Friday, 29 May 2015

'Mental health patients treated like 'animals in a zoo' at Ablett Unit in North Wales, report finds' ITV News 28 May 2015

ITV News: 'Mental health patients treated like 'animals in a zoo' at Ablett Unit in North Wales, report finds' 28 May 2015

"Patients were kept "like animals in a zoo" at a mental health unit in Wales, families have said.

Ysbyty Glan Clwyd in Rhyl
A sign for unit at Ysbyty Glan Clwyd hospital in Rhyl. Credit: PA
An investigation into the Ablett psychiatric unit in Rhyl, North Wales has found a series of alarming allegations to be true.

These included:
  • Patients being sworn at by staff
  • Patients left unsupervised for hours at a time
  • Patients nursed on the floor in corridors and rooms
  • Patients being left in urine-soaked beds
  • One patient left lying in their own excrement
  • Furniture used to restrain patients
The unit was closed down in 2013 after "serious concerns" were raised by medical staff and families.

North Wales Police launched an investigation and several members of staff were also suspended.

The Health Board also ordered an external independent review, which has now been published.

Executive Medical Director Dr Matthew Makin said the failures were down to a lack of robust checks in place and poor communication with the families."

"The family of one patient described what they saw as "like when you go in a zoo and see animals that have been captured there for a long time and that's all they've got to do is walk around and around."

The report also details one occasion when a patient was complaining of discomfort in their arm.

The report says the response from staff was: 'Oh [the patient] did complain of a painful arm, but we didn't take much notice really.'

After being taken to an Accident & Emergency department, the patient was diagnosed with a broken wrist, the investigation found.

The chief executive of the Betsi Cadwaladr University health board has apologised.
"I am extremely sorry that we let our our vulnerable patients and their families down so badly.
We have prioritised a range of work to prevent anything like this from happening again."
– Trevor Purt ITV
News reporter Ben Chapman on film:

"...but perhaps the most shocking of all is that when patients' relatives raised concerns about what was happening here they were ignored.  And worse, staff turned the blame on them, accusing them of being unreasonable ..."

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I'm speaking out about my son's dehumanising treatment in Stratheden Hospital, near Cupar, in respect of my complaint against NHS Fife health board being upheld by the Scottish Public Services Ombudsman.


Tuesday, 26 May 2015

'NHS Fife told to apologise to family after tragic suicide' in Fife Today, 25 May 2015

'NHS Fife told to apologise to family after tragic suicide' by Lindsey Alexander in Fife Today,

25 May 2015:

"NHS Fife has been told to apologise to the family of a man who committed suicide after ‘clear and significant’ failings in his care.

Following an investigation by the Scottish Public Services Ombusdman (SPSO) the NHS Board was told to offer an apology to the family of ‘Mr A’ who killed himself just days after being treated at Kirkcaldy’s Victoria Hospital following an overdose.

NHS Fife was also told it must review how all patient records are maintained and shared between departments and provide evidence of action taken in response to the issues raised in this case. It is also to fully review Mr A’s case in a bid to improve communication between frontline NHS staff.

The SPSO report said Mr A suffered anxiety, depression and panic attacks for the last 12 years and as a result, saw his GP regularly and was prescibed drugs including citalopram and, on occasion, the sedative diazepam.

In March 2013 he saw an out-of-hours GP after suffering worsening symptoms and feeling suicidal. He was prescribed lorazepam and told to see his GP the next day. His symptoms did not improve and the next day he saw another out-of-hours GP where he reported suicidal feelings and detailed a specific plan as to how he would end his life. He was sent to a duty pyschiatrist. Mr A was then discharged with a plan to review his medication and a referral to Weston Day Hospital in Cupar for ‘anxiety management’.

Two days later he attended A&E at Victoria Hospital after taking an overdose. He was refused diazapam and discharged into the care of his parents with a list of various support groups he could contact should he reach ‘crisis point’. His parents, ‘Mr and Mrs C’, then contacted his GP to say they felt that because if his panic attacks he could not be left alone. The following day, April 6, he took his own life.

Following the death Mr A’s parents and partner made a complaint to Fife NHS Board. It said that because Mr A’s suicidal thoughts had been ‘fleeting and intermittent’, a decision was made that he could be treated safely in the community. He had also been declined further medication, which he had requested, due to the risk of overdose. The family were told that a Sigificant Events Analysis (SEA) identified that benzodiazepine withdrawal may have been a factor in his mental health deterioration. The Board concluded that, in hindsight, Mr A’s risk of harm to himself had not been anticipated. The Board had noted that Mr A had a close, loving family, no history of self-harm and no problem with illicit drugs or alcohol.

The SPSO investigation determined that although care by the out-of-hours GP was reasonable the duty psychiatrists assessment did not detail suicide risk factors and there was no evidence that Mr A’s partner, who attended with him, had been included in any discussions. He was also not told what to do should his condition deteriorate.

Upholding the family’s complaint the author of the SPSP report said: “When Mr A attended A&E, staff did not know that he had already presented twice to NHS services with suicidal feelings, which he was now acting upon. Had staff known this, they would have been able to see that his condition was developing, and different, more urgent action may have been taken.”

The Ombudsman’s own consultant forensic psychiatrist pointed out that the duty junior psychiatrist did not seek advice from a more senior specialist.

