How To Juggle Glass

‘Hooked on happy pills’? How the media demonises mental health medication

Izzi — Mon, 18 Feb 2013 01:20:25 +0000

By Rachel Whitehead

Working in a busy press office for a major mental health
charity Rethink Mental Illness,
I often get calls from journalists asking if I can put them in touch with
someone to interview about their experiences of mental illness.

Nothing unusual about that. What I have noticed about these conversations however, is the familiar phrases that so often tend to pop up. Do we have anyone who has been ‘parked’ on medication for over 10 years? A mum who is ‘hooked’ on Prozac? Take a look at almost any media coverage about antidepressants or antipsychotics and you’ll often find this kind of language creeping in.

Every time new figures come out showing increases in prescriptions for these types of drugs, we get a flurry of calls from the media asking if we’re ‘concerned’ about the ‘shocking rise’ in the ‘antidepressant epidemic’.

What I find worrying, is the automatic assumption that a rise in prescriptions, or someone taking medication for a number of years, is necessarily A Bad Thing.

Medication for mental illness can save lives and give people the stability they need to survive. That may be for a few months, it may be years. While no one wants to be on any kind of medication unnecessarily, for some people, it’s the best option.

The language used in the media around this is very telling. There is a clear dividing line between those who simply ‘take’ medication, such as people with diabetes, and those who are ‘hooked’ on it – people with mental health problems.

Antidepressants in particular are often written about in the context of someone trying desperately to ‘give them up’ as if they’re some kind of bad habit.

The subtext to all this is that to take mental health medication is unnecessary, a sign of weakness and failure. I can’t help wondering if this stems from the deep seated suspicion, which is rarely voiced, but still surprisingly pervasive, that the vast majority of people with mental health problems aren’t really ill, they’re just a bit sad or being a bit difficult. If as a society, we can’t truly accept that people with depression are ill, then how can we accept that it’s ok for them to take medication for it?

These deep-seated beliefs are not only stigmatising, they have a very real impact on people living with mental illness every day. It’s bad enough to be diagnosed with a mental illness and accept that you may need to take medication, but to be made to feel guilty for doing so, is especially hard.

When speaking to members of my charity, I often detect a sense of guilt when people talk about medication, as if it is an admission of weakness. I’ve seen it in my personal life too. One of my best friends was prescribed antidepressants for a severe mental illness last year. She found it incredibly helpful, but as soon as she stabilized, her immediate concern was to get off it as soon as possible. While of course it’s a good idea to try and come off any kind of medication if it’s not necessary, talking to her about it, it was clear that the main driving force wasn’t her health, but the sense of shame and inadequacy she felt for needing it.

Would she feel this way if she was taking medication for high blood pressure? I very much doubt it.

Rethink Mental Illness, is neither ‘for’ or ‘against’ medication, what we’re interested in is people having a choice over their own treatment and finding what works for them. The real problem is that in the vast majority of cases, this isn’t happening. Far too often, due to squeezed NHS budgets, people are only offered drugs when they could benefit from talking therapies either instead of, or alongside it.

My charity is the first to point out what a scandal it is that antipsychotic medications haven’t vastly improved since the 1950s. We have long campaigned for improvements in drugs which come with a range of horrific side-effects and double your chances of dying from heart disease. Despite all this, for many people, taking this medication is still their preferred option, which says a lot about how devastating psychosis can be.

Many people manage their mental heath problems very successfully without any medication; others may need to take it for the rest of their lives, there is no right or wrong. What is wrong however, is that anyone should be made to feel inadequate for falling into the latter group.

The media plays such a powerful role in shaping our understanding of mental illness, it’s vital journalists start thinking twice before lazily throwing around words like ‘hooked’ when they write about this sensitive subject. I look forward to the day I can open a newspaper and see decisions over medication presented as a straightforward health issue, rather than a moral struggle to resist the ‘happy pills’

http://www.independent.co.uk/voices/comment/hooked-on-happy-pills-how-the-media-demonises-mental-health-medication-8494801.html

Mania come down

Izzi — Sun, 17 Feb 2013 04:17:20 +0000

My mania appears to have burnt itself out. Now I am left in some kind of limbo where I am feeling slightly depressed but nothing to write home about. The thing that bothers me is where my mood will go from here. Am I due for a depression now? Had my valproate increased a few weeks ago and it doesn’t appear to be doing much good. I’m a little worried that I will keep going on a rapid cycling rampage.

