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Not bad for 3 hours. Wonder if mentalnurse.org.uk can create that sort of blogsteria?

Of course this relates to the release of research by Prof Irving Kirsch, Psychologist and probably very bright chap, who today denounced anti-depressants as being ‘of little use’. Great news for those of us who are just a little tired of being used by the nation as some sort of ‘cheer me up’ service. [caveats apply throughout this article to those with genuine clinical depression for whom anti-depressants remain a significant clinical benefit]

But the makers of Prozac and Seroxat, two of the commonest anti-depressants, said they disagreed with the findings.

d’oh. Did someone actually get paid to write that into the article? Of course they’d say that! We’ve known for years how such companies have spun the information any way they want because it helps to get the point across.

Why even the government aren’t without their once in a while statistical manipulation.

Now, I’m the first to jump up and down and say “Yay, about time. Take that you evil drug pushing bastards”. But before we get carried away with a hysteria akin to a Kazhakistan revolution; let’s take a look at the developing pattern here.

In June 2006, Layard gave this interview, with some Rosie Winterton (something to do with Health), stating that Talking Therapies WILL cure 50% of all those with some variant of depression. His report (which Mental Nurse posted on here) confirms this belief. Lanyard has also gone to the extent of preparing a report on “The case for psychological treatment centres” which may well be the impetus for the development of these new fangled and well received peer reviewed polyclinics.

So, getting back to today’s article, what of the latest addition to the process? Well, to me it seems like some sort of propaganda to get people away from this hysterical panacea pill dependency for those who might just be having a bit of a bad day. The research is probably fairly accurate; as all research usually is - depending on who is presenting it and for what purpose. The fact the Kirsch, who is a psychologist and allowed to deliver a lot more psychological therapies than he is prescribe anti-depressants, and his team went to the extreme lengths of employing the Freedom of Information Act provisions to obtain the data they desperately wanted says something for their determination. Having read that part, I was then not so surprised to read that their findings generally and overwhelmingly denounced prior claims by Big Pharma and, by default, offered opportunity to reinvigorate the provision of Talking Therapies debate. Yay for psychology!

Now, in principle, I’m all for the adjunct use of psycho-and-pharmacological interventions - in any mental health issue. Used correctly, this is one of my anecdotally favoured prognoses for a good (or best) outcome.

So what am I concerned about?

If we’re going to favour the co-therapeutic alliance of medication and psychological interventions; shouldn’t we be a little bit more prepared for it before we send the country into pandemonium?

Originally the reports suggested 30,000 psychologists (or CBT trained therapists). Of course the government is 100% behind this economically sound health strategy - so they agreed to fund a third - 10,000. By October that reduced to 3,600 actualised posts.

Layard clearly states that those delivering the treatment must be of the “highest professional level”. So… they’re giving them the best possible care; cCBT - the new computerised CBT using interactive software over the internet. Sounds good; sounds new-age; sounds like I’m not sure if there’s much evidence-base on this intervention either. NICE supported it - but aren’t reporting back on it til September 2008. Mental Nurse had a thought on this idea too, back in 2005.

Well anyhow, it’s all going ahead. Though I’m not sure if any of the promised outcome data has actually been published yet. If anyone knows how they all went in Doncaster and Newham, or the other ten pilot sites that were supposed to happen please let me know. Or when reports might be due out. Any information about the cCBT programmes would also be greatfully received.

After all, we wouldn’t want to be pushing a therapeutic intervention that was not delivered in the optimum fashion or without solid supporting evidence-basis, would we? For those wanting guidance on psychological therapies for depression - I recommend you start here

I decided to stay at home (no surprise) although I’ve got kindof mixed feelings about this. Although I feel very relieved at not being forced to go into hospital I’m still really struggling to keep myself “safe”. I don’t really know how to describe what I’m thinking of (and don’t want to give anyone else “ideas”) It kindof feels like I’m walking a tightrope just now (without a safety net or harness!!)…… sometimes it scares me that I’ll “fall”, at other times I hope I’ll “fall” and at other times I feel compelled to make sure I “fall”. I don’t feel able to continue manage this myself safely although don’t really know what would help me to manage this. For the most part I have no interest in keeping myself “safe” for me (in fact it’s not what I want at all) but have massive guilt at what not staying “safe” will do to my family. Having woken up to the consequences and impact of my last attempt, I can’t pretend to myself that it’d be ok to do this. Although still there’s terrible temptation. Having stayed at home I have access to the following “support”

