Saturday, 26 January 2013

new blog

Started new blog today to include all writing at

locked doors at community mental health drop-ins

Friday 25 January 2013

I received a letter today from, in response to a complaint I'd made about a service funded by statutory agencies. The service was a sort of drop-in but with a locked door. I say 'sort of' for this mental health service that is 'in the community', is run by a voluntary sector housing organisation but does not have an open door policy.

Like a day hospital but locked door, from the outside. You can get out once you're in but can't get in if you're out. On the day I visited last year, it was in response to a recommendation from the local carers' project who said I should drop by this facility and I might buy some lunch. I thought "good idea" so dropped by, rang the bell, they let me in and I bought a roll and a drink.

Nothing was said to me at this point that I shouldn't be there. I've been there before and had lunch. So I sat down with my roll and drink, and was immediately joined by one the workers. Who asked me questions and didn't answer any of mine. It was a one-sided conversation, a bit like when I was a patient in a psychiatric ward. Very odd. Then when I finished my roll and there were no other service users about the worker said that I shouldn't have come in, a person had to be referred to attend.

And so began a most uncomfortable exchange. Another patient/service user came through the room and spoke to me, saying I could maybe come in another day when it was quieter. I said no I couldn't because I had to be referred and then suddenly 3 other workers appeared behind the food counter, joining in the conversation. The service user disappeared. Four against one, me. It felt like bullying and intimidation. I tried to speak civilly but the man in charge turned his back on me as I spoke, me sitting, he standing. I was dismissed.

I let myself out the locked door and fled to the safety of my car, thankful I wasn't a service user that had to be referred to this facility 'in the community'. Would anyone want to attend voluntarily? Maybe they would if they had the choice. I've been there before and it was quite enjoyable. They have different activities, music groups, football, snooker, other stuff.  But this time there were different staff on duty. 

My complaint to the organisation that runs the locked door drop-in wasn't upheld. They say I wasn't made to feel unwelcome even though I say I was made to feel unwelcome, and under pressure. The social work Service Manager, with the support of health services, agree with the organisation, that my views are "individual" and obviously not representative of the other folk who have to attend this locked facility.  Wonder if there is a choice?  Of anything else?

It's like having a choice of a tin of beans or a tin of spaghetti. I would rather have a fish supper. So there you have it. Only positive feedback welcome at these mental health facilities. If you have any complaints well keep them to yourself for you're only going to get a letter of complaint back, saying that you are the odd one out and everyone else is happy.

I don't believe it!

Friday, 25 January 2013

taking the psych drugs when detained in 2002 after going in voluntarily

A short post about my acute inpatient experience in Lomond Ward, Stratheden Hospital, in 2002, following a menopausal psychosis at age 50.  

I had been working full-time as a manager in the voluntary sector, in my home town of Perth.  It was a temporary post, and an enjoyable one where I did a variety of jobs, including independent advocacy for people with disabilities and in the psychiatric system.  There were challenges in the post, including a bullying situation that had been going on for some years in the workplace and resulted in workers going to the union and getting the main bully dismissed.

There were also challenges to do with a family member who became mentally unwell and was hospitalised.  But the main trigger was the hormonal changes occurring in my body as I transitioned between childbearing years into older age.  This caused me to move into a sensitive phase, described as 'psychosis' by psychiatry, where everything sensory became acute.  Visuals, hearing, smell, thoughts.

My sons were concerned because I wasn't 'myself' and took me in their car up to Lomond Ward which is just up the road.  I went in of my own volition.  I knew I wasn't well.  Took a look round the ward and women's dormitory, overlooked by male patients in single rooms.  I decided to leave.  Whereupon I was told that I was on a 72 hour detention and had to take the 'medication'.  Previous inpatient stays meant I knew that if I didn't swallow the drugs then I would be forced to take them.  So I swallowed them under compulsion.

I didn't want to take the drugs, the anti-psychotics make me clinically depressed, and so they did.  However I wasn't 'psychotic' so was released after about a week, depressed and flat, and it took me a year or two to summon up the strength and resilience to take charge of my own mental health, taper the drugs, resist the labels and recover.


