Mental Health Triage – a Role for OTs?

There have been numerous articles recently regarding the trials of mental health nurses  accompanying police officers on patrols and attending calls to provide a triage-type service.
An example of which can be found below:

http://m.bbc.co.uk/news/uk-england-23759565

Great! It’s about time.

However… I see a brilliant opportunity for OTs to be involved.
Think about it  for a moment – many mental health OTs specialise in looking at community living and coping strategies for dealing with activities of daily living. They can analyse individuals’ capacity to cope in the community and provide short and long term strategies for helping individuals to remain or become independent in their home and social environments.

It is also not well known by all that OTs can also be AMHPs.

One of the things holding back these triage-type teams is that other agencies are not open outside of office hours. OTs can put together short term plans for intervention to maintain function until other agencies can assist.

It would be wonderful if the College of Occupational Therapists (COT) and individual OTs got involved in highlighting the potential benefits of having OTs in these teams.

I am not suggesting OTs replace nurses in these teams, but to work alongside.

Together, it might just work…

ASDA’s trick or treat: Stigmatizing people with mental illness (TW)

One in four people will experience mental health problems in their lifetime. With that in mind, read on…

I was alerted via Twitter of a Halloween costume that ASDA are selling this year.

Usually I post links at the bottom of posts, but it may be useful for readers on this occasion to check it out first before continuing to read…

http://direct.asda.com/on/demandware.store/Sites-ASDA-Site/default/Product-Show?pid=G004314909

Yes, for £20 you can purchase a:

Mental Patient Fancy Dress Costume

With the following description:

Everyone will be running away from you in fear in this mental patient fancy dress costume. Comprising of a torn blood stained shirt, blood stained plastic meat cleaver and gory facemask it’s a terrifying Halloween option.

In the 21st century, how can this type of perception continue?

We need to think about how entrenched views of mental illness are in our society, and how we can address something so ingrained in history. For hundreds, if not thousands, of years mental illness has been feared and people experiencing symptoms have been victimised and stigmatised. Whilst what ASDA has done is completely and utterly worthy of outrage, it is also an important reminder that misconceptions about mental illness and psychiatric patients persist and need to be addressed.

The responses to Stan Collymore (@StanCollymore) when he tweeted regarding the ASDA costume mentioned above are further proof that stigma towards the mentally ill is widespread and overt.

Mental health patients are not the danger they are so often portrayed in the media.

MIND have produced an excellent leaflet, which can be viewed on their website or downloaded from there, which gives statistics and facts on mental illness. It has a section on “dangerousness”. It can be viewed via the link below:

http://www.mind.org.uk/mental_health_a-z/8105_mental_health_facts_and_statistics

I apologise if this post comes across as ranting in nature or not as polished / coherent as some of the previous posts on my blog; on this occasion I wanted to write rather than let my feelings about the issue build.

So again… One in four people will experience mental health problems in their lifetime. My one request is that anyone who has read this post this far thinks about what they can do to address mental health stigma today.

*** UPDATE 23:15 25/09/13***

Asda (@asda) have tweeted:

We’d like to offer our sincere apologies for the offence it’s caused and will be making a sizeable donation to @MindCharity.

However, ASDA it seems are not the only ones to offer such goods this Halloween. How about this from Tesco?:

http://www.tescoparty.com/FancyDress/Product_Detail.aspx?ProductID=FANC1712

Apparently AmazonUK also have similar items for sale. More evidence that we need to tackle the stigma around mental illness.

The Saga of Supermax and Solitary

Earlier this week, the media reported on a female prisoner who was seen by inspectors on an unannounced visit to HMP Bronzefield in Ashford, Surrey. She has been in segregation since prior to the inspectors’ last visit in 2010. So, over 5 years. In a “squalid” cell (as described by various media outlets). The individual is reported to have displayed long term challenging behaviours and we don’t know the full story, as (as is right), it is confidential. I am not highlighting this case as a criticism of the care and treatment this individual has received, because I don’t know the facts to criticise. I do however feel the need to highlight certain aspects of what has been reported and comment on it.

As an occupational therapist, one part of this story I picked up on and took note of was the fact that despite the fact that the inspectors commented on the provision of an improved activity programme for this lady since the last inspection, she still did not have enough to occupy her. I wonder how much of this is down to a lack of variety of activity or actually due to the restrictions in the environment. How much activity can be offered in segregation? I mean, seriously? I had a think about this and, with the confines of the physical environment, and also what therapeutic tools you can provide for a patient that might use those tools to damage / threaten to damage the self or others, the options are severely limited.

This makes me think back to the earliest days of fledgeling OT and psychiatric nursing. Patients were not trusted with anything that could vaguely be used as a weapon and so the best they could hope for was a walk in the grounds. Some staff in some institutions, such as Brislington House near Bristol, started giving patients gardening tools whilst out in the grounds. They found that far from being dangerous, the patients thrived on being given some control and responsibility back.

Put an individual in segregation and the easiest form of control for them is often just not to cooperate. Once disillusionment and the (well documented) effects of solitary confinement have kicked in, the downward spiral is dangerous, steep and difficult to stop.

