In Praise of Psychiatric Services? (2)

Dr Rant

I’ve just tried to change my password to ‘Community Mental Health Team’ but Facebook said: contains too many useless characters.  (Facebook 16/12/11)

Sorry Community Mental Health Teams  (CMHTs) – I find this to be true – well certainly in my neck of the woods.   God help the unfortunate soul who experiences an exacerbation of mental health ‘ishoos’ while residing in social care for they are truly lost!

I have written about this before and unfortunately nothing has changed.  The CMHT completely ignore us (staff) in that they do not seek our input, our knowledge and our concerns.  Liaison – what’s that?  Do they consult the referring GP (?) – I tend to think not (and indeed sometimes know) as GPs are equally frustrated re the lack of communication and cooperation between ‘colleagues’ and that (wrong) decisions are made (by the CMHT) after a thirty minute interview with the poor resident in question.

Ted entered our home some five years ago – he does not have any problems related to memory but that of depression and apathy which has dogged him since a traumatic incident in early adulthood.   He is isolated due to social anxiety which increases his depression and feelings of hopelessness and low self-worth. 

This has been his life for nigh on thirty years and increasing apathy, hopelessness led to Ted being at high risk of self-neglect and increasingly vulnerable to those in society who ‘befriend’ him and rob him of his benefits and thus him becoming a welcome resident of our home.  Our home is now his home.   (It is Ted's home - I/we have the privilege of working there!)

For some time Ted has become reflective re his personal situation and this in itself has led to a deeper depression (‘I am worthless’) and as he is comfortable in his home he is also able to express anger (‘I am useless!’) both verbally and physically (as in punching inanimate objects and destroying his own personal effects).

Ted has – for the first time – begun to self-harm.   He also exhibits behaviours that some might construe as sexual in nature – but to me (and I have discussed this with him) are an expression of his need to be loved and reverting to babyhood and the intervention required is to him, proof of caring.

Ted’s GP referred him to psychiatric services requesting the input of a psychiatrist.  In turn, said psychiatrist did not see Ted rather placing Ted’s future in the hands of the CMHT.   What is the purpose of the CMHT?   A CMHT meets the needs of people with mental health problems who don’t need a psychiatrist.

So it needs to be asked:  Does this little collusion of anonymity (psychiatrist and CMHT) have an agenda?    Why is the GP referral of secondary importance to that of the CMHT – who make their decisions based on a thirty minute interview without liaising with other interested professionals who know Ted?

The CMHT in their wisdom decided that Ted did not need to see a psychiatrist.  This decision – to Ted – was further evidence of his unimportance (‘Why is no-one interested in me?’).

Ted’s continued and deepening depression began to compromise his physical health in that he ceased to eat and had poor fluid intake causing an electrolyte imbalance which led to problems and the need for medication to counteract this.

Ted’s GP, who had long realised that Ted’s needs were beyond his expertise again contacted psychiatric services, pressing for the input of a psychiatrist and again this led to a swoop by the CMHT, who again decided that Ted did not need to be seen by a psychiatrist?

Six months ago, near death (malnutrition and dehydration), Ted was hospitalised.  He was at this time (finally) seen by a psychiatrist and when strong enough was transferred to a psychiatric hospital to treat his depression!

The psychiatrist contacted the home for a history of Ted and requested our thoughts – something the CMHT (and indeed the psychiatrist prior to this) did not!

It appears to me that the little collusion of anonymity ensured Ted paid a high cost both physically and mentally by denying him access to a psychiatrist – but that is what collusion of anonymity is all about – bouncing patients back and forth from one specialist/discipline to another with nobody taking responsibility for the patient as a person.

Ted is a person.

Before I close I would like to assure those who exist in CMHTs that this is a specific post to experiences in my neck of the woods and is not a gross generalisation of all.  I am sure that team members offer a vital hand to those in the community who do not need to see a psychiatrist.