1. I see my GP (although as I go as infrequently as possible – monthly for sicklines)
2. I’ m being encouraged/made to see the psychiatrist weekly for review. I find this difficult as I get scared of going to see him and don’t talk to him. The psychiatrist tends to ask me what he can do to help/support me when I see him but this is an impossible question to answer as he doesn’t tend to say what services could be provided. (I think I’m supposed to know because I work in a related field)
3. I am “allowed” to phone the “crisis team” for support although haven’t found this particularly helpful. I phoned last week on a REALLY bad day where I felt unable to resist making myself “fall” off the tightrope that I’m walking and was advised to “take a bubble bath, use aromatherapy oils or flick through a glossy magazine” I knew that I could phone back later if I felt worse but just didn’t think there was any point so acted on the stuff I was thinking of before the call.

I do know as well that my attitude to going to hospital and seeing the GP and seeing the psychiatrist isn’t helpful and will try not to be such a nightmare about this.

I really don’t know what to do or what would help me to stay “safe” at home although maybe nothing will. I would appreciate ANY advice (if at all possible, please don’t tell me to avoid killing myself by having a bubble bath though). L

I’ve been “ill” (altho that doesn’t seem like the right word) for the past 11mths with PTSD and depression and have felt suicidal to a greater or lesser extent for alot of that time. Things get a little better then MUCH worse and it seems like I’m heading towards worse.

3mths ago I was detained briefly after being assessed by ASW, psychiatrist and GP as being a risk to myself in terms of self neglect and ?suicide. Being in hospital was a nightmare that I’d wish to avoid for a number of reasons - one being that I work as a SW in the city that I was detained in (altho am obviously off sick) and was unfortunately in a locked ward with two of my clients (not great for me or them)While in hospital I overdosed on saved meds from home altho much to my regret was found in time.

I’m really aware that how I’m feeling and what I’m thinking of probably makes me as much a risk as before (insight into MH act from work makes me worry about this)and altho I know that hospital is a safe place I don’t feel it’s the answer. Is there any way to avoid going into hospital when acutely suicidal or any alternative support I could ask for? If I do have to go to hospital does anyone think I’d have any say in not being placed somewhere I work

Hi i have an interview next month, for my nursing diploma, i have wanted this for so many yrs. I have suffered bouts of depression for yrs, due to a bad childhood, but always worked through them, and carried on working. But last year i had a personal tragedy, the worst thing that could happen to a mother, i stayed strong for couple of months but then cracked. had a breakdown and tried suicide. I have never felt this feeling of despair ever in 40yrs of life. A monster took over me, i am now in therapy and feeling much better, i now look forward to the future again. I have been in college doing a-levels in all this trauma, so i know i can do it, i am so determined, i just had a flash of weakness. Anyway what i want to know, does my doctor have to give all my details like the suicide, as i am so ashamed now. I know OH have to look up records, but to what extent, and should i wait till it comes up to explain, or discuss it in the interview. Please help i am really worried, because i have done so much to get this far.

Thanks Calligas

Similar posts can be found here:

Mental Nurse - Help Wanted and also here.

I can already sense the backlash from those eager to remind me that depression was totally misunderstood and underdiagnosed sixty years ago. These days our knowledge is so much more sophisticated and our assessment tools so much more sensitive. Stigma, although still a problem, is nowhere near as pervasive as it used to be. We accept that it`s much better to flag your problems up rather than suffer in silence as a slave to stoicism and the traditional British admiration of the stiff upper lip.

I accept those arguments, to a large(ish) degree, however, it doesn`t explain the whole picture to me, not by a long way. Are all these suggestions that we are statistically likely to experience depression becoming self fulfilling prophecies ?. Are we losing the capacity to deal with issues that our grandparents dealt with routinely ? Are we paying the price for ubiquitous marital breakdown, family fragmentation, the erosion of community spirit and even the disappearance of Christian values ?. Can Prozac and primary care counsellors compensate for what we seem to have lost ?. They don`t appear to be having much impact to me. More importantly, is the application of sticking plasters to the newly “depressed” diverting too much attention, not to mention resources, from those we classify as having severe and enduring mental illness ?.

