Thursday, 30 August 2012

the not so fine line between compulsion and force

As an ex-mental patient I have always been aware of the threat of forced treatment in psychiatric institutions.  Grabbing and jagging I call it.  Professionals use the words compulsory treatment and rapid tranquilisation.  Forced injections.  As a result of being unco-operative or non-compliant.  Because you've found yourself detained or constrained.  Surrounded by strangers in uniforms for whom engagement is a last resort.  If you are in mental distress.

The notes are the thing.  Written up by a range of professionals.  With the power to detain and constrain.  As a mental patient you're powerless to resist.  Adding to the distress that brought you in to this supposed refuge, asylum.  No respite.  From brain altering drugs that make you compliant.  Obedient to the regime.  On the outside.  But on the inside you're waiting for a chance to escape.  Abscond.  Waiting for an opportunity to get out from under the rule of psychiatry.

The police force are then called for.  Impressively uniformed and equipped.  With batons, handcuffs (speedcuffs), sprays, restraints.  Sent out by the nurses to bring back absconders.  Expensive honorary members of the psychiatric fraternity.  Scouring the countryside for the mental patient.  Investigating family residences.  Looking in garden sheds.

You're forced to return to the institution, to do as you're told, take the pills or be forcibly injected.  Play the game, join the team.  Take up smoking or become a passive smoker.  Bide your time until the psychiatrist deems you fit for discharge.  On the recommendation of the nurses.  It's written in the notes.  Your diagnoses, behaviours, attitudes, family history, psychiatric drug regime.  Nothing about your hopes, dreams or aspirations.  Of who you are or want to be.  The mental illness label has been forced upon you.  And will remain with you.  Despite recovery.

Wednesday, 29 August 2012

police presence in psychiatric wards

Where I live the police have become honorary members of the psychiatric nursing fraternity.  They are a familiar presence in psychiatric wards.  Like sheriffs in the wild west.  Bringing law and order to a chaotic environment.  Sent out after runaways.  Investigating crimes or misdemeanors.  In full uniform they are an imposing presence to carers and to patients experiencing mental distress. 

It seems that in Stratheden Hospital therapeutic staff have been replaced by the police.  There used to be occupational therapists on the wards, doing group work and activities to aid recovery and restore confidence.  I remember this.  Now there are no activities ongoing apart from smoking groups of patients outside in the patio (while nurses have been known to smoke inside the ward).  Nurses are too busy with writing notes and having important meetings.  

The head nurses in the acute ward have even got their own room now, away from the patients, where they can have peace and quiet to write their notes.  To phone the police.  To discuss management of patients.  To meet with carers and visitors and others.  To talk over confidential matters.  To reflect on their practice.

Meanwhile the police are sent for, most days, to deal with the problems that the nurses can't handle.  Meaning that the acute psychiatric ward environment has become a battle ground.  Of ever increasing compulsion and force.  Do what you're told or else.  Take the psychiatric drugs or else.  Stand back or else.  Restraint, seclusion and forced treatment an ever present threat.  And the police on hand to back them up.

Monday, 27 August 2012

daring to be a psychiatric survivor activist

Looking back over the months since the beginning of February I am beginning to count the cost of being a psychiatric survivor activist.  The bullying, intimidation, slandering of my reputation and attacks on my family.  By people who should be protecting the rights of vulnerable people and respecting carers.  

It's been an interesting journey, my decent into the bowels of the psychiatric system.  Something of an adventure, like fairy tales of old and time travel movies.  I've always liked adventures, from reading Enid Blyton's Famous Five and Secret Seven stories as a child.  When good triumphs and the baddies get their comeuppance.

Of course in real life it's a lot messier than this.  (a colleague used the word 'messy' recently to describe a situation I'd been involved in)   The baddies often seem to get away with it and the good folk struggle with the injustice of it.  But I'm of the belief that what goes around comes around.  That there are consequence to actions.  It might take a while for it to happen.  I can wait.

Friday, 24 August 2012

collusion and control

The unholy trinity of restraint, seclusion and forced treatment in the psychiatric system can lead to collusion by agencies who should be protecting the rights of vulnerable people.  In an attempt to keep control on the slippery slope of patriarchal power.  Where patients are treated like children and real family are sidelined, surplus to requirements.  

Investigations into adult protection can be like shutting the gate after the horse has bolted.  Too late too little.  Diversionary tactics of blaming others.  Non system others.  Keeping up the appearances.  That force is justified if a person is mentally ill.  Does that mean they deserve it?

