In Praise of Psychiatric Services?

What does a Community Mental Health Team (CMHT) actually do?  Of course I do know what the remit of their existence is:  Meeting the needs of people with mental health problems who don't need a psychiatrist.

But what if your GP decides you do need the input of a psychiatrist, why isn't her/his decision acknowledged, respected and action taken, rather than the CMHT swoop down on you instead?

We have a sixty year old resident ('Winnie') with complex mental health problems including ongoing addiction.  You might think we are being remiss in not addressing her addiction but our hands are tied by Safeguarding Vulnerable Adults (SVA) and Deprivation Of Liberty Safeguards (DOLS) legislation, and of course, importantly, whether this legislation exists or not, Winnie has the right to choose her own path in life.

Winnie presents as quite a strong character with a seemingly happy disposition, but there are strong suggestions (of late) that all is not well.  I love my job and see my main purpose as that of promoting well-being and being 'there' for the residents.  I have regular daily chats with many residents and these chats, quite rightly represent the bulk of my work.

Winnie is one of these residents.  We chat about everything past, present and future.  As said, of late, there are obvious signs that all is not well and our chats have taken on a deeper nature.  She talks of a deep depression that she hides under her happy veneer and indeed, my last post is based loosely on that she has disclosed - the real Winnie.

Her depressions is something that she has coped with for the majority of her adult life.  She receives antidepressant medication and it has been enough - along with her own self-medication of alcohol - to control her symptoms until a recent event led to feelings of helplessness and hopelessness that dogged her in her early twenties.

We contacted her GP who is a good GP who visited Winnie in the home and spent time with her, listened to her, increased and augmented her antidepressants and referred her to psychiatric services.

Psychiatric services initiated a CMHT visit, although which professionals were represented in this team we do not know as we were not privy to this information.  Why might this be - perhaps the bad reputation of care homes and the assumption we would not be interested?  If this is the case - it is bad practice.

The team spent half an hour with Winnie and left - no staff being approached to give input into Winnie's situation.  A few days later, my manager was contacted by a psychologist (who had not been part of the team) to advise that the home was to be reported re SVA and DOLS issues in relation to Winnie.  Flabbergasted my manager asked why and the reason given was incredible.  He asked why he had not been contacted previously as to enable the team to be aware of the true facts and was met with an embarrassed silence.  We were not reported, nor did we receive a cc of the letter to the GP which is good practice and good manners as we are very much involved in Winnie's care.

Winnie continued to deteriorate both mentally and physically and my manager contacted the CMHT again requesting further input, only to be told that their work was done.

What is their purpose?

The good GP is bringing together a CMHT of her own making and being a good GP visits Winnie weekly as she shares our concerns.  In the meantime Winnie continues to suffer.  Hopefully, somewhere in the near future, Winnie will receive the input of a good psychiatrist, emphasis on good as we have four psychiatrists who serve the residents in our home.

One is a good psychiatrist - the old school variety of 'doctor knows best' who listens to and understands the real needs of his patients and follows up their care regularly.  His patients have the best outcomes.

The remainder are of the newer breed who offer choice-ism.  "Which tablets do you want to take?" and/or "I hear you attempted to strangle X - can we discuss this?" (if "No" to the latter it is not addressed!) and is all well and good until  you display florid psychosis and/or come very near to actually strangling X and are sectioned.  What kind of care is this?

You are never offered the choice of mental ill-health - but hey, even if you lack insight you can choose your medication based on the knowledge you acquired while being a medical student!  You were not a medical student?  You don't have a degree in psychiatry?   Never mind, your mental health issues may not be addressed - but hey, you do have choice!

You may think from the above that I believe those with mental health problems have no rights at all - but this is not the case as I am very BIG on the rights of residents, as is my home.  I believe they have a right to the best of treatment and not the superficial fluff of caring they receive now, although as said, even receiving superficial fluff takes an awful lot of time to get to as there is an awful lot of hoops to jump through first.  And you continue to deteriorate.

