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

Thoughts on Henrietta Lacks and The Forgotten in Psychiatry

A few years ago I read an article about the campaign to recognise the amazing contribution Henrietta Lacks has made to medicine. She has transformed so many areas of medical practice, furthered our understanding of our bodies’ cells’ processes and disease, and been the foundation for so many drug therapies and treatments for so many illnesses. She did all of this. Without her knowledge and her consent.

This blog post is not an attempt to write a biography of Lacks’ life. There are much better people who can do and have done that.

It seems such a far off time and place, where 62 years ago in the US a poor black woman was treated for cervical cancer and cells spirited away during her therapy without being asked. These were cells that didn’t die and became known as the immortal HeLa cells by those who used them for research.

But, before everyone gets indignant about the treatment of a black woman in America half a century ago, and it was most certainly a horrendous abuse of power over another human being, remember that we in this country are not immune to carrying out similar abuses on the vulnerable, or those unable to give consent. The Alder Hey scandal regarding human tissue retention without consent took place in the UK between 1988 to 1995 and was by no means an isolated occurence.

On this day when Henrietta Lacks will be so much in the news after a ruling in the US has decided that her legacy should be more recognised, it would be great if we could all think about people we know who have benefited from HeLa. Anyone who has received treatment for cancer or AIDS, for example. We have all been touched by Henrietta Lacks either ourselves or through friends and relatives, and perhaps today is a time to be thankful to her and others like her in whatever way we can.

Also…

While today signifies a victory, if it can be called that, for Lacks, I would like to highlight the experimentation that went on with mental health patients without any form of consent for many years. Centuries, even.

I was fortunate enough to work on a unit with individuals who had severe and enduring mental health problems. Many of them had been kept in hospital without being sectioned and without consent. Some with admissions dating back to the 1940s. That, however, I will most likely come back to in another post. But one of the jobs I had when I started on the ward was to go through these patients’ archived old notes and see what rehab they had been through in the past, noting what they had responded to and what they hadn’t found beneficial. Looking through these histories, I saw time and again how these patients were given treatments that for some of them led to catastrophic physical and mental impairments, for example being left without speech and altered gait. What I didn’t see were consent or consent exemption forms.

Many of the drug therapies used to address severe mental health problems have been used for decades. And we should perhaps give thanks to the patients who, in a time of little regulation on the use of medication, gave us an evidence base we use today. I’d like to think, and yes this is a personal view in a personal blog, that we can honour their memories by ensuring that these practices never happen again and that we continue to ensure that patient welfare and informed consent wherever possible, is paramount.

***

More can be found on Henrietta Lacks here:
http://henriettalacksfoundation.org/

The Perfect Job…

… has been advertised. A job that if I could have written an ideal job description for myself, or if those that know me were to try and describe a role I’d be well suited to, this would be it. And yet for some reason, instead of finishing off the inviting form on the NHS jobs website, I’m writing this.

Jobs in NHS forensic care that are not only open to current employees in the same Trust are very very rare. Jobs that OTs can apply for even more so. But perhaps I’ve just touched upon why I am so reluctant to finish off the form…

I am an OT. Yes, an OT. The weight of other professionals’ attitudes towards OT tends to weigh on me heavily.

I have never seen myself as elitist or aloof as an OT, just a regular part of the MDT. I am happy to help patients and other staff on whichever unit I work in carrying out general tasks that need doing, whether it’s counting the restricted cutlery items at lunch or assisting in tMVA incidents if I’m in the vicinity and it is appropriate for me to do so.

I believe that it is only by seeing patients in their daily environment I can truly get an idea of where they are coming from. Seeing people in sterile therapy sessions is all well and good but it’s by being there first thing in the morning to see if they can actually get up and dressed, seeing if they can sort out their own laundry or whether they need prompting, seeing them attempt to make a cup of tea or interact with others, that I can get a good idea of their strengths and abilities. Yes I can and do run therapy sessions, but what I am saying is that’s not all I do. Or all I CAN do.

Yet time and again I get people who haven’t worked with me saying to me variations on “you lot swan in and out, get to do nice stuff with the patients, and then leave”. I want to bang my head on the wall. Not only is that underestimating my skills but more inportantly it is quite demeaning to the patients who might be doing what on the surface may look nice but is actually taking a massive amount of concentration and effort.

There are so many things I would like to say about OT and it’s perception by some (but by no means all) other professionals. But I’m tired of feeling like I’m banging my head against a brick wall.

So, I will complete the application because the job is brilliant and I want it and I have such a lot to give it. It’s just I hope the people who receive the application can see that too.

