Tag Archives: Mental Health

Medication time.

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As many of you know by now, it`s not a secret, the young chap I wrote about in a previous blog is my grandson.

https://anightinwithnelly.wordpress.com/2018/09/02/mental-health-services-in-birmingham-are-woefully-lacking/

Since that time, he has returned to live at home.

From when he was first sectioned nearly four months ago, he has had a whole conglomerate of anti-psychotic drugs and mood enhancers, none of which have really improved his mood very much at all although he does have some better days from time to time. Drugs he has been prescribed and occasionally made to take without his consent include Risperidone, Depakote, Haloperidol which incidentally, he was given too high a dose of and this resulted in him being “wired” and unable to properly relax or sleep for about five days, Procyclidine, Lorazepam, Olanzapine, Propranolol, the list goes on. In spite of his family suggesting he is lucid and wishes to engage in talking therapies, so far our suggestions have not been accepted as a good way to go by the team “supporting” his recovery. They say that he is unable to attend talking therapies while he is being medicated.

Catch 22.

Our dear boy struggles a great deal with his condition. The anti-pyschotic medication sedates him to the point where he feels immobilised and despairing of ever getting better. He is fortunate though and tells us that some of the young people he met in hospital have no-one, no family loving them and helping them as they try to get through it. I can only imagine how lonely and isolating an experience this must be.

Last Wednesday, he was taken off the current anti-psychotic and also Lorazepam, which is a strong sedative, for a period of five days to “see how he would cope.” He has suffered withdrawal from Lorazepam, which is a highly addictive drug as well as whatever his brain is experiencing as it wakes up from the last round of anti-psychotics. He is managing with PRN medication (as and when needed) mostly Depakote which stops him from sleeping and Propranolol which is an anti-anxiety drug. He takes them in a fairly haphazard fashion and his greatest desire is not to take them at all. Unfortunately, he is still ill and becomes very anxious and `pacey` without them.

I fail to see how this treatment resembles anything like a recovery or as one of the women I supported some years ago recently said to me, “I got better IN SPITE OF mental health services, not because of.”  She is in her mid-sixties and has spent several years of her life in hospitals under a Section 3. It doesn’t bode well does it.  I hope one day we will be able to look back as a family on this time and laugh and say, “fuck me that was shit wasn`t it!”

The problem with mental health issues is that they don`t show and people can mask their symptoms sometimes for years living in a kind of hell and with no support or anyone to talk to. The effects and impact that mental health breakdown has on individuals and families is major and the episode my grandson experienced and is trying very hard to recover from, has fractured us as a family. We`ve cried, we`ve sometimes laughed at his idiosyncratic behaviours, we`ve disagreed with one another and argued, we have gradually concluded that heavy drugs do not really help, certainly not in his case. They contain the issue, they do not heal. We are hopeful that natural therapies, diet in particular; talking therapies, patience, innovative distraction ideas and plain old love, will get him through this.

If anyone reading my blog can make any suggestions as to a way forward, then do please feel free to comment. I`ll warmly respond to all comments.

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Mental Health services in Birmingham are woefully lacking.

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I`​d like to tell you about a young​ adult of 23. who I know.  Recently, he has been significantly troubled by a lack of clarity, balance and joy in his life. Over time he has become seriously off kilter, depressed and like many young people, disillusioned with life, the universe and everything. He tried to purge himself of his morose thoughts by commencing various diets such as gluten free, low carb`, low protein etc. or by not eating at all. He sometimes binged and then vomited. Over time he lost quite a lot weight and became very pale and withdrawn and further down the line, he was clearly very unwell.  Eventually he became delusional and paranoid, he started to hear voices, he believed he was being pursued by people who wanted to harm him, he thought everyone was talking about him.

A recent global study evidenced that 72% of people who experience psychotic episodes have a single experience. https://www.nationalelfservice.net/mental-health/psychosis/psychotic-experiences-how-common-are-they-and-how-can-we-predict-their-onset-course-and-consequences/

In the UK, it is generally recognised that about 50 percent of young people who have a psychotic episode will not have a further episode throughout the remainder of their lives. We do not understand why, or what triggers these events and there are many schools of thought as to why they happen relating to hormones, inherited likelihood, diet, stress, street drugs, head injury as a child and imbalances of chemicals which affect the way the brain behaves, amongst other factors.

