“Mad” or “Bad”?

In my new (and so far neglected) blog “Do I Look Like I Care?” I received a comment from a reader who calls herself Kim. Kim said, in part:

“Ann* is very unwell; she is a paranoid schizophrenic, and has not had her depot injection for 8 weeks. She is a real danger to herself and others, and is getting rather aggressive. She assaulted 2 nurses up at the local unit last week, they called the police, and the unit said they couldn’t have her as she was being violent and the police wouldn’t have her as she was mentally unstable, so sent her home. Now we (her friends) take turns looking after her, it’s one crisis after another, and we are all starting to fear for our own safety. We have contacted all the relevant people and no one will take any notice of us as we are patients under the same team. We are at our wits end, and getting unwell ourselves.

They won’t do anything until she puts an axe in someone else’s head or her own, by which time it’s too late. They will spend millions on a public enquiry, where if they had done their job properly no one would get hurt and would save lots of money.”

*Not her real name.

I feel this experience highlights two major problems which I have written about previously: the difficulty in accessing services for people with mental health problems - even for those who are familiar with how the system works; and also the fact that the responsibility for caring for such ones often falls on those who are neither equipped nor qualified to do so. But also, I can’t help but wonder if Ann will end up in a similar situation to Justin.

Justin is a young man suffering from mental health problems. He set fire to his flat and as a result was given a discretionary life sentence.

Slurry tells us regarding Justin:

“It was his mental illness which led up to the event. He was not being looked after by the CMHT very well at all. We (his friends) knew something big was going to happen so we rang the CPN many times in the week leading up to it. Never did they come and visit Justin or speak to him like they promised, then it was too late.

He does not do well in the prison system, as it’s the wrong place for a mentally ill person, and I am so bitter at the system which failed him and so many others.”

Now don’t get me wrong; I’m sure that there are people with mental health problems who are just as capable of breaking the law as someone without these problems, and being ill isn’t necessarily the cause of someone breaking the law. But in both of these cases, and many like them, the deterioration of the person’s symptoms were obvious to others, to the extent that friends feared that at some point the individual would take extreme action which would usually be completely out of character for them.

This point is important for two reasons:

Firstly, the general public wrongly presume that people with mental health problems are unpredictable and could go off on a murdering spree at any moment. The two cases above clearly show that if people bother to take notice, the warning signs are there.

Secondly, the CMHT were obviously unable or unwilling to act on the concerns of others. This is either because their resources are desperately lacking or because they don’t take the concerns of others seriously. My guess is that it is a combination of both.

So the question is: how many people are in prison because they have been failed by the Mental Health System? I know we often hear in the news about people on trial who have had a psychiatric assessment, and I’m sure that this is often an attempt to avoid the full penalty for their actions. But what about those who are genuinely ill, and who were well known to their local CMHT before the incident? And even neglected by their CMHT before the incident?

“Service users” are often seen as faceless objects.

"Faceless Care" by Philippa King

Not quite out of the woods

The last few days Mr Man hasn’t been feeling very well. The voices have become intrusive again and he’s been anxiously pacing the floor and standing by the window checking for people watching the house.

I know I have to expect that his symptoms will fluctuate, but it’s so disheartening when he’s been doing so well. I just hope that this isn’t a result of the extra responsibilities he has taken on recently, and I hope that he will still feel able to manage them.

Thinking Blogger Awards

Thank you to Seaneen who has awarded me with the “Thinking Blogger Award”. What this really means is that I have simply been tagged with a glorified meme, but I feel honoured just the same!

According to the rules, you can only select others to receive this award if you have received it yourself, and you must link to the origin of the meme.

I would say that many of the blogs I read are enlightening or interesting in some way, but to be given the “Thinking Blogger Award” I suppose they really have to be ones that either inspire me to write my own thoughts on a subject, make me question my own opinions, or make me think deeply in some other way. Bearing this in mind, and in no particular order, I nominate as follows:

Mental Nurse – often inspires me to write of my own experiences, and has helped me to realise that some psychiatric nurses actually care about what they do.

The Police Inspector Blog – has helped me to see the human side of officers who try hard to protect the public, although often with their hands tied behind their backs.

Pole to Polar – no other blog fires me up in quite the same way and makes me want to walk the streets of London in protest!