What do you think ? Will depression take its rightful place if, as predicted, it becomes acknowledged as the world`s second most debilitating disease by 2020. Or do we need to start addressing the flaws in modern society and reminding people they can pick themselves up, brush themselves down and get back in the race.

She made a post recently that left me a lot to think about, in which she suggested that accepting a diagnosis of mental illness is comparable to a grieving process.

After my diagnosis, I did go through, “The Five Stages of Grief”:

1.

Denial. Manic depression? Look, that shit is serious. There’s nothing seriously wrong with me. I’m just a bit, y’know *whistle*. Don’t be stupid.

2.

Anger. I was raging! After all I had been through in my life, why did I have to be manic depressive as well? This isn’t fair! Can’t something good happen to me? Why can’t I be normal? I’m so young! How could I let this happen? How could I let this happen to myself? I’m so weak. I’m so pathetic. Why wasn’t I stronger? What is wrong with me?

3.

Bargaining. Right, look. Okay. Yeah. I might have a problem. But it’s not manic depression! It’s, like, something else. Isn’t it? What if I, I don’t know, be quiet for a bit, does that make it go away, yeah? So, right, if we stop this whole jape and I stop taking these pills and I’m okay, doesn’t that prove that I’m okay? That I’m not ill? Can’t we try that?

4.

Depression. I can’t believe it. I have manic depression. I am 21 years old and as well as having a dead alcoholic dad, no prospects and no talent, I’m fucking mentally ill on top of it. I really believed that I’d be Okay one day. That everything would work out and I’d get a bit of counselling and life would be okay for me. That I’d write a lovely book and on the back of it, I’d look really happy and be called “a survivor” or something. I can’t believe I have this mental illness for the rest of my life.

5.

Acceptance. So. I’m manic depressive. Well, I guess that explains all those mood swings. And the hallucinating. And delusions. And why I act so weirdly. And why I have a shit memory. Could be worse, I guess. Could have cancer or something. And there’s medications, isn’t there. Right. Let’s do this.

And there you go.

The rest of her blog is worth reading too. Definitely one to add to your blogrolls.

TOP shrinks have claimed stressed-out bully Jade Goody should be locked away in rehab for six months.

And they dismissed her stay in London’s Priory clinic as a “publicity stunt” after it was revealed she was planning to visit India later this week.

Well, the bit about her stay in the Priory being a publicity stunt is probably fair enough. Admittedly I’m no more privy to her mental state than any other viewer of Celebrity Big Brother. Even so, it’s hard to imagine her symptoms being anything more than would get us mortals dependent on the NHS anything more than a prescription for some Cipralex and, if we’re lucky, six sessions of counselling. If the Priory really are allowing celebs to use their facilities as a holiday camp, then shame on them.

It’s more the first paragraph I have the problem with. “Jade Goody should be locked away for six months”? Seems a tad excessive for a bout of depression.

Where on earth did they get that idea from?

Psychologist Dr Lesley Perman-Kerr said: “Three or four days of treatment is nothing. You cannot do anything in such a short time.

“If it was one of my patients I would want to keep her treatment going for at least six months.

So that’s six months of treatment, as in counselling, CBT, antidepressants, physical exercise, not six months of being locked up!

Just a slight difference.

Okay, maybe I’m getting over-annoyed by a crass headline, but recently I had to calm down a friend who had been told by her GP that the antidepressants weren’t working, so he was referring her “to the mental health team”. I had to assure her that a routine referral to the Community Mental Health Team didn’t mean she was about to be sectioned. Some people do get afraid that if they come into contact with mental health services they’ll be locked away on a psych ward, and inaccurate headlines like this really don’t help.

POINT 1: The human brain weighs just over 2lbs. Yet it has the capacity to consume 15 – 20 % of our energy.