The mania was pretty bad, spent way too much money on random crap and ran around like a tornado doing dangerous things in the backstreets of central London in the middle of the night. I also forgot to eat which for me is saying something. I also got really paranoid which is unusual for me. Oh well at least it appears to have gone down now.

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MPs get mental health clinic after rise in cases of depression and anxiety

Izzi — Sun, 17 Feb 2013 00:06:04 +0000

I am not impressed. I feel like some groups of people get special treatment and extra money spent on them. The government is spending all this extra money on the mental health of the MPs. I also know that doctors get their own special services and it really annoys me. Is the ordinary NHS mental health service not good enough for them? If not then they should be giving the money to ordinary NHS services to improve them not one special group of people. Let them deal with the terrible provisions like the rest of us.

End of rant

!zz

‘Failures by mental health staff’ the root cause of patient Sally Ann Vye’s suicide, Leicester inquest told

Izzi — Sat, 16 Feb 2013 23:25:45 +0000

‘Failures by mental health staff’ the root cause of patient Sally Ann Vye’s suicide, Leicester inquest told

By Tim Healy

The “failure of a number of specific” mental health staff was the root cause of a woman taking her own life, a coroner has ruled.

Leicester coroner Catherine Mason said Sally Ann Vye jumped from cliffs at Beachy Head, Sussex, while her mind was unbalanced, on June 20 last year.

The previous day, a care support worker had allowed Miss Vye, 39, to walk out of the Bradgate Unit at Glenfield Hospital, contrary to policy.

A four-day hearing at Leicester Town Hall heard her absence was not discovered until nearly eight hours later, following a call from her parents.

After the verdict, her father, Ronald Vye, of Tennyson Way, Melton, read a statement on behalf of himself and his wife Marilyn.

He said: “Sally was very kind, considerate and generous. She made us into a happy family, sharing many wonderful experiences together that will give us fond memories in time.

“This inquest has heard that on June 19 a number of staff on the Beaumont Ward, from the top to the bottom, failed to do the jobs that they were paid for.

“As a result, Sally was unaccounted for for eight hours before she was reported missing.

“She was therefore denied the chance of being intercepted before she reached Beachy Head.

“Nothing can bring Sally back, Marilyn and I will miss her for the rest of our lives.”

The inquest was told a number of policies and procedures had been breached by staff on the unit’s Beaumont Ward.

One person said she saw nurses celebrating a doctor’s birthday with cake at about the time Miss Vye absconded, and that the ward was chaotic at the time because of problems with other patients. This was denied by a senior manager.

Mrs Mason said there was a failure to properly observe and record details of Miss Vye’s mental condition.

She said when Miss Vye absconded it was known or should have been known there was a real risk of suicide.

Mrs Mason said: “Yet the observations and authorised period of unescorted leave specifically prescribed were not followed. This failure had a clear and direct causal connection with Miss Vye not being found sooner.

“The root cause of this incident is a failure of a number of specific staff to follow the systems and processes in place to monitor Miss Vye’s leave and her whereabouts.”

Mrs Mason said she was pleased to hear of significant improvements at the Bradgate Unit since the tragedy.

The inquest was one of seven into deaths of mental health patients in the care of the Leicestershire Partnership NHS Trust between November 2010 and June 2012, with one still to be heard.

It has emerged the coroner will investigate three further cases of mental health patients who died in the trust’s care.

Recording a narrative verdict, Mrs Mason said: “Despite the known existence of a real and immediate risk to Miss Vye’s life from self-harm, she was able to go missing, undetected, for nearly eight hours.”

However, she said it would never be known if earlier realisation of her disappearance could have prevented her death.

Paul Miller, divisional director for adult mental health services at the trust, said: “We fully accept the coroner’s verdict.

“A number of errors by individuals contributed to Miss Vye’s death, which fell well short of the level of care we expect from our staff.

“I can provide reassurance that we took immediate action at the time and have implemented recommendations and actions to make sure we reduce the risk of a tragic incident such as this happening again.”

Mum blasts mental health teams after young son was found hanged with xBox cable

Izzi — Sat, 09 Feb 2013 23:28:22 +0000

The mother of young father Ben Harding, who was found dead in the back garden of his family home, has condemned the support her 21-year-old son received from mental health teams.