Thursday, 24 January 2013

management and leadership in psychiatric situations

Is it me?  Should I not be expecting good management and leadership in psychiatric situations?  As in it's only for business settings and the real world of normal people.  Where there is accountability, evaluation and customer feedback.  Where people vote with their feet and go somewhere else for the service.

But maybe this is the issue after all.  For in psychiatry we don't have the choice of setting or doctor or treatment.  You have to take what you're given, swallow the drugs if detained or be forcibly injected if non-compliant.  It's the name of the game in terms of crisis management psychiatrically speaking.  Unless you have money to pay for The Priory or suchlike.

Even after 40yrs of engagement with the psychiatric system it's interesting that there are surprises to be found.  For why should psychiatric system management and clinical decision making be any different to any other setting?  It should make sense, both financially and personnel wise.  So that people are consulted and the best use of money is made.  As a good manager I really don't like having to witness stuff like this.

Scotland is where I was born and brought up, and have lived here for 60yrs, so think that I can speak with some authority on its culture.  My early years up to when I got married at 19 were spent in Perth.  Then a few years in Aberdeen at university.  Living most of the next 15yrs in the Lanark area with brief spells in the Crieff and Arbroath areas.  And now in the Cupar area since 1990.  A mixture of city, town, village and farm settings.  

Working as a shepherdess, youth worker, lecturer, advocate, shop manager, volunteer co-ordinator.  Driving tractors, milking cows, selling sheep at market.  Running my own business, warden and cook for elderly, setting up church groups, writing news articles, managing websites.  Developing numerous community projects in different areas, working in schools, colleges and universities.  Above all being a mother and grandmother.

What has got clearer over the years is the different cultures in the Scottish areas, even if only 20mls or so apart.  I'm thinking it goes back to our heritage and history, of clans and settlers.  And a weaving of people through the generations, a rich tapestry which makes life interesting if challenging but never dull.  For me the latter is the most important as I really don't like being bored.  Never did.

John Knox House on the Royal Mile Edinburgh
Therefore in psychiatric system management the recognition of Scottish culture has to be considered.  It makes no sense to think only of logistics and saving money.  There are people involved, the patients, staff and family/carers.  Cultural considerations of language, background, upbringing, history and meaning.  The reasons for people choosing to live and work in a certain area.  And if it's working well then why fiddle with it?

Trying to fit a square peg in a round hole isn't a good idea.  No matter if the high heid yins think it to be so.  For Scotland is a grassroots country and we're not keen on folk telling us what to do.  Think of John Knox and the covenanters.  Or the present day plans for political independence.  We really don't want to be following orders that don't make sense.  It stands to reason.

Wednesday, 23 January 2013

cracking open a nut

You know how sometimes it can be very difficult to crack open a nut?  The hard ones require the use of a nutcracker.  To force open the shell and get into it.  Well I think this is what it can sometimes be like in the world of mental health and psychiatry.  Where the nuts are difficult to reach and it requires a nutcracker and a certain amount of skill and lived experience.  Of cracking nuts.

In the real world of nuts eg hazlenut, walnut, peanut, we know by the shell what sort of nut is inside.  But in the mental health world we're not always aware of the nut until we start using the nutcracker.  When we can be in for a big surprise, if not prepared.  Pressure applied produces resistance until we find the crack in the shell.

Except for peanuts I always buy my nuts deshelled from the supermarket, in plastic bags.  It's much easier than trying to work a nutcracker.  For I'm not an expert in it.  However the mental health world is a different matter.  I've got over 40yrs of working with the metaphorical 'nuts', and I'm not meaning the mad people.  

Who aren't nuts at all, to my mind.  It's the other 'nuts', the ones who think they are secure within their shells and safe from the 'nutcrackers'.  And we don't need a sledgehammer to crack a nut.  The real nuts know the score, that they are always at risk from the nutcrackers.  For the shells are only a temporary protection, whatever type of nut you are.

Monday, 21 January 2013

psychiatric drugs cause psychosis, let's find alternatives for human distress

The problem with pumping a person full of psychiatric drugs is that it causes psychosis.  I can say this from recent experience.  Not personal.  As if the aim is to lessen a person's emotional and mental distress by taking them into a psychosis.  From which they will have to find their own way out.  It can't be ideal.