POINT 2: Dr. David Horrobin wrote an interesting book named “The Madness of Adam and Eve”. Among other things he focussed on our evolutionary history. Man moved out of the east African rift valley along rivers and coastlines. Our ancestors ate a lot of fish, game and foraged on nuts, berries and the like. Dr. H emphasised the importance of diet and the particular importance of Omega 3 fatty acids. He believed that if we don’t provide our brains with the nutrients that evolution suggests we require then our mental states become increasingly vulnerable to illness.

POINT 3: By the age of around five I was aware that “fish makes you brainy”. In fact, I went through a phase when I believed that my brain comprised of a mesh of fish bone. For the curious amongst you, the MRI scan and X-Ray were inconclusive.

POINT 4: There is a rapidly growing evidence base suggesting that a healthy diet can combat anxiety disorders, depression, bi-polar disorder, schizophrenia, ADHD and Alzheimer’s disease. A balanced diet will also contribute towards improved memory, concentration and a decrease in aggression and anti – social behaviour

POINT 5: Spirit of `76`s site has recently reported that a single Risperdal Consta depot injection costs £148.55.

POINT 6: The NHS is very adept at surreptitiously sweeping any financial deficit under the nearest available carpet but I do know that last year my ward alone was overspent on medication by a sizeable five figure sum.

POINT 7: I know of no in-patient psychiatric facility that doesn’t provide embarrassingly cheap, processed, largely re – heated meals.

So where did it all go wrong. I think it’s indicative of the power of the medical profession and Big Pharma but nurses aren’t blameless. Mealtimes used to be an extremely important part of the nursing day, now they’re almost incidental. We also defer too much to the “evidence base” and are reluctant to try anything before the researchers report their findings. Why? Wasn’t the nursing process supposed to be fluid? There are endless care opportunities, enhancing diet being just one of them, where there is nothing to be lost by trying something. If it doesn’t work evaluate and re – assess. Simple.

It’s time to flex our nursing muscles. Let’s put diet back on the agenda. Evolutionary history demonstrates its importance, my Grandmother knew its importance, commonsense tells us it’s important and now, at last, the “evidence base” agrees. What, exactly, have we got to lose?

Footnote: Dr Horrobin didn’t worry too much about referencing and balanced argument. He had an opinion and he wasn’t slow to share it. He upset a few people. He has passed away now and I understand that he was the first medic ever to receive a less than glowing obituary in the BMJ. Make of that what you will.

hi!

I’ve just been referred to my local mental health team via my GP after suffering from depression for at least 6 years. got my appointment with CPN in October and not really sure as to what will happen when i go.

Would be really grateful if anybody could tell me what will happen when i go (facts, not fiction please!)

Any CPN’s in the audience wanting to explain what happens next …

Therapy could ‘cut benefits bill’

The UK incapacity benefit bill could be cut by spending more on psychotherapy, a group of economists says.

The team from the London School of Economics says expanding therapy services would even pay for itself.

The report can be found here.

I’ve not got round to reading it yet The news report was a gushing piece on the wonders of CBT, with the figure that 1 in 6 adults suffered from anxiety and depression, and left me with the feeling that everything would be alright with the power of psychology.

From the Depression Report:

The treatment costs £750. The result is nearly two months extra in work, and
nearly two months less on incapacity benefits. And the cost of one month on incapacity
benefits is £750 (if we include the fall in tax receipts as well as the benefit payments). So
the treatment pays for itself.

Probably just me but this looks like it was a back of the envelope calculation.

Did anyone else catch it ?

Cognitive behavioural therapy for depression can be effectively delivered over the internet, according to new research.

Right I am going to try this therapy over the Internet thing:

Mental: Pull yourselves together !

Did it work ?

“What should I do next ?”

The question came up while trying to convince my partner that the Muppet Show had hidden depths, it does. Trying to make me stop talking about Muppets the issue of Mental Nurse was raised. I asked the above question.

“Do something serious”

Was the suggestion. I was shocked. Serious ? More serious than the cynic’s guide to job adverts or the psychiatric hotline.

“Write about something that affected you deeply.”

This did not sound good.

“You mean ..?”

I said.

“Yes.”

So here it is. A brief snippet of my worst shift ever and a little about the effect nursing had on me. I strongly suggest you don’t read it.

Really don’t read I don’t come out well. Somewhat whiny and weak willed on the whole.