What say you?

Anna :o]

Depression

You watch me
Through those damn dewy eyes
That torment my soul
And steal
The very heart of me.

The warning growl
Through snarling teeth;
The putrid breath
Feeding despair
And souring hope.

You're are my black dog,
Forever vigilant.
There is no escape.

Damn your dewy eyes.

Anna :o]

The Art of Death

The Art of Death

I paint in brilliant red;
Swift indiscriminate brushstrokes
Rend the canvas
Of my battlefields.

You hang me like some
Clumsy masterpiece.

Strip away the security
Of my shield
And see my stark imagery,
My epitaph
Of battles won
And lives forever lost.

I am Death
Cold and clinical.

Anna :o]

With thanks to Tess at Magpie Tales

Saving our NHS Forest

I love my NHS.  It is probably true that I love it less than I did.  The steady privatisation, fragmentation, low staff moral, the illusion of choice has left harshness, a coldness that is felt by patients.  It is also true that within the NHS there are many good people who genuinely care and in themselves are part of the healing process.

The NHS that I knew and loved is so eloquently described by Dr No in Alma Mater.  I was so taken with it; I emailed it to David Cameron's election HQ, then naively believing that the Conservatives would indeed look after our NHS and perhaps even attempt to recover the NHS as it once was.  Whether he read it or not - I don't know.

Of course I wasn't a doctor and not yet a nurse then in the NHS that Dr No described, but a patient.  Several admissions during childhood and for the delivery of my own children, I was aware of the warmth and camaraderie for it indeed rubbed off on patients.  Times have changed and changed the NHS, the sense of temporarily belonging to that family during admittance is very seldom apparent.  Yet the NHS is still worth saving and I am grateful that it exists.

The NHS can be likened to a great oak that stands proudly in an ancient forest existing on the peripheries of our lives; not a constant requirement - but there when we need it.  Its great branches supporting its lush green canopy offering us shelter when we are diseased or injured; its roots searching and probing for life saving cures; its leaves providing us with the oxygen we require for our very existence; its fruits offering new life; its whole self offering a place of refuge in times of need.

Our real forest have recently been under threat, the coalition government planned to sell 15% of the public forest estate by 2015.  Critics objected to the sale on the grounds that it might be more difficult for the public to gain access to them, and even wildlife and the very existence of forests themselves might be threatened as timber companies and developers took control - unfettered by the protection of public management.

The public were up in arms and in a short space of time, a cyber petition gained over 500,000 signatures and our forests were saved.

The very existence of our NHS forest is under threat under the guise of the White Paper: Equity and excellence: Liberating the NHS.   Its apparent aims appear laudable: putting patients at the heart of everything the NHS does; focusing on continuous improvement and empowering and liberating clinicians.

In reality, I believe the White Paper to be a terminal illness masquerading as a miracle cure; its true aim to be that of opening the NHS to privatisation; where the very NHS will be threatened as private providers take control, destroying all that is seen as unprofitable, unfettered by the protection of public management.

The public (as patients) will find in increasingly difficult to gain access - especially if presenting with an illness that threatens the confines of a budget.  GP Consortia - unless a true commercial enterprise - will be doomed to failure and be swallowed up by the private sector.  The NHS as we know it will cease to exist.

You would think that the medical and health professions and all in healthcare would be up in arms about the destruction of our NHS forest - but no, bar a small few!  You would think that the general public would be up in arms about the destruction of our NHS forest - but no!  A Save our NHS petition has only gained a mere 37,489 signatures.

A recently published survey commissioned by the BMA would suggest that the great majority of the medical profession have great concerns re NHS reforms.  It is a fact that the key findings are a sham with less than 9% of doctors contacted even bothering to respond.  Amongst its real findings are: under four in ten do not understand what the reforms mean to them individually; over a third are waiting to see what happens; 11% of GP practices have taken no steps in preparing for the reform; 37% know very little or nothing at all about current NHS reforms; 33% of doctors (excluding GPs) have taken no steps to prepare for reform - and so it goes on.  Read the real results of the survey here: Ipsos Mori.  Read it (the downloads!) and weep!