Families left to pick up the pieces.  Put their reputations back together again.  Shake off the disappointment but retain a modicum of distrust.  Learning from the experience that not everything does what it says on the tin.  Older and wiser and stronger.  Ready for the next round.

More about this in future blogs.  

Thursday, 23 August 2012

is adult protection in the psychiatric setting all it's cracked up to be?

"Fife Council Social Work, NHS Fife and Fife Constabulary are working in partnership to keep people safe from harm."  According to the adult protection information on the Fife Council website.

I'm wondering how this translates into the psychiatric setting where restraint, seclusion and forced treatment are ways of working with vulnerable people.  Where locked wards and seclusion rooms within locked wards mean that vulnerable people/patients are out of sight and out of mind.  Where carers, family members and named persons are not allowed to go, except by permission and even then could be by the back door.

What constitutes safety in the psychiatric ward?  Does it mean taking the pills and doing what you're told?  Being compliant and not questioning the decisions of professionals.  Accepting that they know best even if they don't know you.  

Or should it mean person centred care, getting to know the patient and carer and family members?  Mutual partnerships and shared decision making.  Like it says in the new mental health strategy for Scotland.  I say yes to this and to a safe psychiatric inpatient environment where adult protection is all that it should be.

respect for carers?

Something happened yesterday to make me doubt that there is any respect for carers under the mental health act where I live.  

I have been left reeling after receiving a report from professionals.  In which my character and intentions are maligned.  Because of their failure to protect people at risk of human rights abuses.

I won't go into details at this point and have raised a complaint.  We'll see how it goes.  I am not confident of a fair hearing. 

Tuesday, 21 August 2012

the cost of redefining independence to mental health advocacy

Where I live they have been debating the meaning of independence, in respect of advocacy.  And after much discussion and rhetoric there is still no consensus about what independent advocacy amounts to in Fife.  (I'm talking about others as for me there is no doubt)

In the rest of Scotland there doesn't seem to be a problem.  The Scottish Independent Advocacy Alliance (SIAA), devoted to the promotion, support and defence of Independent Advocacy in Scotland, tells us:

"Independent Advocacy is a way to help people have a stronger voice and to have as much control as possible over their own lives. Independent Advocacy organisations are separate from organisations that provide other types of services."

But Fife decided to do their own thing and had to cut their coat according to their cloth.  Because in 2009 the Fife statutory agencies awarded the mental health advocacy contract to a (learning disability) service provider, Circles Network.  Taking the contracts away from the grassroots user led historical mental health advocacy groups.  And ever since then in Fife the meaning and practice of independent advocacy has been diluted.  

With the result that people with a mental disorder, locked up and at risk of restraint, seclusion and forced treatment, are disadvantaged.  What they need is consistent, strong and independent advocacy.  To have a voice and take back control of their lives.  Advocacy that is prepared to take a stand with the person/patient against the psychiatric system, if necessary.  This is independent advocacy.

Because of the local situation I found myself advocating for a relative in a locked ward recently.  It meant that, at the clinical meetings, I set aside the carer role and took up the independent advocacy position.  Standing with him throughout.  Helping him to have a voice and to take back control.  It wasn't easy.  The powers that be don't like to be challenged.  But it was necessary and the right thing to do.

What about the people and patients in Fife, locked up and/or under compulsory treatment, who don't have access to independent advocacy?  It looks like they'll just have to put up with the situation.  Do what they're told, be compliant, take the pills, accept the diagnosis, agree with the experts and wait until you're out of the system to take back control.  That's what I did in 2002 as a psychiatric inpatient.  But it took much longer to recover than it should have, had I been able to access advocacy, which I wasn't offered.  

Advocacy is one of the safeguards in the Mental Health Act Scotland 2003.  Protecting the rights of people under the act and with a mental disorder.  It's one of the balances that are important in a psychiatric system where the power firmly rests with the professionals.  Power that is liable to misuse and abuse.  Where incapacity can be a reason for denying freedom of speech and basic human rights.  

Therefore the cost of redefining independence is far too great, in terms of mental health advocacy and human rights.  And Fife statutory agencies have to consider the consequences of their actions.  And I would like to see support from Scottish Government in the upholding of the advocacy safeguard and its independence.  For the sake of all of us who may have to engage with the psychiatric system involuntarily.