A futher complaint by Mr A’s father that the Board unreasonably failed to provide his family with sufficient information about his health to allow them to support him, was also upheld. The report said the Board’s own SEA already recommended that, in cases, where suicide plans had been expressed and hospital admission is not taking place, best practice is to agree with patients that partners, family or carers will be fully informed to help prevent harm.

Responding to the report, NHS Fife General Manager Mary Porter said: “This is a particularly tragic case and I would like to extend our deepest sympathies to the family involved.

“We endeavour to provide the best possible care for all of our patients, however, we accept that on this occasion we fell short.

She added: “A number of actions have already been taken in order to minimise the risk of such an incident recurring in future. we also accept the recommendations made by the Ombudsman and these will be implemented in full.

“We will be apologising to the family in the coming days and we welcome the opportunity to reiterate that apology publicly.”

------------------------------

'NHS Fife told to apologise after man’s suicide' in The Courier, 25 May 2015

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'Health board apology to family of mentally ill man who killed himself' STV News, 22 May 2015

'Mental health services in Scotland get £85m funding boost' [better late than never]

'Mental health services in Scotland get £85m funding boost' BBC Scotland News, 24 May 2015:

"Mental health services are to receive an extra £85m for improvements over the next five years, the Scottish government has announced.

Some of the fund will be used to provide more care for children and young people.

There has been a 35% increase in those starting treatment with Child and Adolescent Mental Health Services (CAMHS) in the past two years.

Scottish labour described the funding increase as "pure spin".

Ministers previously revealed an extra £15m for mental health innovation. 

The additional cash will also be used to promote better wellbeing through physical activity, improving patients' rights, to help GPs treat those suffering from mental health problems and providing services in community settings.

Waiting times down

Jamie Hepburn, minister for health improvement, mental health and sport, said: "Mental health services are an absolute priority of this government. 

"These are some of the most vulnerable people in our country and it's vital that the health service is properly equipped to give them the support and treatment they need.

"We have been investing heavily for a number of years and waiting times have come down significantly, despite an unprecedented rise in the number of people seeking help."

However, Dr Richard Simpson, Labour public and mental health spokesman, said the share of the NHS budget for mental health had reduced. 

He said: "This is pure spin from the SNP. Their cuts to mental health came to £80m a year, this additional money only sees an extra £20m in helping some of the most vulnerable people in Scotland. 

"Of course additional funding for mental health is welcome, but this comes after years of reductions in the share of the NHS budget for mental health."

Dr Simpson added: "The SNP are trying to spin they are protecting NHS budgets - they are simply trying to undo some of their own damage"

'Postcode lottery'

Royal College of Nursing (RCN) Scotland associate director Norman Provan said: "There are many examples of nurses operating innovative services that improve care for people with mental health problems, not only in NHS services in hospitals and the community, but also in local authority services.

"But while such innovative services make a huge difference, they are often subject to funding cuts, and don't know how long they'll be open and providing much-needed support. They, and the people who rely on their services, need to know that they will continue in the future."

He added: "So we need to see long-term investment by Scotland's new joint integration boards in services designed to meet the needs of our most vulnerable people."

Scottish Liberal Democrat health spokesman Jim Hume said: "The Scottish government needs to give equal status to mental ill health as physical illness.

"Under the SNP's watch the number of trained psychology professionals has dropped. A postcode lottery means people in some parts of Scotland are half as likely to get proper access as people in other parts.

"We know that GPs are not referring patients for therapies because the therapies simply aren't there."'

-------------------

I am in agreement with Dr Simpson MSP's statements and believe that the targeting from Scottish Government's mental health division has been punishing to health boards and most especially to their psychiatric inpatients and people using mental health services.  

I can testify to this as an unpaid carer and mother, picking up the pieces after traumatic "unreasonable" psychiatric treatment where my son's basic human rights were denied. 

Scottish Parliamentary SNP government ministers should be speaking out on behalf of patient rights and patient safety in their own localities.  Standing up and for the human rights of detained patients and their families.
 

Monday, 18 May 2015

confirmation: there is a Music Therapist working in Stratheden Hospital

I heard it yesterday from a colleague, the former Programme Leader of the MSc Music Therapy (Nordoff Robbins) at Queen Margaret University (QMU), Edinburgh.

There is a Music Therapist working in Stratheden Hospital, a QMU graduate.

My eldest son is starting the MSc in music therapy at QMU in September this year, leaving his day job in the oil industry:

from PTC Live Global 2014 Mass, USA


---------------------------



Published on Apr 30, 2015
Listen to the new album in full, then buy : http://bit.ly/getdayjob
Full track list with direct links:
01 - 0:00 - High Girders
02 - 3:57 - Daisy
03 - 7:38 - Day Job
04 - 12:11 - Way it Goes
05 - 15:23 - Off the Cliff
06 - 17:22 - Well Worthwhile
07 - 19:52 - Cold Stares
08 - 23:38 - Where is the Love?
09 - 27:12 - Two Kinds of Blue
10 - 32:32 - When You Sleep
11 - 35:16 - Walking Down the Road
12 - 38:41 - Harder I Work

All 12 tracks plus another 4 bonus tracks available on CD and bandcamp download.

http://tattierecords.com/dayjob

---------------------------

Dundee Piano website
I remember well buying the piano from someone in Rigside, Lanark, where we lived at the time and bringing it round to our council house in a wheelbarrow.  My 3 sons got piano lessons from Mrs Whitefield in Lanark.  They also learned a number of other instruments over the years, including flute, clarinet, accordion, violin, bass/accoustic guitar and drums.  My two younger sisters graduated from the RSAMD.  Music appreciation runs in and through our family.  It's generational.