If those in the medical profession and indeed those in nursing and allied professions do not appear to care - how in hells name are we going to engage the general public?

Some of us care and I am thinking here of all the good doctors who blog: Dr No, The Witch Doctor, Dr Grumble, The Cockroach Catcher et al, Militant Medical Nurse and the lovely Julie at Campaigning for Health - but are these fine bloggers truly representative of their professions - or are they the voice of the minority, the majority just waiting to see what happens?  I would hope that they are not and would echo Julie's sentiments in that all who work in health professions - and care about the NHS - should not just 'stand there and moan - do something!'

When we mourn the death of our NHS in years to come, we will throw our hands in the air and exclaim "Why didn't somebody do something?"

Anna :o]

Addendum:  I have been made aware of another petition that seems to be enjoying more success.  Please visit 38degrees, sign and help save our NHS.  (These are the folks whose petition saved our forests!)

The Shamrock

The Shamrock

He stands the proud sentinel,
No more the Irish rover.
True to his love of sweet Violet
They spend their days in clover.

Anna :o]

With thanks to Tess Kincaid at Magpie Tales for the inspiration.

Cafe Alliaceous

Cafe Alliaceous

Night black recesses
Offer
A masquerade
Of flickering candles,
Disguising infidelities
Met at
Red frocked tables.

Escargot Bourguignon.
Every breath savoured,
All passions melded,
Tongues licking lips
In excited anticipation.

Bon appetit!

Fellow bloggers.  Take a break from the norm and excite your creative juices!  Visit Magpie Tales every Monday and let your imagination run wild!

Anna :o]

Never Events

The lovely Andrew

Never events should never happen - but they will, for to err is human.  Never events happen in health care settings and sometimes in a patients home.  Never events cover wrong site surgery to an overdose of insulin.

A previous list of eight never events has recently been increased  to twenty-five and details can be found here.  There are one or two detailed there that I have great concerns with -  with regard to inappropriate use and one of them reminds me very much of Dr Jane Barton.  We have a guidance plastered on the clinic wall at work re the opioid naive patient and as said, whenever I read it - I think of her; but that is another matter.

I do not think that any surgeon, nurse or technician deliberately leaves instruments. etc in operation sites, nor do I think that a doctor or nurse deliberately overdoses a patient - forget nutters like Beverly Allitt for this is not about them.  Errors should never occur - but they will.
Now the list of never events is greater - it stands to reason that the number of actual events per year will increase.

I have given the wrong medicine to residents twice - perhaps more than this and I am unaware of it?  It wasn't a deliberate action, but caused by a moments distraction.

Health Secretary (the lovely) Andrew Lansley has declared that understaffing is not an excuse for 'never events'.  What's that you say "Understaffing?"  So he finally admits that wards are understaffed!  This issue of course does not limit itself to nursing and includes doctors and midwifes.  The more doctors and nurses are made redundant or not replaced (despite election promises to protect front-line staff) - the more never events will occur.

However, this post is based on an interview with dear Andrew in the Nursing Times (which occasionally rises above the banal) in which he declared he would not tolerate excuses from nurses who blamed life-threatening mistakes on understaffing and being over-stretched.

A wag left this brilliant comment:  "Presumably if staffing levels have nothing to do with safety, one nurse could run the entire NHS?????"

Beware doctors and nurses - the shit won't hit the fan - it will hit you!

Anna :o]

Internet-informed Patient: 27th & 28th March, 2011

A one-day symposium and hack day is being held at the Moller Centre, Churchill College, Cambridge on the 27th & 28th March regarding the Internet-informed Patient.  Full details can be found here.

My - how I would love to attend - but I can't as they are my work days and I have no annual leave left.

Please - if anyone reading this is lucky enough to attend - I would really be grateful if you would email me after the event and let me know the outcomes.

Cheers in anticipation!

Anna :o]