How Acute Mental Health Nursing Broke Me

My first job was in a busy acute ward in a distant part of the country. There was a very rapid turnover of staff. After a fairly rocky start I settled into the job well. I enjoyed it. I liked the patients the other staff. It was a ward where you had to sink or swim, sinking was not an option so the whole team pulled together to make sure people had all the support they needed.

Time passed after a year and a half I was one of the most experienced staff on the ward. I told you there was rapid turnover. I taught students, covered the psychiatric hotline (a serious one), carried the bleeps on night, did nursey stuff, did vast amounts of extra hours as always there was something requiring extra staff.

We worked with people on their way down from Broadmoor, working their way up to Broadmoor, depressed people, very broken people, people seeking benefits, people avoiding court, manic people, anorexic people, nice people, nasty people, young, old, violent, timid … a wide part of the psychiatric spectrum.

Often many of the above categories could be found in one person.

I was tired a lot of the time. I couldn’t sleep. I was far from home and had little life outside of work. I was having dreams about work. Not nice fluffy dreams.

One of the dreams I named ‘The One With The Room Full Of Hanging Dead People‘, I titled them as if they were episodes of Friends.

Once a nightmare had woken me up I couldn’t go back to sleep, because I would return to the same nightmare or one worse. The nightmares were awful. Lets just describe them as every horror movie you’ve ever seen mixed with things I had picked up from mad people being very unwell in a psychiatric ward.

This was an award winning psychiatric ward.

I liked it, it was a good ward.

We had a patient, John.

John was well known to us. Very depressed, responded fairly well to antidepressants when compliant, loving family, occasional game playing. John was admitted as he felt very suicidal, a fairly standard presentation.

I was John’s nurse.

John and I got on well. We spent quite a lot of time talking, I invested a lot of myself.

John had been making suicide attempts on the ward. Generally with some warning and in places where he could reliably expect to be found fairly quickly. We increased the observation levels though to be on the safe side. John was very depressed, he may have wanted to be found but part of him did want to die.

Eventually I thought we had begun to turn a corner. John was picking up. Seeing a future again, making plans.

Hooray !

To be on the safe side John was kept on the highest level of observations below constant, which would have required one member of staff to follow him about all the time, very intrusive. John location was checked at least every few minutes by a dedicated member of staff.

To cut a short story short he hanged himself with a piece of cord. I can still see it clearly in my minds eye.

He was found within minutes, the alarm was raised. I stood there frozen as my colleagues began CPR, I snapped out of it and started getting ready for the crash team and ambulance. Sending staff to do various jobs around the ward that needed doing.

Eventually John was taken to the general hospital and put on a ventilator in an intensive care ward.

Everybody on the ward was debriefed by management. Which was good. I was stunned, I was useless, I had frozen. What if it happened again ? What if I froze again ?

People complimented me on the job I had done. If only they knew I had frozen, I thought. I had probably only paused for a few seconds, it felt like hours.

John died some days later without ever regaining consciousness. His family were with him.

I don’t remember much of what happened next. There was a big review of what had happened. There was an inquest.

I had the pleasure of reading and checking all the notes I had made heading towards Johns death. A particular highlight was discussing John’s decades long history of depression and attempted suicide; we agreed that if in all the time he had not actually killed himself chances were, that even when depressed, a part of him wanted to live, John agreed.

Inside my head I am still screaming idiot! at myself.

There is a danger point when a deep depression lifts that the motivation to to something returns a bit quicker than the mood returning to ‘normal’. So what happens in you get a deeply depressed person with the motivation to do something about it.

We came through the inquest, as far as I know the family never blamed us.

But I knew I had failed. I was broken as an acute mental health nurse.

I might have been able to fix myself but I didn’t want to. The dreams were not getting any better.

The next patient that asked if he could go out, simply out of politeness, was almost refused for no reason other than my own fear. Discussion of raising peoples observation levels were likewise biased.

It was time to go job hunting. Luckily I found one that did not involve people regularly trying to kill themselves. To this day I consider a shift with no dead people at the end of it to be satisfactory. Almost all other problems can at least be attempted to be solved.

Death on the other hand is final. Unless my dream about the zombies turns out to be true !

