'Catastrophic failings' in schizophrenia care

'Catastrophic failings' in schizophrenia care

By Jane Dreaper 
Health correspondent, BBC News


 I'm so pleased someone has noticed. 

Abuse in Mental Health Care? Surely Not!

The BBC's Focus on Africa TV programme has uncovered a number of abuses in a mental health institution in the Ghanaian capital, Accra. 

When asked why the conditions were so poor, the Medical Director replied that hospitals are seriously challenged - financially, logistically, and so on, and that what you are seeing is probably the best that you can get under the circumstances.  He also added that Mental Health services have not been a priority.

And why would they be?  It's easy to neglect vulnerable people when no one cares about them.  Who will notice?  Especially when they have been dropped off by a family member and abandoned.  What chance do they have of recovery?

Doris, who manages her mental health with the support of family says: "You need a family to accept the person.  You need a family to show them love."

And sadly, in a world that stigmatises mental health issues, and where vulnerable people are abused or neglected, they also need a family that will protect them, even from mental health "care" at times.

While You Were Sleeping...

Ok, so, I've been away for a while.  Yes, you've probably noticed that I don't post anywhere near as often as I used to, but I check in on other blogs even less often than that.  So tonight I am awake (for a change), and bored, and curious, so I clicked on a few links in my side bar.  And what do I find?  That blog land is not how I left it!  It's like returning to an abandoned memory and finding there is nothing even remotely familiar about it at all!

First I find that Random Acts of Reality doesn't even exist any more, NeeNaw is off-line, and Mike hasn't posted for 2 years after finding out that a fellow blogger was facing execution in Iran!  And what the hell happened to Mental Nurse?

Some good things have happened though:  lovely Seaneen is getting married! (Congratulations!) And Shiv has bought himself a couch and become a Psychology student!

Wow.  I suppose I really need to clean up my blogroll... another day maybe... I just need to take a little nap...

Trauma

I just listened to this very short snippet from an interview with David Nutt on BBC Radio 4's "The Life Scientific", and suddenly I couldn't stop crying.

It just seemed to come from nowhere, as it often does whenever anyone mentions the word "trauma".

I've never actually been allowed to talk about what happened to Mr Man in hospital and how it made me feel. Even my counsellor didn't want me to focus on that, but to talk about my mundane everyday problems, such as paying bills and getting enough "me time". Maybe that's why it is still effecting me 10 years later. No one wants to hear it. "That was all in the past", "It's time to move on!", "It doesn't help you to keep focusing on that". But what if you can't help it? What do you do when only one word brings everything back?

You know, she did say one thing that could actually be true though, although I didn't want to accept it at the time. She said that she thought my problems stemmed from my childhood. Why do I now believe that could be true? Because I watched my Dad nearly die while he was having a convulsion when I was too young to understand what was going on, and I wasn't allowed to talk about that either. No one asked me how it made me feel. It was like it never happened. I can't tell you how frightened I was as I knelt by his side, sobbing, and no one explained to me what was happening.

I felt as helpless in 2002 as I did back then. I was so scared. Like a little girl again. I thought the person I loved most in the whole world was going to die. And people behave like it never happened.

At least with my Dad I remember nurses and people running in and out and doing everything they could to save him. But with Mr Man they didn't care. It was like kneeling by his side, sobbing, while he convulsed on the floor, vomiting and turning blue, and no one doing anything to help him.

I wish you could see me sobbing right now, because there are no words to explain the pain, the fear, the desperation. There are no words at all. Only tears.

One Law For One...

Unfortunately I still have days where I want to round up all those who were involved in Mr Man's "care", particularly during 2002, and tie them up and gag them, slap them around the head a bit, and tell them how stupid they are, and just generally rant and rave until I've exhausted my rage.  I thought I had recovered, but there are still triggers.

Unfortunately it's illegal to do things like that, even to really stupid people who deserve it.  Even to people who have caused suffering to others, like they did.  It would be fine if I was a doctor though.  Then I could legally hold them against their will and cause them all sorts of suffering.