The body of former Abbey school pupil Ben was found in The Ridgeway, Boughton, in May last year.

An inquest heard how he was found hanged from a tree with a cable from his xBox games console.

But coroner Rachel Redman decided he had been drinking so heavily that she could not be sure he intended suicide so recorded an open verdict.

The dad-of-one had made several attempts to take his life before he died.

Now his mother Ruth Jayes has blasted health officials and spoken of her commitment to help other families facing the same feelings of grief and isolation.

The mother-of-five said: “It was the worst feeling I will ever go through.

“If I can stop one other mum from going through what I have been through I would be glad.

“It has been six months now and I am not back on my feet.

“The range of emotions is unbearable. My other children have been great but they have their own grief.

“I found him with my daughter and that image is not something I would wish on anyone.

“That was the hardest thing, seeing him like that.

“I want to get a support group up for other mothers and fathers that are going through this.

“I watched my son spiral out of control and there was nothing in my power I could do, which was torture in itself.”

Ben Hardings’s mum Ruth Jayes with the memorial to her son in her garden

Ruth believes mothers should have increased rights when it comes to their children’s health, no matter what their age.

She said: “I had no authority because Ben was an adult. I knew there was something wrong growing up, his behaviour was different to others.

“But it was so hard for me to get anyone to recognise he had problems. He had tried to kill himself about eight times before.

“As a mother I feel I should have had some say, but because he was an adult I didn’t know what was going on when he went to the doctors.

“I think we should change the law by letting mums take some action to help them. I knew he needed assessment.

“He was 12 years old when I first noticed signs and at 13 I took him to see someone.

“I went up to the hospital six times but he was never taken into hospital. I spoke to the doctor on several occasions. She then offered to help, but it was too little, too late. I feel the system failed.

“The mental health team should have been there for him, or even sectioned him. I felt totally isolated and let down.”

But the family remains committed to remembering happier times with Ben as a son, brother and father.

“I feel the system failed. The mental health team should have been there for him, or even sectioned him. I felt totally isolated and let down.” – Ruth Jayes

They are planning a charity skydive in his memory. They have also created a special tribute to him at the spot where he died.

Ruth added: “My daughter and sons are going to do a sky dive and use the sponsorship to help me to set up the support group.

“Ben’s father died at 31. I have lost my son’s father and my son. It has broken us.

“But I have a really close family and Ben has brought us closer together.

“Without my sister, brother and mum’s support I do not think I would have got through it.

“This Christmas was terrible. It was the first time in 21 years I did not have my son with me. It was heartbreaking.

“But we want something positive to come out of all this negative. I want to help other people. I have not got any qualifications but what I do have is real life.

“I feel if my son had been assessed earlier in his life or if I had had some authority Ben might still be here today.”

Spokesman for Kent and Medway NHS and Social Care Partnership Trust Martin Sawden said: “We would like to offer our sincere condolences to Mr Harding’s family.

“Since Mr Harding’s death we have reviewed the care he received from our services and are satisfied that our staff did everything they could to engage with Mr Harding and to support him.

“We must work within the law regarding confidentiality and can only share information about an individual’s care and treatment with their family if they consent to do so.

“Where family members are formally identified as a carer we offer them an assessment to identify what we can do to support them too.”

Thanks to Kent online: http://www.kentonline.co.uk/kentish_gazette/news/2013/february/8/ben_harding.aspx

Crazy soup for the soul

Izzi — Tue, 05 Feb 2013 21:07:14 +0000

Crazy Soup for the Soul

I hear voices telling me to kill myself. They won’t go away, they tell me that I am worth nothing, that there is no point in me being alive because I’m just a waste of space. The problem is I agree with them.

Two years ago, after returning from a night of heavy drinking, I fell so low that I decided to take a scalpel to my wrist. Relief washed over me until I looked down at the blood pooling around me. So I panicked.

I wrapped a towel around my arm and ran to the hospital. Next thing, I’m being told I lost a lot of blood but that I would be okay. I was not going to be okay.

My biggest fear was how I would explain this to my boyfriend. That turned out to be the least of my worries. The psychiatrists were on their way.