Forensic News Blog – makes me think in more of an academic, scientific kind of way. A fascinating blog, with content that often leads to additional research on my part.

A Long Walk to Forever – thought provoking in a beautifully simple kind of way. Her quotes often leave me speechless.

To all of the above:

Congratulations! You’ve won a

Should you choose to participate, please make sure you pass this list of rules to the blogs you are tagging. The participation rules are simple:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think.
2. Link to this post so that people can easily find the exact origin of the meme.
3. Optional: Proudly display the “Thinking Blogger Award” with a link to the post that you wrote.

Some Updates

The daughter of the man mentioned in my post entitled “Helpless” managed to get her Dad to the Community Mental Health Day Hospital last week, and he saw a psychiatrist there. His medication has been changed, and his daughter bought him a mobile phone so that she can ring him daily. Despite having a full time job and being a single parent with two children to look after, she has realised that she now has to take control of his care, and has decided to go with him to all of his appointments.

The strain of the previous weeks events, coupled with the realisation of her responsibilities as her Fathers carer, finally took its toll on her over the weekend, and she broke down in tears. I spoke to the new* Carer Support Worker at the CMHT today to get some support for her.

Funnily enough, the first question I was asked was “Who is her Dads Care Co-ordinator?” I don’t understand why people who actually work in mental health automatically presume that people always have access these services, when they know full well that these services are limited and many people are going without. Anyway, the lady said she would look into the matter and find out why he doesn’t have a CPN, and also contact the daughter to offer her support.


In other news…
Mr Man is doing exceptionally well at the moment. He keeps surprising me by taking on more and more responsibilities.

In my last update I wrote that as well as attending Table Tennis practice regularly, he was also taking part in the Summer League and helping out with coaching. Despite the Summer League and the coaching being held on the same night, and thus taking him out of the house for 4 ½ + hours on that night, he seems to be coping with that very well. He has also started going to practice twice a week now instead of just once a week, and this week he has decided to go to coaching nights twice a week as well! That will take him out of the house four times a week!

His offer of redesigning the club website has been accepted, which now means he is a member of the Clubs Committee, and last week he attended a Committee meeting. After the stress of having to speak up at the meeting about his plans for the website, he began to feel very unwell and the voices started becoming very intrusive. He excused himself and sat in the locker room for a while and had a drink, and then returned when he felt able to. Obviously he is still having problems from time to time but he is coping with his symptoms much better now.

And finally, Mr Man has also been asked to Captain his team next season. It seems that since it was announced at the Committee meeting that Mr Man will be able to save the club nearly £200 a year in hosting fees, he has become flavour of the month!



*This new position is something I had been meaning to write about for ages. I suppose now it is a topic for my new blog.

Too Little, Too Late

Following on from yesterdays post entitled “Helpless” I would like to continue part of the discussion that followed in the form of a blog post, as I feel that the struggle to access services for people suffering with mental health problems is an important issue which many people may be unaware of.

Catherine said:

“Your post left me feeling sad and empty inside. Recently I have read a lot of posts coming from bloggers saying that the very people that are supposed to help them, aren’t.”

Catherine, the whole situation leaves me feeling sad and empty as well, but also angry. As you have found from reading other blogs, this isn’t an isolated case, and this is an important issue that mental health services need to address.

“Is this just what happens when you cannot fight for yourself? Everyone ignores you?”

The fact that people find it so hard to access services even when they have someone fighting for them suggests to me that there must be people on their own who are not getting help at all. I suppose this could be for a variety of reasons; for a start, people working in mental health aren’t psychic, so unless a person states that they need help no one will know. But I feel that once a person is known to a CMHT they should be provided with an adequate support system, and this is where they are being failed.

This leads me to Slurry’s comment about the CPN.

“I totally understand what you were saying in that post. In regards to “where is the CPN” etc, if it’s not Mon-Fri 9-5 they don’t want to know, even in those hours they probably wouldn’t want to anyhow.”

Slurry, you’re right, the fact that Community Psychiatric Nurses only work Monday–Friday, 9-5 is less than helpful. But the reason why I asked the questions: “Where is this mans Care Co-ordinator? Where is his CPN? Where is his Care Plan?” is because I don’t think he even has any of these things, although he should have.