I had recently been planning to blog post about the phenomenon of Supermax facilities in the US, but the media coverage this week of events closer to home in terms of solitary confinement and segregation meant that wanted to explore the UK situation first.

It is easy for me to wonder and ponder as I’m not currently working in the forensic environment, and health and safety considerations would not allow it. But I would be fascinated to know what would happen if this individual, or others in a similar situation, were just given the opportunity to take some control back. With no real conditions attached in relation to past behavioural sanctions. Wipe the slate clean in terms of behavioural history. Transfer to another institution and start again. Long-term segregation clearly is not working apart from the bare minimum of keeping the individual and staff physically safe. Meanwhile, people’s mental states are being severely affected.

RD Laing had much to say on trusting patients with schizophrenia to work out their own issues. I’d like to go in to that in more detail, but that is for another post. I wonder if perhaps the time has come for individuals with challenging behaviour to have the opportunity to do the same.

***

More on the story that sparked this post can be found at:

http://www.independent.co.uk/news/uk/home-news/cruel-inhumane-and-degrading-female-prisoner-kept-segregated-in-squalid-cell-for-five-years-8777722.html

Thoughts on International Left Handers Day and Mental Health

Every day is a day to celebrate something, or to be made aware of something. Today it is the turn of Left Handers everywhere to be celebrated (according to Left Handers International, who has been celebrating this day since 1976).

Go us Southpaws (for I am one)!

Should we be celebrating, though? Or should we be using the day more to highlight the increased risk of mental health problems for those of the Left (hand).

Imagine a world where parents are told this by teachers or paediatricians:

“Your child is left handed, here’s a leaflet on schizophrenia, because they are more likely to get it. Sorry and all that but on the plus side they are more likely to be creative”.

OK so that is far fetched and not appropriate but…

Risk factors for mental illnesses such as schizophrenia (being a sibling in a large family and in a low socio-economic group) were instilled in me throughout my uni days and beyond in to my practice. Whilst the correlation between being left handed and mentally ill was talked about, it was fleeting and in passing. Not ever seriously.

As an OT it caused all sorts of practical considerations – finding enough pairs of left handed scissors for art and craft interventions, watching patients with tremor or altered spatial awareness as a side effect of meds or disease process nearly burn themselves on right-handed cookers (yes, try looking at most hobs and they are right handed).

The last unit I worked on had twelve patients. Only three were right handed. Bearing in mind less than 10% of the world’s population are lefties, even that small unit may be telling us something. I can’t remember the figures now but the ward I worked on before that was larger but had a similar percentage of lefties.

As usual on this blog I’m not suggesting answers, just highlighting issues and raising questions. So for this post I am asking whether perhaps we should be paying more attention to patients’ handedness? Perhaps especially in early intervention settings. Should left handers be considered at higher risk of relapse? Should their treatment differ in any way to take account of any differences in the way a leftie’s brain functions?

Or perhaps we should ignore the correlation altogether because everyone is an individual, right?

Sticking plasters and Suicide

Warning: may trigger

Today the Welsh part of the BBC News website reported on The Samaritans’ and Network Rail’s campaign to reduce suicide on the railways by 20% in 5 years. The campaign was launched in 2010.

The article goes on the report that:

“Suicide rates in Wales have risen 30% in two years to the highest level since 2004 and are higher than in England.”

There are so may facets to this…

The national Samaritans/Network Rail initiative (displaying information at stations re: helplines etc) is a positive step. There can be no doubt about that. Anything that can help must be surely welcomed. However, it is a reactionary approach and a last resort for those in crisis. Violent, or active, suicide attempts (e.g. jumping, hanging) are more “successful” than passive (e.g. overdose) methods of ending life and so the idea of relying on posters at train stations etc. when someone is in the process of trying to kill themselves is a dangerous game to play. We can’t afford to hope that someone when in such distress will be able to comprehend a poster or be rational enough to be able  to do something about it.

Surely what we need to be doing when looking at these increased rates of suicide is think about getting to people before they feel the need to end their lives in this way. Better crisis prevention and crisis intervention. More people are in crisis? Then the simple answer is that we need to expand our service catchment and that means, I’m sorry the Government, the NHS et al, that more money needs to be spent to achieve this. There is no other way. There is no cheaper way to help prevent these needless deaths.

Another aspect to this article that I want to raise is the issue of suicides rising faster in Wales than England. This is not something we can just dismiss. It needs to be shouted about. We really need to be delving in to why this is, and what we are able to do address this. For perhaps if we can find the reason why there is this discrepancy we can target our resources to those most in need. Although something inside me hates the idea of having to target resources; in an ideal world everyone in need should receive assistance.

We also need to look at what in particular has changed to make the suicide rate soar. The BBC article talks about “anecdotal evidence” regarding the financial state of the country. However, anecdotal evidence is not enough. Mental health needs to get more evidence-based as a matter of urgency. Because after all, it isn’t a case of “wouldn’t it be nice to know”, it is a case of real people’s lives being at stake.

***

The full BBC Wales article can be found here:

http://www.bbc.co.uk/news/uk-wales-south-east-wales-23641945