Sunday, 17 May 2015

music therapy in Lomond Ward, so I hear: but is it by a qualified Music Therapist or an OT who can play the guitar?

I was hearing on Wednesday night at the information session about the new build IPCU that there is a Music Therapist working in Lomond Ward.  I heard it from the Head Occupational Therapist, a woman I know well, who was standing by the board which had these posters on it:




However I am wondering if this is actual, proper Music Therapy by a qualified music therapist or is it by an OT who has musical abilities?  As in, can strum a few chords on the guitar or sing a few notes of a tune.  Like me.

Excuse my scepticism but I've got plenty of experience engaging with the OT department at Stratheden, since 2010 and before, whose leaders are not about "micromanagement" or group work.  In 2012 I could never find an OT anywhere except at clinical meetings in the IPCU or having lunch with their fellow colleagues, sequestered in a room in the Ceres Centre.  Out of the way of mental patients and carers.  Great job if you can get it.

I remember asking for feedback from the OT Head about the patient experience of their service and being told it was confidential or suchlike.  Lack of accountability and getting away with doing what they like.  Unanswerable to the public who pay their wages or to carers who have to pick up the pieces after unreasonable treatment.

But I may be wrong.  They might have changed their tune and started working in the wards at Stratheden Hospital with the patients, providing skilled, trained therapists in music and art.  If so I will update this post with any information, when I receive it and can confirm it. 

Re the NHS Fife "Legislation Manager": I recommend a focus on the HUMAN RIGHTS of patients and monitored outcomes

Yesterday and on Wednesday evening, at the Public Information Sessions for the new build IPCU at Stratheden Hospital I came into contact with the NHS Fife "Legislation Manager" Dr Susan Anderson.  At one point she turned on her heel and walked off when I was speaking to her because she didn't agree with what I was saying.

The Legislation Manager claims that her "dynamic" post is "unique", there is none like it in any other NHS health board in Scotland.  She mentions managing a wide-ranging team covering health and Adult Protection, policies and procedures.  Her "key objectives" look impressive, the final tick point being:
  • Assist patients and their carers in the understanding of healthcare legislation: eg detention in hospital, confidentiality, data protection, diversity, equality, good relations and human rights
Here is a photo of her resume and raison d'ĂȘtre which was on display in the South View conference centre, Psychology building.  In duplicate:



Following the unreasonable treatment/human rights abuse perpetrated on my son in the Stratheden IPCU (unfit for purpose) and upheld Ombudsman complaint, I recommend that the NHS Fife Legislation Manager change her focus to the Human Rights of detained patients and their carers.

The Mental Health Act safeguards were not safe when my son was a psychiatric inpatient at Stratheden in Feb12.  The legislation wasn't working to protect the patients under the Act.  There has to be proper implementation and effective monitoring of the legislation in respect of staff practices within the psychiatric wards.

We knew our rights under the Act, the Principles contained within, but the staff did not respect either the legislation or us.  (see post lawless individuals)  There was a major gap between theory and practice.  The Adult Protection Investigation report, a multi-agency endeavour, in 2012, after I raised concerns in the February, tried to put the blame on me for causing "psychological harm".

Therefore I contend that there has to be monitoring of the outcomes to the objectives written on the Legislation Manager's resume.  Otherwise it's nothing more than a piece of paper and pie in the sky.  We need action not just words.


Saturday, 16 May 2015

"NHS Fife finds it difficult to engage with you" (but I will continue to actively engage with them)

This is what was said to me today (16 May 2015) by the Acting General Manager for Mental Health, Graham Monteith, at the Public Information Session on the new build IPCU in Stratheden Hospital, held in the South View conference room in the Psychology building.

And the Acting General Manager proceeded to be difficult and resisted any attempt to engage meaningfully with me.  The barriers were up.  There was no level playing field.  It's happened on the two occasions I've met with this man before, at an SIHR (Scottish Institute of Human Relations) event in June 2011, then in Playfield Institute, December 2012.

I wonder if the two years on secondment that the Acting General Manager had with Scottish Government's mental health division, prior to this post and after working at Playfield Institute, has caused him to get too big for his boots?  Like other civil/uncivil servants I have known.

Maybe he just doesn't like me and that's OK.  However I don't appreciate the man speaking as if he is the voice of NHS Fife.  If he was a mental patient they would be diagnosing him with delusions of grandeur.

Here are some photos from today:

prior to going in

person-centred care (but not from the Acting General Manager)

no MWC staff were on hand
 
new IPCU plans explained to me by helpful architect, estates manager, project manager & builder rep
manager who has responsibilities for MH Act training (more human rights focus needed)

carers info
view from psychology building after coming out
relaxing cream tea in Cupar Tearoom after info session

Finally and fortunately, despite the negative vibes from the Acting General Manager, I enjoyed the two information sessions and networking with a wide range of people, including Dr Reid, Consultant Psychiatrist, Jim Leiper, Estates Director, staff nurses who work at the IPCU and low secure unit, Estates staff, the architect and building project reps, health board members, advocacy workers, patients and others.