Why do psychiatrists not take heed of GPs here?  Why in these instances are decisions left to CMHTs as to whether a patient requires the input of a psychiatrist – why does the psychiatrist not see the patient and make the decision him or herself?   Just wondering, that’s all…

What say you?

Anna :o]

Winter Feasts

Stripped bare

By autumns theft,

Skeletal now

Her frigid branches

Ache

To touch the warmth

Of rising Sol.

Dormouse, dormant

Curled deep

In winters sleep

Scratched out by

Hungry Fox.

Opportunist he,

He watches waiting

As Redbreast bobs

Through evergreen

Bearing

Seasons berries.

And distracted by

Her luscious feast of

Rich red rubies

Becomes easy fare

Feathers

On his winter table.

Jingle Poetry at Gooseberry Gardens prompt is:  Snow, December, Winter Vacations and Wildness.

Also posted re The Poetry Pantry # 80 at Poets United.

I must admit to being lazy and greatly slightly unprepared for Christmas, hence I have taken the easy way out and stolen an earlier (written in May)  post from t’other much neglected blog (Puzzelicious).

Merry Christmas folks!

Anna :o]

Change

Image by Mostafa Habibi

The boat,

the means of escape

is there. 

He could easily

step aboard,

cast off, set sail

and once afloat,

be free, unburdened. 

Does he? 

No.

He could go

yet always procrastinates,

always finds a ‘but’,

an ‘I can’t’

or ‘I’d better wait’

and buries himself

deeper

in the sand. 

He could go,

could leave the land,

but won’t cast off the burden

of his self-made anchor,

his self-made shackle.

He will stay stuck,

he does not want

the uncertainty

that change might bring. 

He will stay stuck,

remain the landsman

while gazing

longingly out to sea,

wondering,

“What if… …”

With thanks to Tess at  Magpie Tales for the inspiration.

Anna :o]

the cockroach catcher

‘The ability to dissect out a full set of cockroach salivary glands was a prerequisite requirement for medical school entrance in Hong Kong in our days.’

I purchased Dr Am Ang Zhangs’ book last November and placed it at the bottom of my ‘to read’ pile – I should not have done so.

Holidaying earlier this year – I decided that ‘the cockroach catcher’ would be my holiday read (even though it was still only half way up the pile) – it was a good decision.

Am Ang takes you on a fine journey from his poor beginnings in China to his education in Hong Kong, his life and experience at medical school, his decision to enter psychiatry leading to a post as registrar at The Tavistock Clinic  and to his role as a consultant paediatric psychiatrist within the NHS (and many interesting places in between). 

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.

Although the back cover summary describes the book as a work of fiction, the contents are based on a good and a very real doctors’ journey through medicine.  It is a must read for all those either working in medicine or interested in child psychiatry and indeed childhood itself, and an invaluable read for parents who have concerns regarding their children’s mental health.

It is a fascinating well penned book with references documented in the footnotes and is available from  Amazon.  Visit the cockroach catcher here

Anna :o]

Freedom Of Speech?

Lunch, George Tooker (1964),
Columbus Museum of Art

When first viewing the fine painting opposite, there was not immediate inspiration and then I noticed the fellow at the bottom right hand corner.  Now he stands out as he appears to be thinking, whereas his colleagues appear to be to be lost in some awful blandness.

Viewing this scene reminded me of a post I had not long read at Bad Medicine and inspired, I wrote the below:

He Thinks

He thinks,

Therefore

He exists outside

The comfort zone

In which reside

Those who do not

Bend the rules,

Instead becoming

Slavish fools

To the dictates of those

Who profess to lead,

Control his every

Thought and deed.

He fights the system,

Will not conform,

Will not obey,

Become the norm,

Become a slavish automaton,

Where

Individuality is frowned upon

And freewill is all but gone.

………………………………

For those of you who do not read medical blogs, please visit BadMed and read Dr No’s post.   It deals with the aftermath of a particular ‘incident’ – I am not going to re-open an old wound, so visit blogs mentioned there and discover – which has led to a suppression of free speech.