N.B. This blog was never supposed to be a professional thing. It wasn’t supposed to be completely psych focused. It was supposed to be personal. However, if your job is something important to you, it IS personal. And to me it is.

Compassion in Mental Health Reporting

Ask me about what I would change about societal attitutes towards mental health issues and I’d have a long, long list. However, pretty close to the top of the list would be addressing the attitude of the media towards mental health.

Yesterday I was sat reading my Twitter feed when I saw the following from @TorbayCID:

“Torquay suicidal man cost Network Rail £37,000 in delays with latest attempt http://www.torquayheraldexpress.co.uk/Torquay-suicidal-man-cost-Network-Rail-37-000/story-19614746-detail/story.html …”

I had to read it twice to make sure what it said was actually what it said. Unfortunately the words didn’t change and I was left aghast. Look at it first time and you see factual reporting. Pure fact, Nothing wrong with that, right? But reporting something involving emotion, perhaps acknowledging that emotion may also be involved, would be appropriate. It chose to single out the financial impact of someone who has tried to commit suicide multiple times. Ever see something like written about someone with a life-threatening physical health problem?

So I replied. Instead of the massive lecture I wante to give them, I could only reply with the following from my account, @cariad_mawr:

“Suggest good MH care not blame? MT”@TorbayCID: Torquay suicidal man cost Net.Rail £37,000 in delays w/latest attempt http://www.torquayheraldexpress.co.uk/Torquay-suicidal-man-cost-Network-Rail-37-000/story-19614746-detail/story.html …

Because if the psychiatric care for this individual had been adequate these acts would not keep happening at the rate that they do.

I have treated psychiatric patients who have been serial trainline disrupters in the past. Yes, there is no denying that their actions cause disruptions, inconveniences and stress to others. In the same way someone having a heart attack in the middle lane of a motorway carriageway can close it for hours and cause delays.

Still, that cold 140-character post from @TorbayCID stayed with me overnight. I recalled a study that was done once, I think in Japan (I wish I could recall the exact details), where people were presented with an individual apparently climbing over the railings of a bridge above a busy road. If the people were close enough that they could make out facial characteristics of the potential jumper, they were relatively understanding. If however, the crowd were further away, where the face of the individual was indistinct, they became impatient and started urging the person to get on with it and jump. Just a matter of distance and visual perspective and their attitude changed pretty much en masse.

Frightening thought, isn’t it?

As I am writing this post, I am reminded of an incident when I was studying at university. I had been on a night out and was returning to my halls of residence, which were on the university hospital site. As I approached the bridge over the dual carriageway I saw people standing around and the traffic stopped. I then made out the sillhouette of a woman leaning over the yellow railings. She was heavily pregnant. Two things struck me as I started forward: firstly that my boyfriend at the time wanted me to ignore it and thought we shouldn’t get involved (we didn’t last long together after that). Secondly, that noone was talking to the woman, who was eerily silent and just staring at the road below. I spoke to one man who introduced himself as a house officer from the A&E department of the hospital, who said he thought she was probably from the mother and baby psychiatric unit on site and that he had called an ambulance but didn’t want to approach her in case she went over. He was saying all of this while she was in earshot. Whether she would have been able to take it in at the time I don’t know, but still. The woman started trying to get her leg over the barrier at this point so I went up to her slowly, saying hello, asking what had brought her to such a place on such a cold wet night, and that I thought it was time she was getting back in the warm. I put my hand on her forearm and after a brief hesitation she took her eyes off the road and I helped her to get down. I walked her back to the mother and baby unit, where an unsmiling nurse showing no emotion at all came to the locked door after I buzzed the intercom and explained who I had with me.

I don’t know why I’ve just shared that, but I have, perhaps because it took no special skill. I was a first year OT student in my first term and I hadn’t ever been presented with that situation before. Just being human and showing a bit of caring was all I could do. Perhaps it could have gone wrong, there are myriad possibilities of outcomes, but it didn’t. I was fortunate that as a student I didn’t have to worry about a professional inquiry or some such if the lady had decided to follow through with her attempt. But all it took was a bit of compassion.

So today I have done the best I can for the individual in the article: I have written about it in my blog and hopefully anyone reading this post will keep an eye out for similar articles reported in this nature and complain, as I hope to do later in the day, to Torbay CID and the Torquay Herald Express.

NOTE: If anyone has a reference for the study I mentioned above regarding attitudes to potential suicide victims I’d be grateful if you could forward it to me for future reference. Many thanks.