I am encouraged to hear that NHS Fife is committed to improving mental health services and to see the quality of the new build IPCU, at a cost of £4.4million from Scottish Government, which has been planned in great detail with a range of resources to provide therapeutic care to patients who require the service.  

I am very proud of my son for exposing the "unreasonable treatment" and the use of the locked seclusion room to manage patients in the old IPCU that was declared "unfit for purpose".  It has cost us both to speak out about the psychiatric abuse which he was subject to.  And it is still costing us.  The new IPCU has my son's name on it.


Friday, 15 May 2015

photos from information session about the new build IPCU 13 May 2015

I dropped by the public information session on the new build IPCU in the South View conference room in the psychology building at Stratheden Hospital yesterday evening, 13 May 2015.  Where I got talking with various NHS Fife folk and took some photos, of the info boards and of the fenced off area for the new unit, near the main gate of the hospital.







I plan to drop by again on Saturday to find out more.


Wednesday, 13 May 2015

abusive cultures: failure to act: a collective responsibility

When it comes to human rights abuses in psychiatric settings it is a matter of action.  It's just not good enough for people to listen, to watch and then do nothing.  Turning a blind eye.  Taking staff out of the firing line.  Or giving lessons in mindfulness.

Institutional bullying in psychiatric settings will result in human rights abuses, patients suffering and carers getting caught in the middle, or having to advocate at clinical meetings.  If they are brave enough to do so and take the flak.

Government ministers with experience in human rights law and advocacy should be playing their part.  In speaking out on behalf of their constituents who have been subject to the bullying and abuses.  

They should also be getting the uncivil servants telt.  Hold them to account.  For not doing the job right.  Too much targeting resulting in too many casualties.  The wrong sort of action.  Defective management and ineffective leadership.  Fail.

Why should families and carers have to continually pick up the pieces after unreasonable treatment and human rights abuses in psychiatric settings?  Why should Scottish Government have to keep baling out health boards with financial awards after failing to keep patients safe?

Why are health boards benefitting to the tune of millions for not managing their money right when carers are only getting £61/week or nothing if on a basic State Pension?  To cope with the fallout.

Will a new build unit prevent bad habits from continuing and reduce the risks of harm to patients who are resistant to the forcing of toxic drugs into their system?  Where are the guarantees?

Is anyone listening?  And more importantly, what are you going to do about it?  Actions speak louder than words.  

"Human rights are rights inherent to all human beings, whatever our nationality, place of residence, sex, national or ethnic origin, colour, religion, language, or any other status. We are all equally entitled to our human rights without discrimination. These rights are all interrelated, interdependent and indivisible.
Office of the High Commissioner for Human Rights (OHCHR)

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Thanks to Dr Richard Simpson MSP for sending me this newsletter about the new build IPCU at Stratheden:



Otherwise I may have been kept in the dark.


Monday, 11 May 2015

culture, management and leadership; the issue of bullying and how to tackle it

I remember studying "organisational behaviour" on my Administration Management degree in 1996 and reading many books on the topic, fascinated by the subject.  Our core reading was Understanding Organisations by Charles Handy and we undertook various class activities around the dynamics of leadership and group behaviour. Culture and management.

The book by Buchanan and Huczynski, now in its 8th edition was a particular favourite of mine: 

1996 copy
"Organizational Behaviour inspires readers to think and to reflect critically on the theories presented, teaching you to see the reality behind projected organizational images and link theory to practice. The text also recognizes the diverse social and cultural factors that affect behaviour in organizations."

Prior to the course I'd been working in communities, developing projects, organising and leading group work, with children, young people and adults of all ages, in a variety of settings, since 1980.  

sheep 1976
In the 1970's I'd worked on farms, doing tasks like milking cows, bagging milk, tractor driving, haymaking.  Latterly we had a small flock of sheep which we lambed, sold at Lanark Market, hogs with lambs at foot.

In community work I tended to lead from the front, whether as the chairperson on a committee to coming up with ideas for development eg holiday clubs for children, after-school activities, recorder group in school, raising funds for playgroups' toy library, acquiring and driving a local community minibus etc.  At the same time I was involved in the local church, visiting older people in their homes and leading groups.

Therefore I knew very well what working with people in groups was like but it was very interesting to study the theory, the why and how of it.  To put some flesh on the bones.  As a children's and youth worker I was used to organising and managing the different personalities, keeping them interested and engaged.  It wasn't about discipline, school was never my "thing" although I did well enough when there and got enough Highers to have unconditional offers from 4 Scottish universities in 1970.

Following the management degree where I got the best student award (doing it in two years not three), I did a postgraduate diploma in community education, now called community learning and development which is a better term, I think, to describe the style of engaging with communities.  It was always about facilitating learning and empowering people.  Getting alongside, a mutual experience, give and take, grassroots, bottom-up. 

Doing this work and studying these topics has prepared me well for the writing, activism and campaigning I now do in mental health matters.  And in the jobs I had from then until 2008 when I set up Peer Support Fife and Chrys Muirhead Associates so as to promote the model of peer support and deliver training in recovery focused topics.  Circumstances caused a change of focus into human rights and justice in psychiatric settings.  I have no regrets.