Monday, 20 August 2012

the importance of strong user/survivor involvement

I believe that strong user/survivor involvement in mental health is key to bringing about balance to psychiatric treatment and ensuring that human rights issues are kept to a minimum.  Realistically it will be impossible to get rid of all issues when there is restraint, seclusion and forced treatment.  It lends itself to abuse by its very nature.

I use the word strong to describe involvement that isn't tokenistic but is where the users and survivors are equal partners at the table when decisions are being made.  In my experience this is not an easy thing to do.  In fact I have rarely seen it happen in mental health land.  And think it is something to be aspired to.

It's all about power, the keeping of it and the taking of it.  As an activist I see my role as rattling the cages of power, using my own power and resisting the fallout.  A balancing act.  Over 30 years of community development activity has been a useful apprenticeship.  Seeing the end from the beginning.  Running with ideas, putting them into action and moving on. 

Mary O'Hagan, NZ thought leader on service user perspectives, led a workshop for us at Peer Support Fife on service user participation and leadership (more info on News Archive page).  Funded by Fife statutory agencies and held in St Andrews, Fife, March 2011.  Mary spoke of the seismic shifts needed to bring about improvement - the four 'P's - philosophical, psychological, power, practical.  With an emphasis on peer run services, collaborative practice and community governance.

The new mental health strategy in Scotland supports person-centred health and care - "Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.".  Which translates into involvement and participation that has weight and power and strength.  In my opinion.

Saturday, 18 August 2012

patients are people too

In psychiatric hospitals where the use of restraint, seclusion and forced treatment is permitted it can be easier to forget that patients are people too.

"One temptation is to retreat into objectification of those identified as mentally ill, insisting on the somatic nature of their illness. An advantage of this strategy is that it protects those trying to provide care from the pain experienced by those needing support." from CPD Bulletin Psychiatry (2000), Critical Psychiatry website.

The biomedical model of mental illness gives weight to the distancing treatment and a reluctance to engage with the mentally distressed patient.  Clinical reasoning that the patient lacks capacity and therefore insight opens the door to restrictive practice.  Take your medicine or else.  An excuse for not providing alternatives.  The safeguards in the Mental Health Act are only as effective as are able to be accessed by the patient and recognised by the powers that be.  Especially advocacy that is independent.

Some of us had no choice but to enter psychiatric hospitals because of mental distress caused by life's problems.  It was a cultural shock to be treated like children, lacking capacity and without insight.  Like going through the looking glass into a distorted world.  The good game players learned to go along with the action, bend the rules and to become returners to the game.  Keeping everyone in a job while things stood still and even went backwards in time.  

I want to see psychiatric patients treated as people and person-centred care meaning what it says.  Putting the person/patient first and at the centre.  Regardless of mental illness labels and things written in medical notes.  Using the Tidal Model of nursing practice will help bring this about.  And the new Mental Health Strategy for Scotland is a positive start.

Friday, 17 August 2012

let's disband the enduring mental illness team

Where I live there seems to be very little support for people on discharge from psychiatric inpatient treatment who have been given a mental disorder label.  Apart from meetings with a psychiatrist and a CPN (community psychiatric nurse).  The former focuses on drugs (medication) and the latter on how to maintain the severe and enduring mentally ill patient in the community.

There might be a sprinkling of clinical psychology, again from the enduring mental illness perspective.  For where I live they have teams of professionals just for this group of severe and enduring mentally ill ex-psychiatric inpatients.  They might give the team a snazzy name.  But the bottom line is that if you're assigned to this team it's all about maintenance and very little/nothing to do with recovery.  In my experience.

I was assigned to this team in 2002.  Went to the local day hospital where I did colouring-in, quiz games and went for long walks.  The latter activity was quite enjoyable.  The former two I couldn't do because of being dozed up on psychiatric drugs.  Couldn't find the answers to the quiz questions and couldn't colour-in without going over the lines.  Felt completely useless and enduringly mentally ill

Until I decided to take charge of my own mental health and recover.  Had to do this myself.  It wasn't part of the psychiatric plan or service provision. I'd been given a label of bipolar then schizoaffective disorder.  I knew it wasn't true but was powerless to resist it, on paper anyway.  Although deep inside the rebellion was stirring despite the numbing neuroleptics.

Volunteering has always been part of my life so I started to get back into this, even though I didn't feel like doing anything.  It was very difficult at first, the lack of motivation and sluggishness.  But it got gradually better and I started to reduce the anti-depressants which kept me depressed.  Latterly the lithium which didn't give me balance.  And recovered.  Completely.