When I had psychoses, on three different occasions, the main trigger was hormonal, after childbirth and at the menopause.  Although there were other stressors the tipping point was to do with being a woman.  However the anti-psychotics (chlorpromazine and risperidone) quickly brought me out of the psychosis into a depression.  Much worse for me.  For I'd rather be in cloud cuckoo land than down in the depths.

It's way beyond time that we came up with alternative ways of working with people in mental distress, crisis and psychoses.  The sledgehammer effect can't be the best, can it?  Or is it more about punishing the sensitive among us for feeling things more than the normal folk?  I can't get my head around this.  Why our distress is seen as weakness or biological or pathological.  

It's only human to feel sad or distressed or elated or pressured.  A normal reaction to a mad world and crazy things happening outwith our control.  But don't compound it by drugging us senseless or locking us up with other mad people, many of them paid to be there.  It's not a solution and costs more in the long term.  Financially and emotionally.  

Sunday, 20 January 2013

mental health tribunal madness

It was my third time, on Friday, of experiencing a Mental Health Tribunal, and it was the worst one yet.  The other two were in Fife and this one not.  The others were weighted against the patient and carer .  Whereas this one was like going through the motions and getting it over with as quick as possible.  A foregone conclusion as obviously a patient in a locked ward should be staying there.

I shouldn't be surprised and was prepared for some resistance, to having a voice and being heard.  But this so-called safeguard took the biscuit.  The occasion was recorded as all MH Tribunals are but the only folk taking/using notes apart from the panel were me and the solicitor.  The psychiatrist and MHO talked off the top of their heads and the advocate said nothing at all. 

I was there as a mother and carer, also meant to be named person.  But in the 24hrs preceding this it had been scuppered due to the MHO arranging for another person to be in this role.  Hence her surprise at me turning up I suppose (what are you doing here?).  As if being a carer and mother meant zilch.  So much for the mental health act principle 7 of Respect for Carers.  At the bottom of the pile as usual.

Ironically it was me who had Emailed the MH Tribunal on 9 January to let them know of my son's wanting to appeal his detention.  I also arranged a solicitor for him.  And yet by the tribunal on 18 January I had received no paperwork or intimation about it.  I had a phone call from the MHO on the 17 January telling me about it and that my son didn't want me to attend.  The same day I had a phone message from my son asking me to attend.  I visited my son in the ward that night with his younger brother, we had a good chat.

Now who would you believe?  I'd only met the MHO once, wasn't impressed.  I've known my son for 34yrs and think he's a great lad.  We get on well even when agreeing to differ.  Social workers don't know anything about me or mine.  They're paid to do a job and should be doing it professionally.  Not interfering or having personal opinions, thinking that they are somehow now 'family'.  They're not and never will be.  It's a job, nothing more, and they get well paid for it.

Well on the day my son had his say, through the solicitor, and I had mine.  I also had to correct both the psychiatrist and the MHO who didn't have their facts right.  The psychiatrist, because he was only filling in temporarily on the ward due to the other locum consultant having left the week before, suddenly.  Another locum psychiatrist is flying in from Ireland to take his place.  The locum duty doctor was also leaving that day.  

Locum doctors on locked psych wards are not a good idea, in my opinion.  Especially two of them at the same time, one who didn't appear to know the mental health act, although a nice person.  Optimisation of services shouldn't impact negatively on staff and patients.  What use the mental health act safeguards if the professionals don't know about them or know how they work?  This question is addressed to the Mental Welfare Commission, if they are listening.

Regardless of the tribunal being ineffective as a safeguard, I am to a certain extent OK about my son's care, because I have got to know the nurses on the ward.  And my son says he's happy, most of the time anyway.  Although he has mental distress because of life's circumstances.  But this doesn't excuse the safeguards not being effective.  They need to be accessible, appropriate and professional.  Otherwise it makes a nonsense of the mental health act and the protection of patient and carer rights.  Some might say like a chocolate teapot.