Since achieving the management degree in 1996, and prior to 2008, I worked for two organisations in particular where bullying was the cultural norm and where the workers eventually joined together to stop the bullying and to get the bullies out.  One of these was voluntary sector, the other a further education college.  In two different regional areas.

When I got the FT post at the voluntary sector organisation the bullying had been going on for a number of years and the staff were nearly at crisis point.  I had been warned of the issues prior to taking the job, by a friend who was a volunteer there.  However I decided to go with the flow and took the post, managing volunteers, which involved recruitment, training, support and supervision.  Advocacy work and other interesting tasks which developed.

The woman who had a bullying style of management and was the root of the problem had a husband working in the building.  He was in the habit of listening at doors and reporting back to his wife.  Cliping (telling) on them.  So there was a lot of whispering going on, by the staff, a "them and us" type of culture.  Suspicion.  Distrust.  Divisions.  Lack of motivation.  Factions.  Intrigue.  Rebellion.  Taking sides.

I got on OK with the manager bully although I wouldn't have sided with her and was careful not to reveal too much at supervision meetings.  She was a complex character with a compelling personality and if I hadn't known the context and had engaged with her in different settings we might have got on fine.  But I was careful in our interactions, being in solidarity with the staff.

Some staff members at this voluntary sector organisation weren't functioning well under this woman's bullying style of management and it had affected their output and decision making abilities.  A lot of time was spent discussing the bullying issue until eventually the staff joined a union and the manager left her post to take up a job elsewhere.  Her husband remained in the job.  I met one of the women who had been bullied, years later, and she was still speaking about it.  

The FE college post was in employability which involved setting up a student mentoring project and finding placements for students who identified as having "barriers to employment".  It was a merged college with different campuses, in different towns.  Some senior staff had been promoted to "Director" posts, spanning the different campuses, and the culture had become hierarchical.  

My manager was a Director and had a bullying style of management.  She had been a senior member of staff in one of the colleges for a long number of years and then was promoted, at the merger, to manage staff at all the campuses.  She wasn't the only one who managed with a top-down style.  Directorial.  Confrontational.  On a few occasions she tried to threaten me, telling me I couldn't do this or that.  

But I stood up to her bullying and explained why I wouldn't be taking her advice.  One example was a student with disabilities who used a wheelchair and wanted a placement at the local radio station so as to undertake a radio broadcasting course at college. He had been denied this due to his disabilities.  I thought this very unfair and was determined to support his wishes, and that of his parents.

My manager wasn't happy about this and took me aside in a room to tell me I couldn't do it.  I resisted her bullying and said that he deserved to have a placement of his choice.  Ironically this woman was head of the special programmes department, of students who had disabilities.  She of anyone should have been supporting equal opportunities.

Eventually I did go to my union rep (having joined the union after the voluntary sector bullying issue) to make a complaint after she had come up and pointed the finger, when no-one else was around, picking on me.  It was out of order.  She did this with others and one woman in particular who she bullied became unwell and had to take time off work due to stress.  Bullying in the workplace is pernicious and damaging to health.

My FE college post was temporary in the bullying manager's department however I had began to do some lecturing, graduating with a TQFE (teaching qualification in further education) at Stirling University in 2008.  I could have continued to do PT lecturing at the college but decided instead to get involved in mental health peer support, from January 2008.

I later heard, in 2012, about a staff revolt at the FE college, who set up a website, "calling on unions to organise a vote of no confidence in the management" and many of the senior managers resigned, including the Principal:

"One member of staff, who did not want to be named, said: “There’s been a culture of bullying at the college for the last four to five years. 

“The governance of colleges is an absolute shambles – it’s all ‘you scratch my back, I’ll scratch yours’. Our principal is paid more than the First Minister for managing what is a relatively small institution.”

The source said staff had been left ill and some had reportedly contemplated suicide due to bullying at the college.Scotsman 3 February 2012
 
Bullying in organisations is a reality and if it is happening in a psychiatric setting then it is very concerning because of the risks to patients and carers.  It will mean that people will fear speaking out because of the repercussions.  What protections are in place for patients who are being bullied in psychiatric settings?  Where compulsory/forced treatment is allowed and declarations of "incapacity" may be used to silence voices and quell any resistance.
MWC website

There has to be a mechanism whereby patients and carers in psychiatric situations are able to speak out about bullying and intimidation without fear of retribution.  The same goes for staff who may feel entrenched and without a voice.  Maybe the Mental Welfare Commission for Scotland could do something in this area?

If there is a culture of bullying in a psychiatric institution it will be systemic, from the top to the bottom.  To sort it out, I contend, will require a solution from the bottom up.  Grassroots.  Involving the Experts by Experience, on level playing fields and as leaders in the agenda-setting and decision-making.  At the sharp edge.


Sunday, 10 May 2015

NHS Fife website page on Stratheden Hospital: 'Replacement of the Intensive Psychiatric Care Unit'

Link to NHS Fife website page on Stratheden Hospital: 'Replacement of the Intensive Psychiatric Care Unit'




"NHS Fife has been granted formal approval to begin construction on a £4.4m project to replace the Intensive Psychiatric Care Unit at Stratheden Hospital.