Since then I've supported other family members who have come out of the psychiatric system.  The challenge, as I see it, has always been to resist the labelling, taper the drugs and get back in control of your own life.  Engaging with the enduring mental illness team has been unavoidable.  For those of us given a mental disorder diagnosis.  You don't have to believe it if you don't want to, is my advice.  Make up your own mind as to labels.  It's all subjective, regardless of what is written in the medical notes (see Notes and Other Fairy Tales).

Tuesday, 14 August 2012

Scotland's new mental health strategy - a positive start

Scotland's new Mental Health Strategy was launched yesterday, setting out the government's objectives 2012-2015, towards improving mental health and treating 'mental illness'.  The challenge, achievements and policy context.  A brief summary:
  • 3 Quality Ambitions - person-centred, safe and effective health and care
  • 7 Key Themes 
    • Working more effectively with families and carers
    • Embedding more peer to peer work and support
    • Increasing the support for self management and self help approaches
    • Extending the anti-stigma agenda forward to include further work on discrimination
    • Focusing on the rights of those with mental illness
    • Developing the outcomes approach to include, personal, social and clinical outcomes
    • Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services 

A number of topics caught my eye on initial reading - crisis houses, focus on families and carers, self help and a move away from the 'illness' model. 
A positive start to potential improvements and shifting perspectives.  For the sake of you and I and all of us who experience problems of living that affect our mental health.

Sunday, 12 August 2012

how safe are the safeguards in the mental health act?

There are a number of safeguards in the Mental Health Act Scotland 2003, for people with a 'mental disorder' and under the Act, to "make sure your rights are protected".

The main ones are the Mental Health Tribunal, named person, advocacy, advance statement, Mental Welfare Commission.   In theory these pillars, along with the Principles of the Act, should ensure fair and just treatment for people in mental distress and under detention.  In practice it depends on the safeguards having the power and place they are meant to have, in my opinion.  (taken from recent blog post 'Mental Health Acts - Protecting Rights or Not?')

I am concerned that there is a gulf between the theory and practice, of safeguards keeping people safe, in the experiences of patients, carers and family members engaging with the psychiatric system.  Locked wards and the use of restraint, seclusion and compulsory/forced treatment are high risk places and procedures. Where basic human rights are in danger of being overlooked or ignored.  The right to adequate food, housing, water and sanitation; the right to freedom of expression.   

As a 'named person' and carer I had limited rights of access to the psychiatric locked ward.  Advocacy was difficult to obtain and, in our opinion, not a voice for the locked-up patient.  The advance statement required more content to be taken seriously.  Another 'bulletproof' one has been written.  The Mental Health Tribunal seemed to be on the side of the system and not the patient, having little impact on patient safetyAs for the Mental Welfare Commission I want to believe it's a watchdog (with teeth) and a guide dog, helping shape policy, develop services and safeguard rights.  See MWC 'Influencing & Challenging'.


Friday, 10 August 2012

independent mental health advocacy in Fife? not in my experience

I am compelled to return to the topic of independent mental health advocacy in Fife.  Or the lack of it.  Following recent experiences of having to access this service for a relative in a locked ward.  Four advocates over four weeks. no consistency.  As a carer I had the phone put down on me by a worker.  My relative was not listened to or supported adequately.  Human rights issues arose without the safeguard of independent advocacy.

I've complained about our experience of the poor service but to no avail.  My voice like others is not being heard.  This is what happens when mental health advocacy services go to tender and market place forces come in to play.  We're told that targets are now being met.  That there are few if any complaints about the service.  I don't believe it.  When I complained I got a solicitor's letter sent to me.  If that's what's happening then few people will complain.  It stands to reason.

Under the Mental Health Act Scotland 2003 independent advocacy is one of the main safeguards, to protect the rights of mental health service users, along with the Mental Health Tribunal, named person, advance statement and Mental Welfare Commission.  I wrote about this recently in a Mad in America blog post 'Mental Health Acts - Protecting Rights or Not?'.   "Independent advocacy that is free from conflict of interest and supports freedom of speech".  Statutory agencies fund mental health advocacy so the service has to be independent, to challenge the 'hand that feeds'.

The mental health advocacy contract in Fife comes to an end next March 2013 so will go to tender.  I want to see a return to independent advocacy for people in Fife with a 'mental disorder' and their carers.  Advocacy that is truly independent of services and prepared to stand up for the rights of people who are detained under the Mental Health Act and who may be at risk of having their basic human rights denied.