One night this young person finally hit his crisis point and had to be taken to A and E. The event was inevitable really since he had managed to hide or “mask” his symptoms and cope alone possibly for several years. After much persuasion at A and E, his parents finally got agreement for their son to have a psychiatric assessment. By now he was utterly exhausted by the thoughts that constantly harangued him and even he had some insight that he was unwell. He was kept waiting 18 hours to be assessed by which time he had become so agitated that in the early hours of the morning he ran away from the hospital. The police became involved. He was found in the city centre by his father and the police helped him to a nearby secure unit where he would be properly assessed. He was placed under Section 2 of the Mental Health Act which meant he could be detained for up to 28 days for a full assessment. His parents were relieved to know that their son would be safe and that they would be able to get their first decent night`s sleep for some days. After just five days the section was lifted and the family received an excited call from their son saying that he was coming home.

The family went into shock. They could not see how an authentic assessment could possibly have taken place in such a short period of time. During visits, their child still seemed rambling and delusional, they were terribly worried. After much to-ing and fro-ing, they finally spoke to a consultant. He said, “I spent an hour with your son today, he was rational, articulate, he made plenty of eye contact, he was not agitated, I cannot in all conscience keep him sectioned.”

The family were concerned that returning home would be a further “trigger”. They spent two days in negotiation with mental health services while their son remained on the ward and finally it was agreed that he would go to a half-way house for a period of respite. Here he would allegedly be supported by a psychiatric team, keeping an eye on his med`s and his moods until he was able to leave and live independently.

The half way house was pleasant enough but not in a great part of the city. His father negotiated with a mental health housing charity to move him to a shared house nearer to various relatives and in a much nicer area that he was familiar with. For a few days the arrangement went well however, the young man was not always compliant with his medication and the view of the house manager was that his mood was becoming flat and deflated. He had become quite rude which is unlike him and so it was decided that he would have an assessment by the Community Psychiatric Team. He waited all day for the assessment team to arrive and no-one turned up.

At 10.30pm the following night, he was woken up and taken from his bed to be sectioned again on a Section 2. His family could not see how on earth a social worker and two doctors can possibly have made an accurate assessment of him in, it appears, no time at all. He was driven to a unit in another county and arrived after 11pm where it was noted that he was “extremely angry.” This is hardly surprising; we would expect any person to be angry if treated in this way. It is shocking and disgraceful.

The following morning he was still angry, thumping walls and slamming doors. The response to this was to restrain him, in other words, pin him down while Lorazapam was administered via an injection, against his will. This is an unacceptable and archaic way to treat someone. It is 2018 and we would hope that in these more enlightened times, staff would be trained in creative ways of assisting people who are upset but apparently not. The ward manager told his family that staff “could not handle” his anger and so it was recommended he be moved yet again to a high security ward about thirty miles away.

Since being at the unit and in fact since the original section took place five weeks ago, at no time has he received any treatment other than being drugged with Olanzapine and other medications that have a tranquilising effect. He is not being treated he is being contained and his family are deeply concerned about this and very unhappy. It was their hope when he was clearly unwell, that he would receive proactive help and support. He hasn`t. Every-one has simply been reacting around him. Their increasing concern is that he will develop an addiction to the current medication and will then have to endure withdrawal symptoms when he is deemed well enough to reduce or cease the dosage.

In spite of this, he is now making small progress towards recovery and feeling better. He has had some anger issues on the secure unit and again we would suggest that this is entirely to be expected.

His family would like to understand if there is a medical reason why talking therapies and psychological support has not yet commenced? Does he meet the criteria to be kept on a section? He does not pose a threat of injury to himself and in twenty- three years he has never hit another person. He may well have made threats on the ward, but they are empty threats born of frustration at being constantly drugged and although I do not condone his bad behaviour, I can understand it. Does he have a mental health disorder? As far as I am aware, he has not yet been diagnosed.

The family is aware that their involvement is crucial to their son`s recovery. They would like him to be released so that he is free to come and go and spend quality time with them.

The family believes that many of the recommendations in the Mental Health Code of Practice have already been contravened. Four overarching principles are:

  1. Least restrictive option and maximising independence Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient’s independence should be encouraged and supported with a focus on promoting recovery wherever possible.
  2. Empowerment and involvement Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this.
  3. Respect and dignity Patients, their families and carers should be treated with respect and dignity and listened to by professionals.
  4. Purpose and effectiveness Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines.