I hate being in the psych hospital; it’s like a prison for the soul. They tell you when to eat, sleep, smoke and take medication. There is nothing to do; watching TV is the limit of available excitement, but you can’t even hear that because the other patients are shouting and screaming at each other or things in their heads.

I met three types of psychiatric nurses: lovely, distant and sadistic. Shrinks act as if they can’t hear anything you say and if they do they often just dismiss it. One asked me questions he already knew the answer to until I got so mad I nearly jumped off my chair and slapped the bastard round the face. Yes, nearly. I am not that stupid.

Psych wards themselves qualify for a diagnosis on the autistic spectrum as they display all the characteristics: no talking, no socializing, everything repeated within tight little boundaries and I was stuck there. Hidden from the world behind locked doors and reinforced glass.

The first friend I made there was Mo, a fat Asian man in his 30s. Mo had paranoid schizophrenia, which meant, like me, he heard voices. He had been on the ward for nearly a year on section; he was not very fond of authority, or so he said. I didn’t blame him; the thought of smashing the nurses office with a baseball bat had occurred to me more than once.

Mo and I would talk over tea, toast and cigarettes about nothing. Mostly we passed the time trying to put psychiatric diagnoses on the patients and sometimes the nurses. He helped me to adjust to this alien prison. He didn’t mind that my speech was all over the place. He made me feel like I wasn’t alone.

For the first few days, I felt a strange sense of peace on the ward. It was safe, if a little intruding. I had my own room and enough art materials to keep me going until Armageddon, so I would be okay. My boyfriend came to see me every day, even though I was a total bitch towards him.

Dealing with the voices was tough. They were talking about me, telling me to hurt myself. I hated being alone as it was just them and me but I struggled to construct a sentence so talking to someone was exhausting.

One day, a new patient arrived. Rose was once a nurse, but now she was a middle-aged woman with schizophrenia, and she was seven months pregnant.

Rose screamed abuse at anyone within 20 meters, patient, nurse or doctor. She filled the ward with racist slurs and homophobic tirades, but nobody tried to shut her up. She had a fearsome right hook, and was very, very pregnant.

Out in the smoking area, a small outdoor cage just next to the dining hall, Mo and I would sometimes chat with Rose. She told us in disjointed speech about how, as a nurse, she used to put people in strait jackets if they were badly behaved. She said they used to force people to take their meds with injections. I was strangely curious about this woman.

With a cigarette in her hands, Rose almost seemed normal. She made me think about my career. She made me wonder if I was going to end up like her. She made me see myself as an old coot, forever screaming and ranting in this hole. It made me feel like I needed to get away from this place and back into normal life.

After a few weeks, I tried art therapy. With Rose on my mind, I started to draw artwork that reflected how I was feeling. It was painful to put my darkness onto paper, but it felt good.

Soon there was another admission to the ward. Heather was only 18, but told me with some pride she has five diagnoses: Asperger’s, antisocial personality disorder, ADHD, schizoaffective disorder and narcissistic personality disorder.

Somehow, I found Heather quite pleasant, if a bit edgy. While she didn’t get on with Mo, it was nice to have someone young to talk to. Heather said her mum couldn’t cope with her any more and dumped her on the ward. Heather’s mum was all she had in the world and she had abandoned her. Would my loved ones, my boyfriend, my friends abandon me too when they got fed up with me? What about my social worker, would he leave me to cope on my own? I just couldn’t manage.

Working on my artwork became my therapy. It distracted me from the destructive voices plaguing my mind. I spent most of the days in the activity room doing artwork like this. The small but quiet room became a place where I could relax and feel a little better about my situation.

My sanctuary was taken away from me when Rose and Heather had a fight. It started off about tea, so I’m told. Something to do with one pushing in front of the other. Within seconds, it escalated into maybe the loudest shouting I have ever heard, and certainly the most profane. There was a flurry of punches, kicks, and furniture across the kitchen. The alarm went off, but the fighting continued. Then five nurses turned up to stop the fight, followed by four security guards and then another ten nurses before the women could finally be separated.

I watched, along with Mo and the rest of the ward, in a kind of sadistic trance. Rose, still throwing her fists and legs, was dragged to the activities room and locked in. Heather was heavily drugged and taken to her room. Then it was over, and everyone diffused back to the nothings they were doing before. I walked to the activities room and looked through the window. Rose was shredding my art.