The problem is that “Service Users” are not made aware of the services available to them or what help they are entitled to, and even the most caring and supportive of families can not demand the services for their relative that they have no knowledge of. This is a problem that Mr Man and I have experienced ourselves; Mr Man was not assigned a CPN until he had been discharged from hospital after his third admission, in which he had been admitted under a section of the Mental Health Act.

So with regards to the man suffering from Bipolar, the question is this: has he been left without this support because the CMHT wrongly assume that his family, with no training, will be able to cope with the responsibility of caring for someone with serious mental health problems? Or - and this is a far worse scenario - are people with mental health problems, including those who live alone, routinely left without an adequate support network from the CMHT until it is deemed impossible to “get away” with it any longer, such as after multiple hospital admissions, or after the person has been hospitalised under a section of the Mental Health Act?

It is my belief that as soon as it becomes apparent that a person is suffering from a serious mental health problem, they should be assigned a Care Co-ordinator, a CPN, and have a Care Plan drawn up. Surely prevention is better than cure? If this man had a CPN regularly calling to see him, I dare say his condition wouldn’t have deteriorated so badly before anyone noticed. If he had a Care Plan, his family would have known exactly what to do and who to call when he reached crisis point.

It makes me so angry that relatives have to fight so damn hard to get help for their sick loved ones, but who will fight for the person with mental health problems who lives alone?



If you want to be depressed even further, please read this article on Mental Nurse, and in particular the article linked to therein.

Helpless

I think my first experience with someone with mental health problems was when I was seventeen. I think I may have been on my way to the shop that was just over the road from where I lived when I saw a woman, obviously in a distressed state, walking down the road talking to herself. I went after her to see if I could help.

I remember the woman wasn’t dressed properly, although I don’t remember what she was wearing. She had slippers on her feet, and she held an unlit cigarette to her mouth. As she walked down the street she looked straight ahead, not even noticing my presence. She kept repeating herself over and over again saying “My husband has left me, my son has gone, and I don’t know where I am” I remember the inflection in her voice so clearly as if it was yesterday. I kept asking her if she knew her address. Could I take her home? Was there someone I could call for her? She didn’t see me or hear a word I said; she just carried on walking and talking, repeating the same thing over and over again. When we got to the bottom of the road, she crossed over and started walking back up the other side. “My husband has left me, my son has gone, and I don’t know where I am” I had no idea what to do to help her. I didn’t want to leave her to get help because I wouldn’t have been able to find her again.

"Portrait of a Woman Standing in a Street at 11.23 am"
by Phillipa King

I saw a Vicar sitting in a parked car going through some paper work. “Great” I thought, “he’ll know what to do”. I tapped on the window and he wound it down. I explained to the Vicar about the woman, pointing her out to him as she walked past on the other side of the road. “Yes, it’s very sad” he said looking over at her, and while he gave me a sermon on how sad it was she wandered off and I lost her.

I went inside feeling very disturbed by what had just happened; not just because the Vicar seemed so unwilling to get involved, but because I had no idea how to help the woman and I was worried about her. I felt utterly helpless. The experience stayed with me for a long time afterwards.


These last few days I have struggled with similar feelings, as a man I know who suffers from Bipolar took a life threatening overdose at the weekend. He was violently shaking and vomiting, hallucinating and passing out. When the ambulance arrived he refused to go to hospital, and so the ambulance crew left him behind.

Like the Vicar, his brother refused to get involved and I, after all my experience with Mr Man, still had no idea how to help. The best I could do was to suggest that his daughter call the out of hours doctor and explain the situation, hoping that the doctor would then make the necessary arrangements for a psychiatric assessment, but her Dad said he would never forgive her if she had him admitted, and he headed for the door. The last thing she wanted was for him to fall unconscious somewhere and to choke to death on his own vomit so, worried for his safety and feeling emotionally tied, she agreed not to call anyone. It seemed the only thing his family could do was to take it in turns to stay with him and hope that he recovered.