You see, if I was a doctor, I could intentionally cause a person to suffer by giving them medication with painful side effects, and refuse to change them, and even smirk when the wife begs me to relieve her husband's suffering.  And that is legal.

I could even enforce the giving of those tablets against the patient's will, even if they don't actually help their medical condition at all.  I could probably get away with that for about two months by saying I had to give them a fair chance to see if they would help.

Or I could deliberately prolong their mental suffering by hindering their diagnosis, by inventing weird and wonderful theories as to why they are ill, or pretending to be ill.  No one would ever know that I was just playing a game, and I could get away with that one for at least six months. 

If I was a nurse I could mentally and emotionally abuse the patients.  No one would believe them because "they're mental" - paranoid, and delusional.  And family members are just "over protective".

Or if they needed medical attention for something physical, and I was supposed to arrange tests, I could let them suffer longer and just say it slipped my mind because we're so busy.  I could probably get away with that for weeks.

If I knew that a patient was already a high suicide risk, I could bully that person to increase their anxiety, so that they try to take their own life, and I would be completely irreproachable.

Also, I could "inadvertently" cause someone's death through neglect, you know, like if I was supposed to check on them every 15 minutes but didn't bother.  I might have to go to court, but I wouldn't have to go to prison.  I could just say we were understaffed or something.

But seeing as I'm not a doctor or a nurse, it would be illegal for me to cause pain and suffering to those who did all these things to Mr Man and others.  So they get away with it, and probably continue doing it.  And ten years later I'm still left struggling to come to terms with the injustice of it all.

Men Vs Women

I read a long time ago on Seaneen's blog that men are more likely to receive a diagnosis of Bipolar, whereas a woman is more likely to be diagnosed with a personality disorder, or told to pull themselves together (this is not a direct quote). I'm here to tell you today that this is absolutely true.

I suffered quite severe mood swings when Mr Man was in hospital, and for quite a few years afterwards as well. I would swing from feeling completely elated, like my heart would burst with love and joy, to feeling that heavy crushing pain in my chest, with unimaginable emotional anguish. I was confused. I didn't know what was wrong with me. I kept a mood diary and went to speak to my GP.

My GP literally dismissed how I was feeling with "We all feel like that" before I had even finished my sentence. He obviously wasn't going to take me seriously, so I dropped it.

I struggled on until eventually it got too much for me again. This time I spoke to a lovely nurse at the surgery, who unfortunately could do nothing to help me, but she took me seriously and urged me to see a different doctor. This time the doctor listened to me, but explained that we all suffer from mood swings (sound familiar?) of varying levels. He refused to increase my anti-depressants, but referred me for counselling, which I never received.

Fast forward another year or so, and I saw yet another GP who increased my medication and I finally got some counselling.

During this time Mr Man frequently spoke about how concerned he was about me to his Occupational Therapist, because he too had noticed my mood swings, and particularly my "angry phase" when I literally wanted to kill people. I can speak about this now that I have recovered, but at the time I was so ashamed, and I didn't think people would believe me or take me seriously. Well... they didn't did they?

Looking back, I now know that I definitely wasn't suffering from Bipolar. I didn't really believe I was at the time, but I was just so confused about what was happening to me. Post Traumatic Stress also causes mood swings, which is what I now believe I was suffering from, but of course no doctor will ever concede that. For the most part I have had to struggle through it on my own, and yes, considering the amount of times I asked for help, and the amount of times Mr Man asked for help for me, I am bitter about this.

Of course, it would all be very different if I was a man. Now don't get me wrong; I am not a feminist, and I don't usually go along with all this "Men Vs Women" baloney, and "Men are from Mars" etc. etc. But, I know of men who have "achieved" the Bipolar status, by simply being... Well, I can't actually think of a polite way of saying it.

Now, I'm not saying that I wanted to be diagnosed with Bipolar - far from it. I simply wanted to understand what was wrong with me and to get help for it. But it really winds me up when I struggled so hard for so long to get help and was never taken seriously, when these men who are manipulative control freaks with a bad temper get told "You can't help it, you have Bipolar".

