Tuesday, 26 August 2014

the bankruptcy of a system where the prevailing culture is coercive

There are no winners in a game where casualties are the outcome.  There is nothing to be proud of.

Stratheden signposts
The problem with psychiatric system thinking and the biomedical model of mental illness is that any resistance is met with patriarchal decision-making and the infantilisation of the conscripts.  On both sides of the fence.  The staff also lose their agency but not their liability.  

"If you fly with the crows, you get shot with the crows": If you wish to be associated with a particular high risk and/or high profile situation and benefit from the rewards of that association, you have to accept the consequences if things go wrong - you cannot dissociate yourself. (Cambridge International Dictionary)

Forcing psychiatric drugs into a person is very risky, regardless of the label they are given beforehand (or after) so as to justify the coercion.  Mental health acts are laws that reinforce the coercion although they are meant to also safeguard the person being detained.  But in my experience the safeguards aren't safe and the Act gives more power to the enforcers.

Stratheden - view from Lomond car park
The risks of working in mental health leadership or as a psychiatrist is that anosognosia (lack of insight) takes root and capacity wanes.  A godlike persona appears, surrounded by their sycophants, and they believe their own press.  Regardless of relationship or scientific proof.  Because they say it then it is so.  Delusions of grandeur.  Madder than a box of ferrets.  (I can name a number of folk like this in Scotland's mental health world)

But it's not funny when people are being disabled by a coercive system and mothers are having to pick up the pieces.  I am really fed up with numpties at the helm.  Mostly men but some women too who have left their marbles back in the playground.  

There are more issues when there are less resources, as with Stratheden Hospital and the other Fife psychiatric settings.  You just need to compare the cost of a patient bed per week.  In Fife it is around £2000-£2500/patient/week whereas in Carseview it is £3000 and in the new Rohallion low/medium secure unit at Murray Royal, Perth, I hear it is £4000/week.  A general acute inpatient hospital bed is around £4500/week.

It won't just be about the money but also about the management of resources.  I met with the Fife heads of Clinical Psychology and OT back in 2011.  The former said she had no authority in Stratheden, the latter said she wasn't about "micro management".  They may have now changed their tunes.  But I do know that there was no psychology available or OT groupwork going on in either Lomond or IPCU wards in 2012.

I also met with clinical management back in 2011 after first raising concerns about Lomond Ward in 2010, and the meeting was a right waste of time.  They were defensive and patronising.  I was bullied.  At that time the leaders at Stratheden were not accountable to their "customers".  I expect things to have improved but have no evidence to prove it.

Stratheden- older wards
In 2012 we tried to access CBT for my son at Stratheden and we could only get Mindfulness, regardless of our trying to negotiate it with the clinical psychologist.  He would not listen.  It was his way or no way and I had to work through CBT techniques with my son.  Like keeping a dog and barking yourself.

I think the patriarchal nature of psychiatry has impacted negatively on Stratheden Hospital in particular, because of its lack of resource and coercive culture.  If they take the facilities out of the wards then the nursing staff will be left to their own devices.  That's what was happening back in 2010.  I raised the alarm to no avail.  Shooting the messenger was our experience come 2012.

We need psychology and occupational therapies in the wards, also voluntary organisations with a presence.  The more people going in and out of the psychiatric wards will lessen the likelihood of abusive practices (keeping it in the family) and patients becoming casualties.  I recommended this back in 2010.  But no-one listened to me.  

I hope someone is listening now.

Monday, 25 August 2014

"keeping it in the family": the issues that can arise when family members work in the same psychiatric settings

I believe there can be problems with family members working in the same psychiatric setting as nurses or managers (or doctors although that is likely very rare) eg father and son, mother and daughter, husband and wife etc.  

Because if a patient or carer raises concerns or a complaint about the unprofessional behaviour of a nurse or manager then this can impact on future care and treatment of the person.  Especially if a culture of intimidation and abuse already exists in a psychiatric hospital.  

For example.  If a nurse in an acute ward was involved with an incident of restraint on a patient which resulted in the patient being injured and transferred to the locked ward where his wife worked as a nurse, then the treatment of that patient and their carer might be compromised.  

I suppose it is understandable that a person will want to protect their family member.  I know what that is like.  However, in my opinion, there is no justification for dehumanising treatment and using force, for bullying mothers and carers, for denying basic human rights to psychiatric patients, for using locked seclusion rooms with no toilets or drinking water. 

Clinical managers in psychiatric settings where there is a history of family members working as nurses or other professionals have to be extra vigilant to ensure that complaints about practice are investigated independently and thoroughly.  It also should apply where clinical managers themselves have family members working in the same medical discipline and geographic area.  

I believe that comprehensive feedback processes and procedures will help with transparency so that all patients and carers can speak openly and truthfully about what their inpatient treatment was like without fear of repercussions.  Like customer feedback in other settings.  

The Patient Opinion website can help with this, in my experience.  Although it's only a start.  All health boards should have their own feedback systems and complaints processes that make it easy for people to give positive and negative feedback on their experiences of NHS services.

This is particularly important in psychiatric and mental health services where people can be compelled and coerced to take treatment, against their will, under law.  Where phrases like "non-compliant" and "without capacity" can be used to justify the use of coercion and the denial of a person's wishes, even if written previously in an Advance Statement which is not a legal document.