It is their intention as a family to put forward their complaints and concerns to the appropriate authority in the strongest way available to them.

Their son will attend his tribunal this week to appeal to have the section lifted. Should the panel make the decision that his section cannot be lifted at this time, then they will appeal again. They would like to ask how are our mental health services intending to help their son recover because after this experience, they are naturally finding it difficult to believe that they will.

One final point, I hate to sound ageist but I question how appropriate is it to appoint nurses who are barely out of school, to comment to tribunal panel and make life changing recommendations on such complex matters?

Autism and Aspergers

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I wrote this article for people who I work with.  I hoped it might help families understand a bit more about autism and especially Aspergers Syndrome.  Many of the individuals we advocate for here at SAtA, have austism as well as a learning disability.

Autism is sometimes known as the hidden disability because it doesn`t show on the outside.  It is a very complicated developmental disability that causes problems with social interactions and communication and the clues can start when a child is very small, even before they are two or three years old. Autism can cause delays in learning and can also bring about many kinds of behavioural problems from infancy, right through to adulthood.

Individuals with autism can have very different ways of being so generally, autism is thought of as a “spectrum disorder,” or a group of disorders with similar features.  Some individuals may have mild signs or symptoms while others may have very serious issues, but they all have an autism spectrum disorder.

Aspergers syndrome sits on the autistic spectrum.  Interestingly the diagnosis of Aspergers is now being used less commonly and has been replaced with the new term Autistic Spectrum Disorder, which covers just about everything.  There is widespread concern about this which was recently highlighted and discussed in the Guardian:

http://www.guardian.co.uk/society/2012/dec/02/aspergers-syndrome-dropped-psychiatric-dsm

People with Aspergers can be similarly mildly to significantly affected.  Many individuals who are mildy affected may be able to function well in their community and live a more or less ordinary life.  Others less fortunate may be so severely affected that the symptoms are completely debilitating and they are unable to function in an ordinary sense at all.

Simon Baron Cohen is a professor of Developmental Psychopathology (and also cousin to the actor Sacha Baron Cohen of Ali G fame).  He has researched and specialised in Autistic Spectrum Disorder and has had several books and eminent articles published on the subject.  He has devised a questionnaire which can be taken by anyone and which pinpoints whether or not you are showing any autistic traits.  Although this is definitely not a diagnosis, I found it enlightening.  Having gone through the test with several friends, family and colleagues, I would imagine that around 75% of the general population sit somewhere on the autistic spectrum.  The link is below if you want to have a go.

http://www.wired.com/wired/archive/9.12/aqtest.html

Thousands of people worldwide go through their lives living with the uncomfortable effects of autism or Aspergers and haven`t got a clue that this is what has been troubling them, their families and friends for all of their lives.  In other words they remain undiagnosed which is a shame because many people who have had a diagnosis report how relieved they are to have an explanation for their varied symptoms.  It can make sense of chaos and a diagnosis can offer people options to bring about change.

Here are some of the challenges a person with aspergers can bring into a relationship:

They often find social situations extremely uncomfortable, people with aspergers find making friends easier said than done and often don`t have any friends to speak of.  Eye contact is difficult or impossible to maintain and they cannot read facial expressions so they can often speak at inappropriate moments, or say something offensive, not understanding they have done so.  When speaking they may go on without a break.  They cannot recognise when it`s the other person`s turn to speak or even if the other person doesn`t find the topic interesting.  It`s possible to turn away from someone with aspergers when they are talking and they may continue with or without your attention.  They may exhibit odd expressions of movement as in Tourettes syndrome or they might adopt  a vacant expression while they talk, sometimes for a long time.

People with autism are often above average intelligence, they can also be funny and charming and so they are very attractive to people who are looking for someone to nurture.  Unfortunately for the person in a relationship with an individual who has autism, they may find that their own emotional needs remain largely unmet because the person with autism simply cannot relate to someone else`s needs.  They are unable to empathise or give back some of that nurture to their non-autistic partner who probably has to seek that kind of emotional sustenance elsewhere.

Someone with aspergers may find it very difficult to recognise when they are becoming wound up.  Most neuro typicals (people who do not have autistic traits) know the signs when they are becoming angry, for example, shortness of breath, a redness of neck, a raising of blood pressure.  The person with aspergers on the other hand, can get more and more wound up and unable to distinguish these feelings from any other, suddenly break out in an explosive display which may include verbal abuse and damaging property.  In other words, put the ornaments away!

