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.

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