Stratheden Hospital cares for patients with mental illness from across Fife in nine inpatient wards. The existing IPCU is housed within one of the older buildings on the western side of the hospital site.

The project to replace the IPCU will see construction of a new state-of-the-art eight-bed unit on the north-eastern part of the hospital grounds, adjacent to the Radernie Low-Secure Unit.

Construction of the new unit is due to commence in May 2015 for completion in Spring 2016.

The project is one element of the ongoing work to modernise areas of Stratheden Hospital and comes on the back of a number of previous recent works; the construction of Elmview in 2009, Muirview in 2010, and the major refurbishment of Radernie Ward to create the Radernie Low-Secure Unit in 2013.

The new facility will include a communal lounge and rooms for rehabilitative and therapeutic activities. Patients will each have their own single en-suite bedrooms, offering more privacy, whilst there will also be access to an outdoor courtyard and private meeting rooms for visits from families or visitors.

NHS Fife Interim Chief Executive, Dr Brian Montgomery said: “I am very pleased that formal approval has been granted to replace the Intensive Psychiatric Care Unit at Stratheden Hospital.

“Replacing the existing unit is a key part of our strategy to improve mental health services in Fife and we, as an organisation, recognise the importance of providing modern, therapeutic environments to support the delivery of high quality patient care.

“The new state-of-the-art unit will ensure that the most vulnerable patients can be cared for in a safer, more secure and supportive environment, designed specifically to meet their needs.”


Fife Herald: '£4.4m Stratheden care unit approved', 8 May 2015

In Friday's Fife Herald news and details about the new build Intensive Psychiatric Care Unit (IPCU) Public Information events to be held this week coming, in Stratheden Hospital.

£4.4million which was awarded by Scottish Government after the "unreasonable treatment" which my son was subject to, in February 2012.  In the old IPCU, a building declared to be "unfit for purpose" by the Mental Welfare Commission for Scotland, prior to this.



------------------------

And on Fife Today website, 6 May 2015: 'Public information events being held on Stratheden Hospital development'

"NHS Fife is hosting a series of public information events this month to keep the public informed about the development of a new intensive psychiatric care unit at Stratheden Hospital in Cupar.

The move comes after formal approval was recently given for the construction of the new purpose-built eight-bed unit on the north-eastern part of the hospital grounds - replacing the existing facility on the site.

Construction of the £4.4m project began earlier this month and is due to be completed in Spring 2016.

As part of keeping the local community informed about how the project is progressing, a number of drop-in events have been scheduled at the hospital.

These will all take place in the south view conference room on: Wednesday, May 13 from 6.30-7.30 p.m; Thursday, May 14 from 2.00-3.00 p.m. and Saturday, May 16 from 11.00 a.m. to 1.00 p.m.

There will be a number of stalls relating to the various aspects of the development, ranging from the design and construction process to the nursing and models of care that will be provided within the unit.

Representatives from NHS Fife, the Mental Welfare Commission, local patients’ groups and the building contractors will be attending and will be available to answer any questions on the project.

For further details visit the Stratheden Hospital section of the NHS Fife Website at: www.nhsfife.org/stratheden"


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See Storify of tweets: Sunday walk Stratheden Hospital @nhsfife on way home from Church; came upon the new IPCU plans




Thursday, 7 May 2015

here is the challenge: making it safe to complain in psychiatric settings

Here is the challenge for health boards and social work departments.  How to make it safe for patients and carers to raise concerns and complaints in psychiatric settings without fear of retaliation.  Being "in for it" the next time of having to access mental health services.

Psychiatric services will only improve for ALL patients if the raising of concerns and complaints are welcomed as a way of improving conditions for staff and patients alike.

In psychiatric settings compulsory treatment is allowed if a person is deemed to be "without capacity".  However the line between capacity and incapacity is not well defined.  A patient who refuses medication may well have the capacity to do so but by being "non-compliant" is seen as having no capacity.

Psychiatric wards may be understaffed and under-resourced which means the nursing staff don't have the time to care for individual patients who are resistant to being medicated and yet have capacity.  Those of us who don't like the drugs and find them toxic to our wellbeing.  It may be "easier" to force the issue and the drugs into the patient.

Some patients may not have an issue with being forcibly medicated, after the event.  Others may feel strongly that their agency was taken away and they had no choice.  However to speak out about it at the time may be risky if they have to return for further treatment.  And so they keep their concerns to themselves.  Internalise it.

Here are some ways in which I think the pathway to complaining can be made straighter:
  • putting Experts by Experience (EbE) at the heart of the process
  • safeguards in place which are safe 
  • confidentiality scrupulously adhered to
  • management ensuring regular training of staff in responding to complaints, involving EbE who may be service users, psychiatric survivors, carers or family members with a range of views
  • de-personalising the procedure, taking away any "blame" aspect
  • training of managers in how to write letters of response to complaints which are neutral and blameless
I believe that the meaningful involvement of EbE, in staff training programmes and debriefing sessions, is paramount in bringing about cultural change in psychiatric settings where people are not free to speak out without fear of retribution.  A range of experiences, from those who welcomed compulsory treatment to those who resisted with all their might.

We need ALL voices represented at the table so as to improve psychiatric services at the roots.  Working at ways to include rather than having to exclude.  Because this demonstrates the limitations of the process and the system.  A deficiency in leadership and management. 