I called for the nurses, but they refused to go in just to get my drawings. So I watched as all my therapy was torn into confetti. Rose watched me back through the window; she was angry and wanted to cause someone pain, and she didn’t care whom. I just sat outside the room crying. I was still crying when Mo came over with a cup of tea and told me it was time to go for a cigarette. Resigned, I got up.

The next day and the days after that, I was still locked away from my art. I resorted to sulking in my room. The nurses told me staying in my room all day was not acceptable behaviour. They never told me why. When I refused to leave I was physically removed and the door was locked.

Now I was really alone. No art materials, nothing to do but sit and be with my voices. I wanted out. I hated this place more than anything so I asked for some leave to go to the shops. They gave me two hours leave so off I went.

From every pharmacy I passed, I picked up as much co-codamol as I could. I hid twelve boxes in my underwear, and made my way back to the ward. It wasn’t a great plan – twelve boxes of meds aren’t inconspicuous even beneath a coat – and I was found out. I thought I was going to be in big trouble.

The nurses just took the meds off me. No questions, no bollocking, no nothing. That made me feel even more depressed, and now I had no means of ending it. I wanted to go cry and scream in my room, but that was still locked, so I hid in the toilets until they came and physically removed me, my heels scraping along the floor as they dragged me into the common room.

There was nowhere for me to hide. I couldn’t leave the ward and the communal areas were full of people dealing with their own daemons. I didn’t want to be anywhere near other people. I wanted to die but that choice had been taken away from me. There was nothing I could do but pretend to watch television. On the outside I sat still as a statue. Inside I was screaming at the top of my lungs in anger and fear at the voices that were plaguing my mind and my captors who would not let me be alone.

The next day I got my precious activities room and my art materials back. I was still angry but I decided to make a conscious effort to try getting better again. I drew pictures over and over and over. Despite the voices I strived to talk to the other patients. I sat myself in art therapy day after day. And slowly, I began to work through what had happened to me as a teenager and what was happening to me now.

I felt a little better. The medications began to take the edge off the voices I was hearing. My mood was improving. As I changed, the ward took on a different personality. It lost its shackles and became a purgatory for those too sick to look after themselves. Attempts at treatment seemed half-hearted or absent. As soon as people showed the most miniscule sign of being able to look after themselves, they were let out with little follow-up. That was all they could do with the little resources they had.

My final meeting with the ward psychiatrist was quite amicable. I almost felt a modicum of respect from him. I was allowed to leave on my own terms. I was discharged back to my social worker who came to see me every day and also my community psychiatrist who saw me frequently. I went back to work on my PhD a couple of weeks later. I was still unwell and was hearing voices (I still do) but I had made the decision that I was not going to let this stop me. The scar and stitches on my wrist also served as a stark warning as to what can happen if I let my illness get on top of me so now I know when I need to ask for help.

Every day I am alone. My boyfriend, my friends and colleagues all know that I have bipolar disorder but the reality is this: People get fed up of you talking about being unwell all the time and I am sick of it. I spend so much of my energy putting on a happy face to the world and why should I? I feel there is no one who will truly understand and be able to stop the feeling of being alone even though I am surrounded by people who care about me. That is the truth of severe mental illness; It is a daily battle and I will always and forever be alone. The only thing that accompanies me to the depths of my insanity is my artwork. It will always be there for me and for that I am eternally grateful.

Hearing voices is just madness

Izzi — Sun, 03 Feb 2013 19:20:45 +0000

I am totally crazy at the moment. The voices won’t leave me alone and I feel surrounded by madness. I’ve been seeing things too, particularly when I’m trying to get to sleep. I feel like a small child, scared of the shadows in their bedroom. I’m back on the diazepam which is helping somewhat but it gives me such a hangover that I have missed so much of my studies.

I wish it would all go away but nothing I try seems to work. Distraction and meds are all useless at the minute and I am really scared that I’ll do something bad.

I can’t write any more, can’t concentrate

Mental health patients are being ‘detained in all but name’

Izzi — Sat, 02 Feb 2013 00:28:33 +0000

More people are being sectioned under the Mental Health Act and too many of those detained are subjected to unnecessary restrictions and get too little help to recover, the NHS watchdog reports today.

