TV makes me rage. Psychiatrists are either quirky but brilliant who can overcome the patient’s reluctance with amazing insights, or they are semi-competent torturers who’ll zap your brain, strap you down, and lock you in a padded room for a mild mood disorder.
Any realistic depictions of psychiatry on TV?
MH Trusts are often split into various teams. There’ll be a Primary Care and Assessment Team, to act as a gateway into services. There’ll be a Crisis Team, to act as a gateway into hospital. There’ll be Community Treatment Teams, to treat people outside hospital. There’ll be Psychiatric Liaison Teams to provide some support in general hospitals. There’ll be Assertive Outreach Teams to work with people who have trouble working with regular teams. There’ll be Forensic Units for people with a forensic history.
How well do all these teams communicate?
You get told by one team that you’re on the books for Crisis Team home visits. So, out of hours, when you’re in Crisis, you phone them to be told that you’re not on their books, and they’re not going to visit. That’s lousy.
You get told by one consultant that you have to make use of the Crisis Team, and consider use of in-patient stays. You call Crisis Team. They visit. They’re happy to admit you as an in-patient. The next day a different consultant tells you that you manipulated the system to get an admission that you should not have had. That’s lousy.
So far everything is within the same mental health trust. Now look what happens when you involve other groups.
Consider processes like MARMAP. (Probably called something else where you live.)
You’re the patient. You’re supposed to be involved in your care planning; you’re supposed to have a say; you’re supposed to be informed so that you can give consent.
At a Marmap meeting all the people involved in your care are supposed to get together with you and agree a plan. What actually happens is that some (but not all) of those people get together for the first part of the meeting -which you’re not allowed into- and then most of them go, leaving a few people to tell you what’s going to happen. You think they’ve got it wrong? Tough. You disagree? Tough. That’s lousy.
Now add in out-of-county treatment. Different hospitals have very different standards for visiting (flexible hours VS rigid adherence to their timetables) medication, mobile phones (use them VS we’ll take them off you if we see it) etc. Imagine being a patient caught up in all these different protocols. What’s acceptable in one ward is seen as trouble-making in another. A normal request for meds in one ward is drug-seeking behaviour in another.
Poor communication sucks. It makes life harder for nurses. It makes life harder for patients. Poor communication causes harm.
I try to avoid images, but this is really tricky for me without them, so here goes.
Imagine your thoughts are churning churning churning, and you just want a bit of rest from them. All your energy is going into keeping those thoughts under control.
You ask for help, and someone suggests diazapam or lorazepam or something similar.
three states of mood: loud, quiet, and out of control
Look at the image on the left. Red (BAD) thoughts are churning churning churning. Blue (person’s self control) is spending all its energy trying to keep red thoughts controlled.
Now look at the image in the centre. This is what we want to happen when we take *azepam. We want the red thoughts to be calmed down, allowing the blue self control to get some relaxation.
Now look at the last image. This is what actually happens. The meds have zonked the last bit of self control the person had, and has allowed the red churning thoughts to erupt in a volcano of (probably quite risky) self harm.
People who dissocciate while they self harm may be at particular risk of this kind of dangerous self harm with no suicidal intent, but with death as a consequence.
I have no idea what the answer is -how to let people get some space from churning thoughts of DSH- but I’d be keen to hear from other people about their ideas.
Deaf people sometimes talk about hearing loss as the ‘invisible disability’. People often think someone is fantastically rude, when in fact they’re just deaf.
BPD¹ is similar. People can appear to be rational, and yet are suffering through crisis.
Maybe this is why advice to people with BPD is sometimes so bad. “You know the consequences, you’re rational, it’s your choice”. Except people say that they don’t feel like it is their choice. They don’t feel rational. They want help setting those boundaries.
¹ BPD: I hate hate hate this name and I wish there was a more suitable name.
We hear a lot about people accused of murder having a history of mental health problems. Here’s an example.
attempted murder accused ’spent time in mental health unit’
Queensland Health says a man charged with the attempted murder of his two-year-old son spent time in the mental health unit of the Ipswich Hospital.
Are stories like this balanced against all the other murders which are carried out by people with no history of mental illness?
How many children are killed each year, and how many of those are killed by their parents?
The NSPCC has some grim statistics.
I’m not going to quote any because it’s important to see them all, and get the context and sources.
One thing that’s missing from those statistics is the rate of mental health problems among murderers, and the number of people whose mental health problems were the cause of their crimes.
How many children would still be alive today if mental health services were better? Or do we just want to think that no-one is capable of killing a child unless there’s something wrong with them?