You may notice that the majority of medibloggers in the UK do so anonymously and may wonder why this is.  Doctors are regulated by the General Medical Council (GMC), once led by the medical profession itself, but now a Government Quango and doctors are now very much policed.   In September the GMC held a poll in which opinion was sought as to whether the GMC should regulate doctors’ lives outside medicine.  How’s that for future policing?

Such is the power of the GMC, where independent thought is frowned upon, that doctors feel the need, the safety net of anonymous blogging.

Why do I blog anonymously?  For exactly the same reason, I love my job yet feel – quite strongly at times – that decisions are made (within the NHS); protocols initiated which actually harm patients.  I have a right, an individual freedom to say so, yet if I blogged under my own name – the nursing regulatory body (NMC) would consider I was bringing my profession into disrepute.

Fear is the driver of anonymous blogging.  Fear of losing ones livelihood. 

We applaud those brave souls who have fought for their freedom in the Arab Spring, yet at the same time are allowing our own freedom to be eroded.  Independent thinkers are being gagged and the gag is becoming tighter.  As illustrated in Dr No’s post – we are even gagging ourselves.

This erosion of freedom, the freedom to think for ones self is being eroded everywhere.  Look closely into aspects of your own lives, notice changes and be afraid, very afraid!

Anna: o]

With thanks to Tess at Magpie Tales for the inspiration.

***8/12/11   Interesting or worrying that the link to the GMC poll finds the page not found.  I wonder why that is then?***  (Link reestablished)

Red Sofa

photo: Christine Donnier-Valentin

I see you abandoned,

Now a street dweller,

As am I. 

You offer respite,

A resting place

For this footsore

World weary wanderer. 

I will sit a while.

I remember home. 

Brick walls

Rendered warm

With paint and plaster. 

Suzanne,

She and I

Made love

On one such as you,

Half-buried,

Deep in plump

Plush red cushions,

Candles flickered

Casting

Dancing shadows overhead,

Watching as we climaxed

In those wondrous moments.

Suzanne, I did love her so,

Even as I took another

Born in fields of tangled vine. 

She, the other,

Gave me succour,

Gives me succour,

Lets me sip her sweet red wine.

Rested,

I will leave you now,

Discard my memories. 

Pockets jangle,

Stuffed full

With buried treasure,

Pennies buried,

Laid long forgotten

Deep within your gaping innards,

Mined greedily by my hungry hands. 

I will court

My waiting lover,

Buy her wares, 

My ladylove

Resting in her bottle,

Suck hard

At her cold hard nipple

As she loves me,

Gives me succour,

Lets me sip,

Lets me taste

Her sweet red wine.

Anna :o]

With thanks to Tess at Magpie Tales for the inspiration.

Where Are All These Obese Women?

The media reported yesterday that the UK has the highest proportion of obese woman and the second highest proportion of obese men in Europe. It would appear that nearly a quarter (23.9%) of British women is obese as are 22.1% of men.

What I want to know is where the hell they are all hiding?

Logic would suggest that at least two (20%) out of  every ten woman I know are clinically obese, and forgive me obese folk, obese is big, not overweight, big and  I would notice – but I don’t because they are just not there (as in 20%)!  That said, I do know (and like) obese women, but totting up family members, friends and colleagues, obese women total 9.5% and overweight women 4.7%.  (I am overweight but have not included myself in this total – although that said I wear size 16 clothing which would suggest I am not overweight, yet my BMI suggests I am, and damn it I know I am!).

These figures (of course) only relate to my little circle of female comrades, whether they are family, friends or colleagues and are therefore not a true representation of female fattiness countrywide.  Yet, my wanderings in the mean streets of the city do not thrust this large population of large women in my face – I would notice – so yet again I would ask – where the hell they are all hiding?