I remember last year, speaking to a woman who was married to a man with aspergers.  He worked in the army and had a very successful career, largely because people with aspergers seek repetition so the every day order and routine of the army suited this man perfectly.  He knew what to expect and his work was nothing to be scared of or become stressed about.  The flip side of this tale though is that his appalling behaviour at social functions especially at family parties, resulted in him being banned from all future visits.  So, living with someone with aspergers is definitely not easy but if you enjoy a challenge…..

There is no cure for autism.  Some behaviours can be changed through CBT  (Cognitive Behaviour Therapy) or NLP (Neuro Linguistic Programming.)  The cause is not yet understood but researchers are leaning more and more towards autism having a genetic cause so the autistic traits may run in families.

Lots of people who have autism or aspergers or any other diagnosis on the spectrum are often labelled as someone with a disability.   Having worked with many people who have aspergers or autism, I prefer to think of people with autism as someone who is marvellous and unique.   🙂

Nurse training.

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In 2001 I had decided that my true calling in life was to be a nurse, so I began a seconded degree in Mental Health nursing at Birmingham University.  I have to say it was one of the most challenging decisions I have ever undertaken and no matter how many  times I employed tricks to remember the order of things, you know  `the hip bone`s connected to the thigh bone` etc. it remained very difficult for me to achieve the standards I knew must be met.  So I didn`t enjoy it all that much, however I met some very nice students there and some pretty far out tutors as well.  Some of the physiology lectures were so enthralling there would be standing room only, yet occasionally I would meet a student so lacking in social awareness or empathy of any kind, I used to think they would be hopeless next to an inanimate object never mind a human being.  I used to wonder what brought them to nursing when it was so clear, they didn`t like people at all.

Every year all students have to work at a placement and there are a number of tests you must pass during a placement in order to continue the course.  For me, one of these was learning CPR and the other was giving my first injection.  The placement was at a large residential nursing home for older people and as I`ve always enjoyed the company of older people; I was looking forward to it.  The manager was an affable Irish man with ruddy cheeks.   I got on with him from the start and it was only when I was a few days into my stay there that I realised he had a problem with drink.  He would slip up the road to the pub at every possible occasion to top up and was the subject of much, highly unprofessional gossip amongst the staff.   In spite of being mildly pissed most of the time, he was an efficient man who ran a tight ship and the standards of care in the home were maintained at an extremely high level. 

 The residents liked him and so did I.

When it came for me to demonstrate CPR to him, he brought out the plastic torso of half a person affectionately known as Jane and laid her on the floor.  Never mind Vinnie Jones telling us `you only kiss your wife` in those days it was de rigeur to place your mouth over the mouth of the person in trouble.   A plastic shield was strategically put in place as protection in case anyone threw up.  I was ready, my patient was ready, my merry manager observing me as I began the CPR.   Unfortunately I must have blown a bit too enthusiastically into Jane as there was a sudden loud bang and both her lungs quickly deflated.  `My God, you`ve blown her up,` my manager stated the obvious, looking at me incredulously through pink rimmed eyes.  He was right and poor old Jane was a gonner!  I think that must have been the prelude to the new ad`s telling us to press hard and fast to Staying Alive……

On another occasion I had to give my first injection.   It being Mental Health nursing, many of the residents had long term mental health issues and were on all kinds of med`s  some of which can only be administered  into the buttock.  It`s quite tricky injecting into the buttock.  You have to divide it mentally into quarters and then make sure you miss a particular area where there are many nerves which can be damaged, irrevocably so.  You also have to ensure you have the correct dosage of medication in the needle.  Nurses have to learn drug conversions which I always found extremely difficult.   I remember my then husband testing me and saying with a playful smile upon his face as I got it wrong for the umpteenth time,  `Helen you`ve just converted enough lithium into our hypothetical needle to knock out most of Acocks Green…..`    Oh how I laughed.

Anyway the old lady who was kind enough to be my guinea pig flinched,  just a tiny bit as the needle went in and she of a thousand injections commented, very generously I thought, `not bad for a first attempt.

Sadly, the manager was sacked but not before he passed me with flying colours.  I was sorry to see him go.  Drink`s a bugger isn`t it.   I only completed year one of my nursing degree as the  following year I went to live in Darwin.   Ever since that time I have been known as Helen, one third of a nurse.