I want to see an end to scapegoating.  Tags like "treatment resistant" or "non-compliant" or "troublemaker".   If the drugs don't work then the drugs don't work.  If a person is non-conformist in real life then they are more than likely to be "non-compliant" in the psychiatric system.  It stands to reason.

Let's do away with the blame culture and bring in a paradigm shift where people are at the centre.  First do no harm.  Next do some good.  Collectively, together, level playing fields and straight paths.

Kirkcaldy, Fife


Monday, 4 May 2015

Public Information Sessions - new IPCU - 13/14/16 May 2015 - South View Conference Room Psychology building

Landscape Masterplan new build IPCU (my photo)
I received a letter via Email, from Mary Porter, NHS Fife General Manager, today at 2.32pm with details of the forthcoming public information sessions about the new build Intensive Care Psychiatric Unit (IPCU) at Stratheden Hospital.  Which are to be held in two weeks time, a choice of 3 different sessions, ALL at the hospital.

Quote from letter:

"On 21 April 2015, the Scottish Government granted formal approval to construct a new purpose-built IPCU on the north-eastern part of the hospital grounds, replacing the existing unit on the site. Construction is due to commence in May 2015, with completion in Spring 2016"

Dates, times and venue as written in the letter:
  • Wednesday 13 May 2015 (6.30-7.30pm) - South View Conference Room, Stratheden Hospital 
  • Thursday 14 May  (2-3pm) - South View Conference Room, Stratheden Hospital 
  • Saturday 16 May  (11am – 1pm) - South View Conference Room, Stratheden Hospital
Another quote:

"There will be a number of stalls relating to the various aspects of the project; ranging from the design and construction process to the nursing and models of care that will be provided within the unit. Representatives of NHS Fife, the Mental Welfare Commission, local patients’ groups and the building contractors will be available to answer any questions you may have in relation to the project."

The South View Conference Room is in the Psychology building at Stratheden Hospital and I am informed that there will be signs on the day to direct visitors.

rough map of Stratheden Hospital for directions (by me)


Saturday, 2 May 2015

my feedback to NHS Fife Associate Nurse Director who did not listen to me: "Developing and maintaining therapeutic relationships"

This morning I wrote a letter in an Email to Nicky Connor, Associate Nurse Director (AND) of NHS Fife, in response to her letter which did not uphold my complaint about a nurse who accosted me in Stratheden Hospital and then reported me to the police (see post misuse of power).  

Scottish Sunday Express 5 October 2014
I describe it as intimidation, bullying and harassment towards a patient advocate, psychiatric survivor activist and human rights campaigner.

Here are some extracts from my letter which reflect the concerns I had with the response from the AND:

Strapline: your letter 27 April 2015 as "designated complaints lead" - my feedback and concerns about the writing style - "Developing and maintaining therapeutic relationships"

[short extracts]
 "Firstly I want to say that, in my opinion, the letter is not well written and reflects everyone mentioned in a bad light.  Particularly FG and KT.  The fact that you did not uphold my complaint based on only what FG said demonstrates a biased and flawed decision. ..."

"I think that your reporting of what was said, the words you use, the implications, the tone, the phrases, are unhelpful and in places provocative.  I would recommend that you undergo training in how to handle complaints appropriately and how to de-escalate a situation when writing about it.  However it may be that your intention in writing this letter was to provoke a reaction?  That's what it reads like.  I am a writer and a wordsmith so this is my area of expertise, nowadays.

For example.  You use the word "entirely" to give emphasis and make a point.  As if that gives your words more validity and authority.  Eg "It is entirely unacceptable to take recordings or photographs ..."  You seem to be lecturing me in your letter.  As if I was a member of staff or a "silly little girl" ...  "

"There is no way that I can put your letter in a blog post because of the way it's written and the fact that you have mentioned the names of KT and FG all the way through, like a stick of rock.  But what I will do is put parts of this letter and yours in a blog post, to explain the reasons for not being as transparent as usual.  I have no desire to shame your staff by name.  It's not productive.  I try to behave professionally even when the professionals don't. ..."

[longer extract]
"FG should not have approached me in the way that she did, on 22 March in the Ceres Centre shop.  It was unexpected and she came right up to me, in my face.  It was intimidating.  This is what the IPCU nurses used to do in February 2012.  On 4 February when I was sitting at the dining room table in the ward five of them came up to me.  Four stood over me while the fifth sat down.  It was bullying and intimidation.  I stood my ground, sat firmly and eventually they moved off.  This was repeated at various times.  The nurses did not appear to have an awareness of body language.  I have described it as "space invaders".  It happens because of forced treatment in psychiatric settings. 

Psychiatric nurses are in the habit of forcing drugs into patients.  It's a fact of life.  However this should not result in them behaving forcefully with anyone they meet.  That is an issue which training might help with.  Plus ongoing supervision and support.  Not all the nurses at Stratheden behaved like this.  Some of them did the opposite and retreated from engaging with patients or family members.  Sat in the staff room writing notes.  

It's all about human relationships and working alongside people.  Therapeutically.  For interest, I have co-written a chapter with a mental health nurse lecturer for a forthcoming book, 3rd edition of 'Psychiatric and Mental Health Nursing: The craft of caring':

Strapline of "Developing and maintaining therapeutic relationships".