I don’t trust stats and these stats are based on this report from the European Health Interview Survey.  The UK figures are based on this Health Survey for England, 2009 which clearly states in Main Topics that “The HSE 2009 was a short survey with a relatively small sample size….”

The questionnaire is here (pdf).   Scroll down to pages 44-8 which deal with height and weight and notice that reasons for refusal (to be weighed) are part of the questionnaire. 

So assuming that some will refuse to be weighed - and are not excluded from the survey (guesstimates used?) - the outcome must be slewed.  Whatever the case, this admitted small sample size has been extrapolated to reach a desired outcome?  And, and this is an important and, when this cross-section of the general public were chosen randomly to represent a true cross-section of the general public, how could ‘they’ know that this random selection did not include a disproportionate amount of obese people?

I will muse on the above while I eat enormous amounts of chocolate (don’t like it very much really) as I exercise by wiggling my toes.

Where are they all hiding?

(On a serious note, I do understand and appreciate that obesity is associated with many health problems and is not really recommended as a ‘lifestyle’.)

Anna :o]

PS  I don't know why there are strange gaps in the first paragraph - but I can't correct.  Maybe because my beloved comp is still not well?

10 Seconds

This (now amended) poem was first published on Poetry 24.  (Thanks Clare and Martin!)  Please visit Poetry 24 and contribute if you can.

The poem deals with the murder of Stephen Lawrence.

10 Seconds

Strength in numbers,

base mentality,

oh brave men they,

sick to the core,

they surround the enemy,

black face marks

his victim status;

Easy prey,

they pounce

(strength in numbers),

a punch, a kick, a knife,

that’s all it takes to snuff

a life.

He escapes,

runs for his life,

unaware that death

now lives within him,

He falls, bleeds,

heart stops,

life ceases.

Strength in numbers,

base mentality,

they watch him

flee and fall. 

Disinterested,

they leave,

as casually as they killed.

Link: Stephen Lawrence killed in ten seconds

Anna :o]

For those of you who do not live in the UK, please read the history here at Wikipedia.

For today's reporting please see this article in The Telegraph.

Let us hope that at this trial, Stephens family finally see justice done.


With kind thanks to the good folk at dVerse ~ Poets Pub for providing the opportunity to publish again.


Mmmm, mega PC problems, hence post a bit of a mish-mash.  Apologies!

Hanging The Elderly Demented Out To Dry and Jailing GPs

Jim couldn’t work a damn thing out.  Bar that he was lying in a strange bed, he understood not a thing.  He was overwhelmed by panic, his heart thumping away in his chest he pulled himself up and sat on the side of the bed.  Christ, he was so damn stiff, his bones ached as how he imagined an old mans would.  ‘Jesus Christ, my hands!’   He raised them up to just below eye level and turned them round slowly not believing what he saw and horror struck at the heart of him.  They were not his hands!   They were old mans hands – just like his granddads, all wrinkled with parchment thin skin and littered with age spots.  His terror increased.

He was distracted by a noise and turned his head and saw two large black dogs (rottweilers, he thought) pacing and snarling underneath the curtained window.  They stopped and returned his gaze, (oh what penetrating evil eyes they have) lips curled as they bared their teeth, saliva drooling from their ugly mouths as they moved menacingly towards him.  “HELP!” he screamed at the top of this voice, “HELP ME!”

Two kids, teenagers maybe, entered and he thought that perhaps he should recognise them, but he didn’t.  A new kind of panic took over as he desperately attempted to complete the jigsaw in his mind.  ‘Are they my kids?  Do I have kids? I can’t remember!  I can’t remember!  I’m sure I do!  I don’t know!  I don’t know!’

“How can we help you Jim?” the girl asked.  He didn’t know what she was talking about.  ‘She called me Jim.  Why would she call me Jim?  Who is she? Should I know her? I’m not Jim to youngsters – I’m Mr Conway!’  “Jim, are you alright?”  Her familiarity enraged and frightened him and he punched her in the stomach.  “Jim, I’m just trying to help you!”  He attempted to punch her again – but she moved away as the young lad held his arm saying “No Jim, No!”  “We’ll come back in a few minutes and help you get dressed.”