The feeling of helplessness in a situation like this is compounded by professionals passing the buck; an ambulance crew who drive away instead of calling an ambulance officer or a GP; then two days later a psychiatrist who refers him to a GP, and a GP who merely “urges” him to go to the hospital the next day for a blood test. If professionals are this unwilling to help, who else is there to turn to? Where is this mans Care Co-ordinator? Where is his CPN? Where is his Care Plan? What does this man have to do before his needs are taken seriously?

If it’s as difficult as this for a man with people looking out for him to get help, how many more are slipping through the system without a person who cares for them to demand services on their behalf?

The Great and the Small

Trying to catch up on some blog reading, I came across an article today written by Bipolarmo on Mental Nurse, entitled Sleeping with the Enemy. It’s about the stigma surrounding mental health - in mental health. In the one place where you would expect to find understanding, some nurses clearly have a poor attitude towards those with mental health problems. It seems that on some wards, if one of the staff members suffers* from mental health problems they fail to gain respect from their co-workers and become something of a laughing stock. Such an attitude towards fellow workers with mental health issues is obviously a reflection of how they feel about people with mental health problems in general, and raises the very serious question of whether such ones should work in mental health.

I've seen this “them and us” attitude in nurses on the ward myself. They wrongly presume that they are immune to the possibility of ever having mental health problems of their own, and view themselves as superior to such “weakness”. As Bipolarmo so rightly points out, how is an attitude like that supposed to help break down the stigma surrounding mental health? Why do some nurses still have this archaic attitude? Did they get their training from cave walls? If mental health staff haven't realised by now that the patients are neither “stupid” nor “weak” then how can we expect the general public to understand?

I think that people who have experienced mental health difficulties themselves would undoubtedly make very good psychiatric nurses - certainly they would be very approachable. In my experience, people with mental health problems are often intelligent; sensitive to peoples needs; gifted, and deep thinkers. I can’t tell you how angry it makes me feel to know that some people who are trained to help these ones view them with such contempt. Do they view people with physical diseases this way? In reality, some of the patients on psychiatric wards are more intelligent and often more gifted than many of the nurses. Rather than looking at people with mental health problems with disdain, nursing staff should feel humbled realising that mental illness, like any other illness, knows no boundaries and can affect the small and the great alike.

You know, when Mr Man was first in hospital we both had such a traumatic time, both with coming to terms with his illness, and with coping with the attitudes of some of the staff. One day this girl smiled at me and started chatting. She asked me how Mr Man was doing, and then asked how I was coping. I was shocked because Mr Man had already been on the ward for quite a while and she was the first person to ask me that. Do you know who she was? She was a patient who had just been moved to the Acute ward from ICU. She went on to tell me that when she is well again she wants to work in mental health. I sincerely hope that she has achieved her goal.

*I use the term “suffers” meaning someone who has previously suffered, or someone with a diagnosis of mental illness which is obviously under control, allowing them to function as well as any other individual who may occasionally have recurring problems with a physical condition, such as a back problem.

Fame Beckons

Well, that’s a little bit of an exaggeration, but I have been asked to speak on the radio about carers issues during Carers Week, which is next week. I declined, as speaking publicly isn’t really my forte, and getting up early in the morning even less so! Personally I find it easier to write what I want to say as it gives me more time to think over my words. Regular readers will know that I often edit posts several times even after they have been posted, but once a word has been spoken it can’t be changed. I can’t say I’m not flattered though.

This all came about due to a Carers Reference Meeting that I attended last week, the purpose of which is for services for Mental Health service users and their carers to be discussed and developed. The experience was enlightening, and I will definitely go again. I’m glad to see that services are slowly improving and are better now than what they were when Mr Man first became ill, and it’s nice to know that my experience can be put to good use and that I can have a say in services which are being developed for the future.

I have written an article about carers which the powers at be have decided is good enough to use, although I’m not sure yet how it will be used exactly. I won’t post the article here as I feel that this blog is starting to steer too much towards carers issues and my complaints about lack of services rather than our experiences in dealing with Mr Mans illness and how he has been treated by Mental Health professionals.

I have however, decided to create a new blog where I can write about these kind of issues. The blog is entitled “Do I Look Like I Care?” as I would like to draw attention to the fact that carers come from all walks of life and can be any age, male or female, and cannot always be picked out from a crowd. From now on, this new blog is where I will discuss any complaints about services, and I will also try to post an update each time I attend the Carers Reference Meeting.