Friday, 20 July 2012

20 July 2012 - Living In The Land That Time Forgot

I've often had the sense of living in the land that time forgot - "A series of adventures ... among various bands of near-human primitives".  Going to national events I hear about the advances in mental health, improvements in services and new build psychiatric wards.  Then I return to the lost world of the kingdom where I live.  A place where the user led mental health groups lost their voices and we our choices of independent mental health advocacy.  Where the main psychiatric hospital is slowly and inexorably becoming desolate and devoid of resource.  With no alternatives on the horizon.

This former asylum is punctuated by cigarette butts underfoot everywhere and are there to welcome you at the gate.  Smoking is encouraged and a way of passing the time.  Staff can be seen partaking, in stolen moments at hidden, and not so hidden, places.  It gets you through the days and nights of keeping patients quiet or locked away, in rooms without toilets or wards without joy.  You can tell the nurses by their uniforms, the patients by their demeanor, the visitors by their leaving.

If you're lucky the hospital shop will be open, where you can stock up on smokes, drinks and confectionery.  It's now run by a voluntary sector organisation and has a (bulletproof?) screen at the counter.  To protect the shop staff and volunteers from flying missiles, so I'm informed.  Visiting the shop allows time to engage with the left behind customers, the people that time forgot, for whom the institution is home and a very familiar place.  Nurses have told me these patients wouldn't manage in the community.  I wondered if it could be more about keeping themselves in a job.

A decision has been made for around 45 of these left behind patients to be discharged from hospital.  From a total bed number of 90.  (has someone told the nurses?)  I suspect it will mean more institutionalised living but at less cost.  These rehab patients will have been given the mantra of lifelong mental illness and lifelong psychiatric drugs with a bit of psychology on the side, for maintenance.  The recovery agenda has passed them by although they may have seen recovery posters on the ward walls.  Merging in.  Visible when lining up for pills.

In Scotland we have a new national mental health strategy imminent.  The consultation highlighted suicide prevention and crisis support as priorities.  In anticipation of the focus on people in mental distress I approached our local partnership coalition of statutory organisations around wellbeing, asking what funds would be available for this, and was told that there is around £1million to spend in 2012/3.  However it had all been allocated up until 2015.  After some further digging for information I found out there were funds for new initiatives.  And an FOI (Freedom of Information) request revealed even more detail.

Yesterday BBC News Scotland put out an article with a great strapline 'Banged up for being suicidal' and a TV programme Scotland's Silent Deaths.  Describing the many times that people who are suicidal end up being arrested and put in police cells overnight.  "The police do not want to arrest them. But sometimes they are left with no choice because there can be nowhere else for them to go."  SAMH (Scottish Association for Mental Health) Suicide Prevention National Programme Manager Kirsty Keay says that police cells can't be the best place for people "at the darkest point of their lives", and that there needs to be a different way of thinking about suicide.  A need to consider the large numbers of suicide attempts and those who slip through the net.

The Edinburgh Crisis Centre is a place where people can go if suicidal.  The only one of its kind in Scotland, the centre "is open 24 hours a day 365 days of the year and provides community based, emotional and practical support at times of crisis".  Carers can also access all the services.  Visitors have the opportunity of staying overnight and the centre has 4 rooms where people can stay for up to 7 nights at a time.

I want to see a crisis service like this where I live.  A service that people can access themselves if suicidal or in mental distress.  Staffed by people who know how to listen and have time to listen.  A place of respite and refuge.  Is this too much to ask for?

Saturday, 14 July 2012

14 July 2012 - Straitjackets, Revolving Door Patients And Forces Of Nature

Don't you sometimes feel like people are longing to put you in a straitjacket? Or is it just me?  It could be when I'm giving an opinion like "there's no such thing as mental illness or schizophrenia" or "I've never believed psychiatrists" or "I think ECT is an abomination" or "peer support has become a cheap alternative".  I suppose they are passionate statements, sort of black or white.  No middle ground.  Borne out of personal experience and the crucible of psychiatry.

Refined in the biomedical fire with memories of neuroleptic numbness and compulsory treatment I hold fast to the belief in alternatives.  In other ways of working with madness or moodiness.  There must be a better way.  There is a better way.  And it involves listening to the person who has had the experience, of mental distress and of being in the psychiatric system.  I know that it's only a relative few of us who have had to undergo hospitalisation and psychiatric treatment yet the threat of this impacts on all of us.  On the frontline GPs (general practitioners) who are often the first port of call for people in distress.  Gatekeepers of the NHS, increasingly prescribing anti-depressants to patients.

In Scotland there was a government pledge to reduce their use but it continued to rise.  The public health spokesperson said "We need to be confident that doctors have the time to explore alternatives to anti-depressants before reaching for the prescription pad.".  To this end we now have a HEAT target of reducing waiting times for psychological therapies, to 18 weeks, from December 2014.  "Our intention is to promote timely delivery of evidence-based psychological therapies to treat mental illness or disorders."  I suppose it's a start.  Although I want to see talking therapies available for people in mental distress and at the point of crisis.  Respite and release.  Rather than a regime of drugs and compulsion.

I see the system's use of drugs, diagnoses and duress as responsible for creating the revolving door patient (RDP).  They've (the system) only got themselves to blame.  The one size fits all scenario in psychiatric hospitals becomes a way of life for some of the residents.  And the locked ward in particular has a culture all of its own.  An acquired taste.  Staff seem to leave their personalities at the door and put on a uniform of institutionalisation.  Anything goes and they can even roll their own cigarettes in front of patients.  For who listens to patients?  Everything that isn't screwed to the ground or wall is seen as a potential weapon. The RDP knows the rules and how to work them.  Childish behaviour is expected and rewarded.  Absconding a way of re-negotiating privileges.

In the open ward the RDP is at home and well known to the nurses.  Like family members their idiosyncrasies are tolerated.  Up to a point.  Which could be clopixol acuphase with head-banging side effects after 24hrs or rapid tranquilisation with haloperidol or olanzapine.  Grabbing and jagging I call this.  It hasn't changed in 40 years in my experience.  Mental health acts have come and gone.  Coercion remains the same.  Involuntary means against your will.  Violation of self and human rights.  Chemical straitjackets.  Requiring resilience to recover from.  Being thrawn (Scottish word for stubborn or contrary) helps.  A determination to get over the indignation and hurt, and to get back on with life.  Drug free and resistant to psychiatric labels.

Recently a senior manager in a national mental health organisation said to my son "your mother is a force of nature" - the urban dictionary defines this as "a person or creature possessing unnatural or god-like power".  I'll take it as a compliment although it might have meant unpredictable, non-conformist and out of control.  Take your pick.  The shoe fits.  Getting out of the psychiatric system did require, for me, to do my own thing and listen to no-one.  For others it might be different.  And that's OK for I wouldn't want to force my opinion on anyone else.