The Care Quality Commission’s (CQC) annual report into the working of the Mental Health Act 1983 (MHA) paints a picture of some pockets of excellent practice, where patients are treated with dignity and respect. But it also highlights concerns that “some hospitals have allowed cultures to develop where control and containment are prioritised over treatment and care”.

David Behan, the CQC’s chief executive, says: “Our report has found too many instances where people have been restricted inappropriately. It is unacceptable for the current situation to continue.”

In total, 48,631 people were detained in hospital to receive mental health treatment in England in 2011–12 – 5% more than the year before. Another 4,220 people became subject to a community treatment order – up 10%. A further 16,000 people voluntarily admitted themselves for treatment.

The CQC based its findings on visiting 1,546 wards, talking to 4,569 detained patients and checking more than 4,500 detention documents. Its findings include that on one in five visits – “an unacceptably high number” – MHA commissioners (inspectors) found that people who were in hospital voluntarily “might be detained in all but name”. Although such patients are supposedly able to leave any time, “in 88 out of 481 visits there were no signs on locked doors that explained to voluntary patients how they could leave the ward”.

The CQC is worried about staff being inadequately trained in how to correctly restrain those exhibiting disturbed or violent behaviour and wants safeguards improved. Some staff at a learning disability unit had not had refresher training for two or three years, despite the high number of such incidents in their unit.

On one ward, two patients who had become very disturbed were restrained by police using a Taser gun, according to the report. The CQC also found “two further examples of patients who were Tasered while being transferred in detention”. Taser use within hospital premises “is of great concern” and raises questions about staff numbers, it said.

Of the 4,576 patient records checked by the CQC, 4% “showed irregularities that called the legality of the detention into question [which] means that more than 180 patients may have been unlawfully detained”.

Paul Farmer, the chief executive of the mental health charity Mind, voiced concern that “people’s basic human rights are being infringed at a time when they are likely to be at their most vulnerable”. He says the overall rise in detentions and community treatment orders is “very worrying” and “is symptomatic of problems elsewhere in mental health services”. According to Farmer, better access to talking therapies, or well-resourced crisis-care services that can respond to a person’s individual needs, can help prevent a situation escalating until compulsion appears to be the only option. “Yet we know from extensive research that mental health services are failing in all these areas,” he says.

For Paul Jenkins, chief executive of Rethink Mental Illness, the report shows that “the system has become too focused on managing risk, at the expense of quality care and treatment”. The NHS is wasting money because some patients are being “needlessly detained in very expensive settings”, which is “unfair and potentially damaging to the individual”, he says. Mental health needs to undertake “a fundamental shift” and put less into secure care and more into early intervention services, to stop people becoming acutely unwell, he adds.

The CQC is also concerned that mental health services are under growing pressure, with wards overcrowded, staff overworked and too few community services. In some places, patients are being discharged too early, or without enough support. The watchdog is also worried that despite many initiatives, such as improvements outlined in the coalition’s mental health strategy and a mandate to the NHS Commissioning Board, which legally requires the board to pursue the objectives of putting mental health on a par with physical health, there is still “a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy“. Its report concludes: “Practice in some areas … is a far cry from the policy vision.”

Thanks to The Guardian http://www.guardian.co.uk/society/2013/jan/30/care-quality-commission-mental-health-services

Coercion in mental health services

Izzi — Fri, 01 Feb 2013 23:59:20 +0000

The Care Quality Commission’s (CQC) annual report into the working of the Mental Health Act reveals disturbing trends in coercive practices by psychiatric services. Compared with the previous year, 2012 saw a 5% increase in involuntary detentions in hospital, and a 10% increase in the use of community treatment orders (CTOs, which require psychiatric patients currently well and living at home to comply with their treatment – usually antipsychotic medication – on penalty of being compulsorily readmitted to hospital if they do not).

These figures almost certainly understate the extent to which, in some services, coercion is routine. As the commission notes, many voluntary patients are voluntary in name only, unable to leave locked wards for fear of being sectioned if they demand to be allowed home. In the community, about a third of patients living at home are subject to informal threats or “leverage”, for example that their accommodation arrangements, benefits or right to care for their children will be affected if they do not follow medical advice.