Independent Advocacy is another important safeguard under the Mental Health Act which unfortunately, I think, has lost its power and is a postcode lottery, in terms of whether a person can access good quality advocacy when necessary or can only get a tokenistic service, 9-5, Mon-Fri, with workers on low wages, managed by a service provider, paid for by statutory monies.

Another safeguard is the Mental Health Tribunal but in my experience this has been weighted in favour of professionals and is rarely won by patients and their advocates.  To win a case requires a good solicitor, supportive carer and an MHO who is on the side of the patient.  The latter is also rare, in my experience.

However despite the MH Act appearing to be more of a tool for the professionals rather than a protection for the people labelled with "mental disorder", and respect for their carers, I will continue to speak out and have a voice, to bring about balance, for the sake of justice.

"There will be justice ... when those who are not injured are as outraged as those who areThucydides

remembering Saturday 4 February 2012 and being bullied by 5 psychiatric nurses

I woke up this morning and remembered what it felt like on Saturday 4 February 2012, to be bullied by 5 psychiatric nurses for wanting to see my son at visiting time in the Stratheden IPCU, to photograph his broken hand and bruising.  You might describe this as a flashback.

I'd only heard the day before, 3 days after it happened, that he had a swollen hand, likely broken, for no-one had said on the Wednesday when the injury occurred, cornered in a back room of Lomond Ward by 3 male nurses.  

IPCU back view
I went in through the back door of the IPCU, although other visitors got in the front door, and said about my wanting to take photos of my son's hand.  The nurses on duty said I couldn't use a camera in the ward.  I said it was the dining room, not the ward, as I wasn't allowed in the ward.

The nurses got agitated and went to confer with the charge nurse and others.  I sat at a table in the dining room, the only person there.  Eventually a group of 5 nurses returned, 4 of them standing round me at the table, the other main charge nurse of the hospital sitting down, an older woman about my age.

They said that my son didn't want to see me (wrong for my son phoned me later asking me to visit).  They said he was sleeping (wrong again).  They stood close and intimidated me by their standing over me where I sat.  I was looking through the IPCU patient booklet which was about 4yrs out of date.  

I stayed where I was, sitting at the table, until they moved away.  I was not going to let them bully me out of the dining room until I was ready to leave.  I eventually got up to leave and let the ward nurse know that I would be coming back at the evening visiting at 6pm.

I came back at 6pm, was let in through the back door, in the dark, no light outside or bell on door.  I had to keep knocking until someone heard.  I visited with my son, saw his broken hand, asked for the junior doctor to examine it, for it hadn't been treated.  I then instructed him to arrange an X-ray and on the Monday I went in my own car to the general hospital to keep an eye on my son during the X-ray where his hand breaks were confirmed.

For two weeks after the Saturday bullying incident I felt physically unwell, exhausted, like I'd been in a fight.  I had to take bed rest, was dehydrated, sore muscles, headache.  My oldest son came to visit, did some housework, got me messages.  My good friend shared the visiting of my son in the IPCU over the next few weeks.  

I won't forget the implied force that was used on me in Stratheden's IPCU which mirrored the forced treatment and human rights abuse perpetrated on patients within the ward at the time.  Learned behaviour by staff which was cultural and had been going on for quite some time, probably decades as I'd heard from a former patient of his experience over 30 years previously.  

I expect that staff in the Fife IPCU will have stopped using bullying methods in their practice and denying basic human rights to patients in their "care".  That staff will have stopped rolling their own cigarettes while they work, in front of patients.  That staff will not be locking patients in the seclusion room which has no toilet or water to drink and a light switch outside, and leaving them unobserved for hours at a time.

I expect that the conditions for patients in the IPCU at Stratheden Hospital will have vastly improved but I have no proof or evidence of it.  One thing is for sure I will not agree to any more of my family members becoming patients at Stratheden Hospital, and that includes me.  We have written Advance Statements to this effect.

It is far too risky for me and mine to be inpatients at Stratheden Hospital.  I raised a number of concerns about Lomond Ward and the nursing practice in 2010, didn't take them to a complaint but told management and Scottish Government mental health division about issues.  Then in 2012 my son and I both had to suffer for it.  Now I take everything to a complaint and speak out at any and every opportunity.

I am not prepared to put up with bullying and intimidation by psychiatric nursing staff and others in mental health organisations.  It's bad enough that they pin stigmatising mental disorder labels on to us which discriminate and mark us out as defective.  Diagnoses which allow staff to force psychiatric drugs into us.  The drugs disable and cause further mental health issues.  A double and even triple whammy. 

I want to see alternative ways of working with people in emotional crises, mental distress or altered mind states, that doesn't mean forced drugs and disabling disorder labels.  People are individuals and should be treated as such.  

The Scottish Mental Health Strategy: "fully supports and adopts the 3 Quality Ambitions for Scotland that health and care must be:

Person centred - which is;

Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

Safe - which is;

There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

Effective - which is;

The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit and wasteful or harmful variation will be eradicated."

I expect Scottish Government mental health division and ministers to ensure that health boards comply with the strategy.  But we're not there yet, in terms of "mutually beneficial partnerships" and "shared decision-making".

Thursday, 14 August 2014

photos from recent walk around Stratheden grounds

daisies in therapeutic garden area

gardens and polytunnels

phone boxes not in use

chickenless coops