It seemed to Jim that time had passed so quickly that they had returned before they had even left.  “C’mon Jim, we’ll help you get ready,” the girl said kindly as she sat on the bed beside him and began to unbutton his pyjama top.  “I can do it myself!” he seethed as he angrily elbowed her away.  “Okay Jim.  Okay.”  ‘My damn fingers won’t work; I can’t undo my own damn pyjama buttons!  Oh my God what is wrong with me?’   He was so damned angry and so damned upset that he could feel that great big lump in his throat and tears welled in his eyes, he hit, kicked and punched as he attempted to cope with the emotions that had welled up inside of him

“We’ll have to change him,” he heard the young lad say; “We can’t leave him like that.”  “I know,” the girl said.  All of a sudden there were three kids in his room and they stood him up saying stuff that he wasn’t even listening to any more as he was just trying to make sense of everything.  Next thing he knew they were pulling his pyjama bottoms down.  ‘Oh Dear God, kids are pulling my pants down!’  He tried to defend himself as best as he could, kicking, punching, biting, elbowing as he screeched “Get off me you f*****g c***s!”

He was suddenly aware of the familiar smell of faeces and looked down.   ‘Oh my God, I’m wearing a bloody nappy and I’ve shit myself, I’ve bloody shit myself!  He was mortified with embarrassment and kicked and punched and elbowed the young kids, hoping to God they would go away as he was so deeply ashamed….

Jim couldn’t work a damn thing out.  Bar that he was sitting (with his breakfast in front of him) at a strange table in a strange room filled with strange people, he understood not a thing.  He was overwhelmed by panic, his heart thumping away in his chest and he was certain, yes quite certain, that he should be at work now.

Next to him sat a very old lady, God she was making a noise eating and food was spilling out of her mouth.  “Will you SHUT UP?” Jim said angrily.  She ignored him.  “Will you SHUT UP!” he repeated.  She ignored him.  He stood up and angrily brought his cup down on the crown of her head.  She shut up.

He noticed two dogs (rottweilers, he thought) glaring at him from across the room.  They stood up and moved towards him.  “HELP!” he screamed, “HELP ME!”

There is no way no way on earth that I can say with certainty that this is the thought process of those with dementia who are suffering from psychosis.   It is merely an observation of those that do and I do so try to understand.  I often think (when I do my hourly checks at work) that sleep is the only time that these unfortunate souls are at peace.

I like to think I do understand.  Decades ago I had a viral infection that attacked my brain.  I had short term memory problems and often couldn’t complete a sentence as I had forgotten what I was talking about, I had visual hallucinations, altered taste (everything tasted of either cardboard or soap – although I have never ate either!), double vision resulting in difficulties in spatial awareness and I often used to (literally) walk round in circles, murderous intent and many other symptoms.

However I did have one thing that those with dementia do not, and that is insight.   I suppose I must be quite weird as I found the whole thing fascinating, that is, apart from the murderous intent which quite concerned me.

It is said that prescribing antipsychotics to those with dementia that are psychotic reduces life span and that they are over prescribed and reductions in prescribing should be made.  It is now proposed that GPs who prescribe antipsychotics without permission from PCTs should be jailed, yes jailed!

I know that some GPs think that nursing home staff is lazy in that they don’t one-to-one folk like Jim as if somehow this intervention could miraculously cure psychosis (as Jim in his highly demented state would suddenly be capable of reason).  Tell me docs – does this intervention work with younger folk who are psychotic – or are they ‘sectioned’ in their best interests and prescribed antipsychotics?

Please come and work a day in our home and show us how it is done or spend a day with a family who are trying to cope with their elderly demented psychotic relative in the community.  Please show us how!