Our piece was a conversation and here is one of my paragraphs:

"C: I believe a therapeutic relationship or helping alliance in psychiatric settings is very similar to the friendships made over the years, with people of like minds.  Therefore in the mental health setting it should be no different from the “real world” and grounded in equality, reciprocity and level playing fields.  It should be about getting alongside a person rather than doing things to or for a person.  It will also be about sharing experiences as if nurse and patient were on the same side of the fence.  The challenge in the psychiatric setting is that personal stories are usually only shared by patient or carer and then written down in the notes.  This is not to advocate mental health nurses revealing their whole life story, issues and problems, but to demonstrate vulnerability and being human, allowing the person/patient to be the expert of their own experience.


As a community development worker since 1980 I have engaged in an empowering way with people where the aim has been to enable, to inform and to create spaces where people can learn, grow and become independent, emancipated members of their community.  It has meant that from the beginning the end was in sight.  You might describe this as having an exit strategy from the entrance door.  I see this as being therapeutic and in the best interests of the “other”.  I would like mental health nurses to empower patients and, in so doing, be empowered themselves.  The challenge as ever will be in the dynamics of nurse/patient/psychiatrist triangle.

I am copying others into this Email, for their information."

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Extracts from the letter received from Ms Connor, Associate Nurse Director, NHS Fife:

"FG advised that she attempted to explain to you that she was simply asking if you were recording her, and she asked you to refrain from doing so as video recording equipment should not be used within patient areas (I had a Blackberry phone with me).  FG advised that your subsequent response was "you have come along here to tell me off haven't you, you silly little girl" and that you appeared to be tapping your phone and allegedly saying "I will be recording this as well, this is great". ..."

"FG advised that she then left the Ceres Centre and sought advice from Senior Nursing Colleague.  It was determined that due to the possibility that you may have been video recording patients and FG felt "assaulted" by your hostility towards her, she contacted the police that day.  On discussion with the police they advised FG that she had grounds to raise a complaint and they suggested to her that they would speak with you regarding the incident. ...."

"Having given consideration to the concerns you have raised and the response provided by KT (Clinical Services Manager) I note that the interactions between yourself and FG in the Ceres shop were unwitnessed and therefore I am unable to verify individual accounts of the event in question. ......  KT assures me that she considers that FG acted in the best interest of her patients and she fully supports her actions ...... I am unable to uphold your complaint."

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I will write more about this in future blog posts.

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front page of booklet from NHS Fife Patient Relations Dept


Friday, 1 May 2015

FOI request: NHS Fife complaints and concerns statistical breakdown 2010-2015

FOI request sent today, 1 May 2015, to NHS Fife:

Strapline: FOI request: NHS Fife complaints and concerns statistical breakdown 2010-2015

"This is an FOI request.

I would like details about NHS Fife Complaints and Concerns in the last five years, 2010-2015.

In particular I am interesting in knowing how many complaints/concerns were raised by patients and/or carers of psychiatric wards in Fife, compared to general hospital wards.  I am wondering if psychiatric patients are free and able to make complaints or whether declarations of "incapacity" make this a rare happening.  Also whether the risk of retaliation is a factor.  As in, if psychiatric patients complain are they at risk of being unreasonably treated if requiring inpatient care in the future?

Therefore a statistical breakdown which gives specific detail such as hospital and area would be useful.  Plus the outcome of the complaint or concern.  Whether the complainant was happy with the response, or not.  I am assuming that you will have customer satisfaction stats or a way of gauging if there is a positive outcome?

Whatever information you have on the complaints process would be appreciated so that I can get a picture of the situation.  Generally and specifically, regarding complaints and concerns raised.

According to the reports given at the health board meeting in St Andrews on Tuesday last (see storify of my tweets) there was an increase in complaints/concerns between Nov14 and Feb15.  I notice the concerns raised were the greatest in Feb15 at 108, the most in that year, while complaints were numbered at 38.  Averaging out about about 36 complaints a month.  I am interested in knowing how many of these were mental health specific and psychiatric treatment in particular.
From NHS Fife Healthcheck Jan/Feb 2015

I suspect that there will be far less complaints made or concerns raised by psychiatric patients and their carers than by "general" patients and carers.  I base this on my own experience of both raising concerns in 2010, about Stratheden Hospital's Lomond Ward, and then having to raise a complaint in 2012 which resulted eventually in an upheld decision by the Ombudsman.  Of "unreasonable treatment" to my son when he was an inpatient of the Stratheden IPCU.

For me the process was one of raising concerns in 2010, with senior NHS Fife staff who I knew in mental health, now retired.  And raising them also with Scottish Government mental health division and with the Mental Welfare Commission, because I knew the civil servants and senior staff involved.  However this was not very satisfactory and I wasn't listened to in any way that had a positive impact on Fife psychiatric services. 

And so in 2012 when again having to access crisis support, with difficulty, the situation escalated in Lomond Ward on 1 February when my son was assaulted by a nurse, face-down restrained by 3 nurses, got a broken hand and eventually locked in the seclusion room with no toilet or water to drink for hours on end.  You know the story.  It wasn't pleasant. 

I look forward to receiving the answer to my FOI request.  Please let me know if you require further clarification regarding my request."