Many mental health professionals, especially psychiatrists, see coercion as an essential tool, so it is important to understand why it should be avoided if at all possible. Respect for autonomy – the right to make choices – is, for good reason, a widely recognised principle in medical ethics. Aside from the fact that autonomy is regarded as a virtue in its own right, its denial is usually distressing. Indeed, a compulsory admission to hospital is often experienced as traumatic, sometimes leading to the same kind of post-trauma symptoms experienced by victims of assault or life-threatening events. Of course, many psychiatric patients have previously experienced physical and sexual abuse, bullying and other kinds of victimisation – that is often why they develop psychiatric problems in the first place – so coercion by services adds to a burden of adversity that is already too great to bear. It also damages relationships between patients and services, often leading to greater reluctance to seek psychiatric help during future crises.

Defenders of coercion typically argue that it is a necessary evil, because patients do not know what is in their best interests. This argument, of course, assumes that patients are irrational in rejecting psychiatric care, that psychiatric treatments such as antipsychotic medication are always beneficial, and that patients compelled to receive treatment do better in the long-run.

Each of these propositions is dubious. Studies show that many patients reject drug treatment because it is experienced as ineffective and associated with side-effects (some of which are life threatening – one recent report estimated that psychotic patients, on average, have about 20 years’ reduced life expectancy, some of which is attributable to drug side effects). Recent randomised controlled trials of drug treatments – both antidepressant and antipsychotic – have shown them to be much less effective than previously thought, with many patients showing a minimal response. Finally, the existing controlled trials of CTOs show little evidence of the expected benefits in terms of reduced future hospitalisation – they are not the solution to the “revolving door” patient they were designed to be.

Ironically, these latest figures on coercion have emerged when official NHS policy is to develop services that follow a “recovery model”, which emphasises good quality relationships between patients and staff, advocates patient choice about the kind of treatment received, and which promotes an optimistic attitude in which recovery is understood holistically instead of being narrowly defined in terms of symptoms. Why, then, is practice heading in the opposite direction?

Risk avoidance is undoubtedly a factor. A quick glance at articles about mental health in the tabloid press confirms that psychiatric patients are often viewed as dangerous (not true in the vast majority of cases) and that psychiatrists are usually blamed if their patients become violent. It is extremely difficult to predict violent behaviour, but this doesn’t prevent 20-20 hindsight when an incident occurs. Poor training is probably another factor. Since the late 1970s, psychiatry has become more medical in its orientation, leaving some psychiatrists lacking the therapeutic skills required to engage with patients effectively. With neither the time nor the training to work psychotherapeutically, drug treatment, however limited, is all they have. As Abraham Maslow remarked, “If the only tool you have is a hammer, everything looks like a nail“. In the last few years there has been intense debate within psychiatry between those who have a strictly medical view of their profession and those who advocate reform and a more patient-centred approach.

Of course, none of the above is to deny that, sometimes, coercion is difficult to avoid. But if coercion is a necessary evil it is still an evil and mental health services need to find ways of resorting to it less. This will require a change of culture and, perhaps, for some mental health professionals to consider alternative careers. In the long term, the solution to the problem of coercion in psychiatry is to design services that patients find helpful and actually want to use.

Read the article at The Guardian: http://www.guardian.co.uk/commentisfree/2013/feb/01/mental-health-services-coercion

A poem on OCD

Izzi — Sat, 12 Jan 2013 23:40:48 +0000

Looking at window display

A black dress I can’t afford

Walking down Regent Street

Bodies bump into me

People pass like cattle

Frustration

Shops blur in the melee

Herded towards the curb

My legs feel…

Fall, Fall, gonna fall, gonna fall

Plastered against shop window

Calming down. Walking

Arms pulled in

Look straight ahead

Eyes front. Avoid the crowds

Restaurant in sight

Walking in

See Mark across the room

Sit down and say hello

Catching up

Adjusting the cutlery

Looking at the…

Dirt, dirt, dirty fork, unclean, dirty fork. Unsafe

Mark removes the fork

Calm

All in order

Order food

Must wash hands

In the bathroom

Stare at taps

Rotate taps five times.

Five quirts of soap

Wash palms

Wash backs

Wash fingers

Wash nails

Rinse

Stare at hands

All done now

Gonna

NO!!!

Didn’t work

Not clean

Feel sick. Wanna run. Wanna hide.

What to do?

Stare into the mirror

Catch my breath

Put on a smile

Return upstairs

Say nothing