists. Though I live with one, even I question whether I’m ill or just weak. And when it comes to mental disabilities, many people may question whether mental illness counts as a disability at all. Why should I get a Freedom Pass? What do I know about genuine disability?

Frontier Psychiatrist has also made the switch over from Blogland to Propah Meeja, with an article on the Guardian’s Comment is Free on binge-drinking.

Many people use alcohol moderately and sensibly. However, millions of us do not. The harm alcohol causes is so broad that it is hard to adequately summarise it. The problems with health and public disorder are well documented, but more invisible is the toll it takes on relationships and mental health. It affects young and old; today an article in the Lancet identifies alcohol as a major factor in teenage mortality.

Despite this, the government’s attitude towards alcohol use has been predominantly soft-touch and we have seen a relaxation of licensing laws as well as local councils that appear to think nothing of allowing so many bars in certain high streets that they become a virtual no-go area to all but the most intoxicated. The large commercial concerns that produce and sell alcohol have been allowed to go about their business largely unchecked and alcohol use is widely encouraged by virtually unrestricted advertising and pricing practice. Also unhelpful is the socially corrosive veneration of alcohol-related culture that is displayed by some influential institutions, including student unions and some radio stations, whose shows regularly encourage people to relate stories of alcoholic excess.

Decisive action is needed towards curbing alcohol misuse. A report this week from the BMA calls for alcohol advertising to be banned and for the trend of music festival tie-ins to be similarly prohibited. A reduction in the density of licensed premises in town centres is also recommended.

It turns out Frontier Psychiatrist is actually called Stephen Ginn. Heheheh…he’s writing about alcohol and his name is ginn…hurhurhurhur….Oh, okay, yes I am actually rather immature.

Writing in the Margins of My Mind is discharged from CAMHS.

It was actually a lot less traumatic than I thought it was going to be. We were actually able to have a bit of a laugh and look at things positively, and it was nice to end on that note. The psychiatrist said that for her, one of the biggest differences in me is that when she first met me I was so ‘inside’ all the painful feelings that I couldn’t get any perspective, whereas now, despite the fact that the pain may well still be there, I can step outside of it sometimes and put it in context – and even look at it with a touch of gallows humour!

I will miss CAMHS. I’ve been there about twice a week for 18 months which adds up to more than a hundred sessions, which seems quite incredible. They have become a bit like a family. As well as my CPA with my psychiatrist and psychotherapist, other members of staff also made a point to say goodbye and wish me good luck, which was very sweet.

Onwards and upwards? To adult services at least!

Abysmal Musings is trying to think positively.

I was thinking very positively all evening. I thought through all of the things it would take to get back to work, doing what I do best.

The emotional cruxes started the negativity. Always bad to work with your best friends, especially when they’ve bailed you out.

So you start trying to think of ways to work that don’t impede them.

And then you hear the litany of “kill yourself” repeated ad nauseum in your ear.

Well, I have the antidote to that, and always will, so fuck off Mr Kill Yourself. I have 3 small boys and a wife upstairs blissfully asleep, so fuck off fuck off fuck off.

I am fine. Just in a bad place, temporarily.

Becoming Hannah dispels a few misconceptions about Borderline Personality Disorder.

If you’re going to slag me off then here’s what you need to know first;

It’s Borderline Personality Disorder that I was diagnosed with, not Bipolar Disorder

I didn’t have a “nervous breakdown”

I voluntarily asked for help at a difficult and emotional time in my life

I have never been sectioned under the mental health act

I’m not a danger to anyone

I’m not violent

I don’t sleep around and I’m not a sex addict

I’m not a bitch and I’m not mad keen on cruel gossip

…and here’s something else you would do well to note: The words mental health, depression, suicide etc. can actually be spoken out loud and do not demand hushed whispers accompanied by raised eyebrows and shifty eyes.

So Sick of Drowning has an enigmatic diagnosis.

I have a truly weird diagnosis – or rather, diagnoses – schizoaffective disorder and bulimia nervosa although like many bulimics I started out with anorexia – at least that’s what it says on my medical notes. I actually started out with binge eating disorder and ‘progressed’ to anorexia when others commented unfavourably on my weight. So I am like Churchill’s Soviet Union: A enigma within an enigma within an enigma. Basically, I am plain weird. I do weird things, say weird things, think weird things and for all of those weird things I take a bucketful of weird medication. And I hate it. Even those bucketfuls of medication don’t make me ‘like everybody else’. But then as a CPN once said to me ‘You will never be normal because there really is no such thing as normal.’

Andy at the Mental Health Nurse Lecturers Tea Party tries – and fails – to define the role of a mental health nurse.

The role of the mental health nurse is ever increasing. With the focus on specialised teams, mental health nurses have become specialised in their own right, adapting and developing skills specific to their area of practice. For example, assertive outreach, home treatment, early intervention, primary care, eating disorders, mother and baby to name but a few of the specific areas a mental health nurse can work and will require an individual approach as a team and towards service users. One benefit is that teams have immediate access to specialist skills, expertise and experience to provide a comprehensive and specialised package of care to that particular client group (Department of Health, 2009). The downside of this perhaps is the employability of the mental health nurse as they become more skilled in say eating disorders with a significant loss of experience in other areas.

OK – it is nearly impossible to define!

It is almost impossible to define the role of the mental health nurse and I am becoming increasingly aware that many people have attempted this task dedicating much more time and thought than I have. It’s actually much bigger than I ever anticipated and almost impossible to quantify. I am aware there are many roles and skills that I have not identified within this blog, mostly because at this rate I would be writing a book not a blog. If it has highlighted one thing it is that the skills of a mental health nurse should not be identified as a one shoe fits all approach. Although, having said that, the areas I have identified are relevant to all. I’m confused! If anyone can highlight any work specific to this I’d be interested to hear and appreciate any feedback.

Obsessively Compulsively Yours discusses avoidance.

Avoidance is an integral and yet oft forgotten part of OCD. When avoidance increases, compulsions decrease – this seesawing problem fuels the disease and means that it is often difficult to tackle. For me, this largely manifests itself in my checking compulsions – if someone else switches the iron off, or turns the knob on the oven, if it is somebody else locking the door, then the responsibility is no longer mine. This starts a vicious circle of avoidance and anxiety – every time I shirk my responsibility then it means that it will only get harder.

It’s easy to see why one gets oneself onto this path, even if you can see that it will only lead to disaster – I imagine that every one of you has evaded liability by passing the task to another person. It is too tempting to avoid the anxiety and compulsions that would arise from completing the action yourself. I could either ask someone else to lock the door, or I could spend three hours wobbling the handle in an attempt to convince myself that it really is shut – which one would you honestly choose? It brings up another reason that CBT is so hard – I have to accept the fact that my OCD will worsen before it will get better. I have to face the compulsions before I can resist them.

Genius Gone Wrong finds a lesson on suicide to be a bit too close to home for comfort.

Health and Social Care class this morning and we did Sociology. A completely new topic for me, but it was interesting to say the least if not surprising when the topic of suicide came into discussion again along with some mental health stuff.

I say surprising because it really did take me by surprise when the statistics about how men and women differ when they commit suicide were talked about by the tutor. I’ll be honest I found the topic a little close to home especially since I was in that situation of planning my own suicide just four months ago. I discreetly reached into my bag for the tissues to wipe away the offending tears as the memories of how I was feeling a few months ago came back to haunt me, at the same time part of me wondering why the hell I was wanting to cry… I had dealt with this crap or maybe I thought I had? It just really hit me out of the blue, it was so strange.