To put this into perspective I know plenty of nurses who deal with the above situations and continue to love acute nursing. They are affected by it but learn from it. The grow, develop and become brilliant nurses. I know nurses who have faced worse and coped with it.

Sadly I know a few who have faced too much. Something inside burns out. The world view becomes warped, compassion becomes twisted by paranoia. Best to avoid that I thought.

Well that was cathartic

Well lets review what was said.

Bleak … yes.

Optimistic … no.

Excellent; an ideal Mental Nurse article.

I promise next time to tell the tale of the Boy Who Was Cured By The System.

It brings a tear to my eye.

Mental Nurse

An easy way to blot it from my memory would be to give myself ECT. Two wires and a plug socket and away I go.

That was my subtle introduction to the topic of this entry. Did you like it ?

ECT For Fun And Profit

I have never had ECT. The only people I know that have had ECT I have met in a professional capacity. The only experience I have had with people and ECT have been limited both in time and geography. The following information is mostly anecdotal and should not be treated as anything more than opinion.

ECT is essentially a treatment for severe mood disorders, primarily depression, that involves a ’small’ charge of electricity through the brain. The person is anaesthetised and given a muscle relaxant, they are not conscious for the actual procedure. It is not One Flew Over The Cuckoos Nest (Film).

http://www.ect.org/
Electroconvulsive Therapy
ECT On-Line

The charge of electricity needs to be strong enough to cause a convulsion. The treatment is done two or three times a week and between 6 and 12 treatments may be required.

It is classed as a surgical procedure due to the use of anaesthetic. Short term memory loss and muscle ache are common complaints. A treatment is likely to put you out of action for most of the day. Some people do come in from the community for treatment and go home with someone afterwards.

Most treatment is given entirely voluntarily. There are extra hoops to be jumped through for the treatment to be given without consent.

It should be given as a treatment of last resort.

I have often seen it to be a treatment that has improved the life of many people.

On the other hand the only way they would ever give me ECT would be over my unconscious body. I would have to be in such a bad state that I would not be able to give meaningful consent about the treatment.

First Time Admission

A middle aged lady, Ethel, was admitted suffering from severe depression, she was accompanied by her loving family and herself seemed to be catatonic. She had become less and less motivated over a period of weeks for no apparent reason until ended up lying still all day not eating or drinking. Not responsive to others around her. No psychiatric history whatsoever.

Ethel needed to be put on drips. Would not respond to talking therapies. Would not move to accept oral medications. Did not seem to notice the world around her. The normal battery of tests did not show any physical reason for this.

Eventually, after discussion with family and advocacy services, it was decided to use compulsory powers to ‘force’ ECT. This required a second medical opinion. Everyone, apart from Ethel who expressed no opinion, was in agreement that something had to be done.

ECT was commenced. After about three weeks Ethel left us. She was smiling and laughing. According to her family she was back to normal. She seemed quite happy with her treatment though she did not really remember much of the previous few months.

A lovely success story.

I Want It, Now !

One person, suffering from Bipolar Affective Disorder, changed his consultant psychiatrist so he could get ECT. He was fairly experienced in the system and came in about once a year for several years. He had often seen and spoken to people that had ECT.

I believe psychiatrists can vary quite a lot in how likely they are to give ECT. Some only like to suggest it when everything else has been given a decent go. Other seem to offer it much more readily.

– can anyone find links to ect usage by county –

The ECT Hall Of Shame

Staff Handover Discussion

A fairly common discussion amongst care staff is what would happen if we need to be treated, as is very likely. General consensus is that we would accept ECT but only ever as a last resort.

Most of us wouldn’t take antipsychotic medication without a serious fight.

Old People Tell Tall Tales

Speaking to people at a day hospital for the elderly. One lady complained of serious memory gaps after receiving ECT about once every couple of years for a number of decades. This would have gone back to the days when they were more generous with the amount of electric and less generous with any kind of comfort.

Sadly the ECT had not affected her memory of obscene jokes involving nuns. I was young and turned red very easily.

I do recall a few people for whom ECT had no effect whatsoever.

Many RMN’s often point out that if we were given electric shocks every time they were depressed they would cheer up pretty sharpish.