Fortunately most GPs don’t think like this and understand Jims needs, yet with the ‘climate’ being as it is will not, are afraid to prescribe antipsychotics and instead refer to Psychiatric Services – which may take weeks.  Jim if he was younger would be ‘sectioned’ and receive immediate care and relief of his symptoms.  So Jim is neglected and abused by the system as he is old.

There is a current ‘rumour’ going round that pain relief is just as effective in calming poor demented, psychotic Jims!  As Jim takes 1G of Paracetamol q.d.s. (plus other analgesia) I think he would like to see the evidence!  I would like to see the evidence!

One of the shining lights to me in GP land is Copperfield and I have sung his praise before!  (Copperfield is in fact two GPs.)  Read him  here and here.

I know I have ranted on folks and I am sorry, but as I said in my previous post on this matter – I would rather (if demented and psychotic) prefer to live for five years with a certain quality to my life than live seven years of sheer hell.   I love my residents and it screws me up to see them suffering.

What say you?

Anna :o]

PS  Apologies for the tiny writing in second part - didn't show like this until published.  Failed experiment!  (Also don't know how to place tabs on this exciting new dashboard!)

Lest We Forget

In Flanders Fields

In Flanders fields the poppies blow

Between the crosses, row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved, and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

John McCrae, 1915

The horrific trenches in Flanders Fields were the site of around half a million deaths of soldiers (French, English, Belgian and German) in WWI.   The majority of soldiers who perished were the victims of the deadly gas Yperite which was invented in the nearby city of Ypres - a city almost destroyed in WWI.  Visit the Flanders Fields museum in Ypres (if you can), and discover the horror and hopelessness of being a soldier in the trenches.

On Remembrance Day we pay homage to all those who have died in battle, we hold our silence on the eleventh hour of the eleventh day of the eleventh month (Armistice Day).  The admonition ‘Lest we forget’ was based on the hope that remembering the terrible human cost of military conflict (both military and civilian) we would learn and never walk that path again.

We have not learned and probably never will.  The very nature of humankind leads us to war.  It is my hope and belief that most warfare (in which we are the defender) is justified in that we seek to fight injustice the world over.  We cannot sit back comfortably while others are subject to man’s inhumanity to man.

First They Came

First they came for the Communists
And I did not speak out
Because I was not a Communist
Then they came for the Socialists
And I did not speak out
Because I was not a Socialist
Then they came for the trade unionists
And I did not speak out
Because I was not a trade unionist
Then they came for the Jews
And I did not speak out
Because I was not a Jew
Then they came for me
And there was no one left
To speak out for me

Attributed to Pastor Martin Niemoller.

We must always speak out, always fight wrongs, for if not we are lost.

We must always remember, always remember those who laid down their life for our freedom.  Remembrance Day does not glorify war nor is it a celebration for there is nothing glorious about war; war is a sad indictment that at base level we are still very much in our infancy, we have far to go before we reach our adulthood.

Hopefully one day, the white poppy of peace will supersede the need to remember lives in the form of red poppies worn today, red poppies that are true to the colour of blood spent on distant battle fields.  Until then, we must honour our dead, must always remember those who laid down their lives for our freedom.  Always remember, always, for if not they died in vain.

Anna

The Betrayal

You lie there safe
Resting in your final slumber,
Buried
With your filthy secrets.

Revered are you,
Homage paid by those
Who have not notion
Of evil hidden under Holy Orders.

Why does God
Protect you even now,
Lying in your silken casket,
Dark heart no longer beating,
Yet still pulsating into mine?

Little lambs lie after lights out,
Begging Sweet Jesus
"Please let it not be me."
Dorm door swings open,
Cassock flowing, heavy breathing,
Excited,
He selects his victim.
Child cries out 
"My God, why hast thou forsaken me?"


Secrets lie deep with me,
Secrets that I dare not tell,
Your evil still resides within me,
I hope to God you rot in Hell.

Anna :o]

With thanks to Tess at Magpie Tales for the inspiration