Being married to someone with a serious mental health issue, I am usually very sympathetic to others in the same plight, but for the same reason, I cannot tolerate men acting like spoilt children and being excused for their behaviour by their wives or girlfriends (or even ex-girlfriends) because they have "Bipolar". Mr Man has his limitations, but his illness never causes him to behave like a spoilt child.

Please correct me if I'm wrong (and I'm sure Seaneen will) but my understanding of Bipolar is that the mood swings are unrelated to daily events in your life? And I don't believe that people with Bipolar use self harm to manipulate the feelings of others? And I always believed that people suffering from Bipolar needed more than just anti-depressants, but mood stabilisers too?

To my mind, a diagnosis of Bipolar for these men tells them that they are being taken seriously, and not just being fobbed off with anti-depressants. But it also tells them that it's ok to act like a spoilt child when you don't get your own way, and it's ok to use self harm to manipulate others, or scare them with violence. And again, doesn't this reinforce the idea that people with mental illness are dangerous and violent? When in fact these people are just bad tempered individuals with depression? (Meaning, the bad temper was present already)

Two things need to change: a) GP's need to stop diagnosing patients with illnesses which are clearly beyond their expertise, and b) men and women need to be treated equally in the area of mental health. Yes, women are generally more emotional than men, but that doesn't mean we can't have mental illness too! And on that thought - when a GP says "we all have mood swings" do they mean all women, or men and women? And if they mean men and women, why are men told they have Bipolar and women are told "we all feel like that"?

I can't say that the counselling I received ever helped with the trauma I was trying to recover from. Even the counsellor preferred to ignore those events and focus on other things in my life. I have slowly recovered with the help of medication, time, and prayer, but it's taken about 9 years.

I can't possibly have suffered from Post Traumatic Stress though - because I'm a woman.

Another Call for Help

Following the post "A Call for Help" I received a comment from another lady struggling to cope with her sick husband and the situation it had placed her in.

I also don't know what to do anymore, after three years struggling with my husband's sickness. I'm from Asia, well-educated, but was forced to move to Europe (in a matter of two days) because of his sickness. I basically abandoned everything I had for him.

But after three years, on top of his sickness, my troublesome mother-in-law is constantly causing problems by demanding way too much attention from her son all the time and bad-mouthing me whenever she can. My husband loves me, but he doesn't see what his mother is doing to me. He needs his family, he said, and his mother loves him and pampers him like a child all the time.

I am depressed and at the end of my strength. I lose my temper very easily these days. My friends and family are all in Asia. And here I can hardly have an independent life due to language barrier and qualification mismatch. I just want to get myself out of this whole mess. But a divorce will be a huge blow to him... yet I can't see myself living a life like this anymore...

I also want to ask, what should I do?

Anonymous, I really wish I knew what to advise. I'm sorry that life has become so unbearable for you. Unfortunately I have no solution for troublesome mother-in-laws! If he enjoys the attention she lavishes on him, I can see why it would be difficult to convince him to leave - but what about you? Don't you also deserve the attention of your family? Maybe you could reason this way with him.

Although he may need additional support due to his illness, it doesn't mean that he can have his own way all the time! Maybe he just doesn't realise how the situation is affecting you?

When Mr Man was in hospital I was at breaking point, and so exhausted. He wanted me to visit twice a day. It was hard, but I had to explain to him that although I loved him very much, I also had to look after myself, otherwise I would get to the point where I wouldn't be able to help him at all. It helped that a nurse explained this to him also, and he was very good about me not coming for a day while I got some much needed rest.

I think sometimes when you are caring for someone with mental illness, the whole situation can become about them, and how they feel. But it really doesn't hurt to let them know how you feel as well. I used to avoid crying in front of Mr Man, but actually, when I did cry he would look surprised, like he'd only just realised that other people feel distressed over things too, and then he would forget about his own feelings for a little while.

So the only thing I can recommend is that you discuss how you feel with your husband. I don't know how ill he is at the moment, but he may surprise you and be stronger than you think.

I would also recommend trying to get some support for yourself. You don't say which European country you are in, so I don't know what the services are like where you are, but maybe visit your GP, get some help with your depression, ask to see a counsellor, and ask if there are any support agencies for carers.

I really hope this helps.