bipolar

Day 247

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Facebook does not mean much to me but today it was a source of immense joy. Purely by accident I opened up a whole album of his photographs with his friends. There were so many of them that I had not seen before, many in which he was playing drums with different bands, having fun with his friends or attending the university ball and so many more! It was a real treat. In all of them he was surrounded with girls and boys his age and they all seemed to be really good friends.

It got me thinking as to why he did not ask any of them for help? It can be difficult to speak with one’s parents but speaking with friends is much easier. He knew he was much loved by so many of his friends but I wonder what stopped him from talking to them. Was it because he did not know how to put his feelings into words, like I do sometimes? Or was it because he didn’t want to be seen as ‘weird’ or ‘weak’? I will never know. What I do know is that most of us are happy to be asked for help. There is a part of us that wants to make a difference to others and help in whatever way we can.

“Call for help.” is one of the first things to do in a crisis management in medicine. Irrespective of the number of years of experience behind the practitioner, calling for help is highly recommended. It brings in a fresh pair of eyes that might see things differently. It also brings in the previous experience and knowledge of another person.

It is our Ego that stops us from asking for help. Ego is a sense of separateness – You and Me.

We are not separate.We are one big consciousness. We are here to help each other.

Writing this blog helps me. The fact that you read it helps me too. Thank you.

Day 246

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“More Mentally Ill Persons Are in Jails and Prisons Than Hospitals” is the title of a survey that was published in the USA in 2010. It states that America’s jails and prisons have become its new mental hospitals, housing 3 times more seriously ill patients (3 million) than hospitals.

Almost 1 in 4 of inmates live with serious mental illness and their conditions are often under-treated or not treated at all. Harsh conditions, isolation and noise can “push them over the edge” into acute psychosis. An estimated 70,000 prisoners suffer from psychosis on any given day. Many of the sickest patients are not able to make any sense of orders screamed out at them. Here is a video that shows how inhuman the treatment of these inmates is. It is difficult to watch and I would not recommend it if you have the slightest worry of it potentially traumatising you.

A sheriff in 1973 said, “a good deal of mental illness is now being interpreted as criminality.” That seems to be the case even today, more than 4 decades later.

7 out of 10 youths in the juvenile justice system also experience mental health disorders, with 2 out of 10 experiencing disorders so severe that their ability to function is significantly impaired.

“The bedlam which ensued each time I walked out into one of those units, the number of people who were screaming, who were begging for help, for attention, the number of people who appeared to be disturbed, the existence, again, of people who were smeared with faeces, the intensity of the noise as people began to shout and ask, ‘Please come over here. Please talk to me. Please help me.’ It was shattering. And as I discussed this atmosphere with the people who worked here, I was told that this was an everyday occurrence, that there was nothing at all unusual about what I was seeing.” (Dr. Craig Haney, quoted in Elsner, Alan (2006). Gates of Injustice: The Crisis in America’s Prisons)

The situation in the UK is not very different as is apparent from the ‘Too little too late” report, an independent review of the unmet mental health need in prisons.

The lack of understanding of mental illness is rampant in all areas of life.  How is it that we have advanced so little since the days of the infamous mental hospitals of the Victorian and pre-Victorian eras?

Day 238

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“Why don’t you do a crossword or something for the next 5 hours?” said the woman who answered the phone to a mental health patient in crisis. The call was made to Emergency services in the wee hours of the morning and the Mental Health Crisis team would come on 5 hours later. This is an excerpt from a CQC (Care Quality Commission) report on Emergency staff attitudes to patients in mental health crisis.

Here are some more observations:

  • Judgemental and unsympathetic attitudes of staff towards patients with injuries inflicted on themselves.
  • Unsafe, unfair and completely unacceptable level of care.
  • “Quite shocking”
  • Only one in seven (14%) of the patients surveyed said the care they received provided the right response and helped to resolve their mental health crisis.
  • Police and ambulance services were much better at helping them than the key types of NHS teams.
  • Increasing difficulty getting patients undergoing a crisis into hospital because of an acute shortage of beds.
  • Helpline staff were hanging up on mentally ill patients because they were seen as ‘difficult’ callers.
  • They constantly have to explain their circumstances to a chain of professionals because notes cannot be accessed out of hours.

They concluded, “It is clear that there is still a long way to go to make sure everyone is treated compassionately in the right place and at the right time.”

Yes. True. Yet we have been accepting this unacceptable behaviour for decades.
Nothing will change as long as public perceptions don’t.
As long as we, the people, continue to tolerate these intolerably intolerant attitudes, things will stay the same.
Awareness in everyone’s hearts and minds is the answer.
Education. Education. Education.

Day 231

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SBK

Communication gaps between teams, poor risk assessment, inadequate training for doctors and carers, poor discharge planning, absent safety planning, failure of proactive follow-up, no consultation with and support to families – these are the most commonly occurring themes from inquest reports on suicides for the last 15 years.

Yet, the story repeats itself again and again and yet again. Why is the rate of suicides amongst men rising when we have known for a long time what needs to be done? In 1982 the rate was 21.5 and by 2012 it was up to 25.9 every 100,000.

While mortality from serious ailments such as cancer, heart disease and AIDS has fallen dramatically over the last 30 years, that from suicide in men has risen. This is happening in our society because we allow it to happen. We as a collective consciousness need to find an honest answer for these questions within ourselves : What value does a person from low socio-economic background hold for us? What value does someone with mental illness hold for us? How much time and attention are we willing to give to people who are so utterly without hope that they end their own lives?

“You make a mistake only once”, I used to say to him. “If you do the same thing a second time it is your unwillingness to learn.” We as humans don’t learn anything till something is at stake. Do we have anything of value at stake here?

It appears 8 months was not long enough for the investigators of our case to prepare a report on what happened during the 10 week period of his illness. Hence the Coroner’s inquest has been delayed until further notice. We were informed today, 5 days before the day. Very disappointing!

The Chief Medical Officer then, Sir Liam Donaldson speaking at the launch of the World Alliance for Patient Safety in Washington DC in 2004 summed up the challenges of patient safety in this way: “To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Words, words and more words.

Day 222

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We have a date for the Coroner’s inquest.
The liason officer has been very considerate in all her correspondence. I requested only those documents that help me understand the care he received before the event. My main questions are:

  1. Was the suicide anticipated?
  2. If not, why not?
  3. If yes, what was done to prevent it?

I have spent hours going through the statements, notes, letters and appendices. It is like reliving the visits to the health practitioners, the helplessness, the sheer angst of trying to help him but not getting anywhere.

In my mind, I am already there in the court-room with all the people concerned, waiting for the proceedings to begin. My notes are ready. I have been preparing for months. I am ready yet I am dreading it. So far I have been very fortunate in my medical career as I have never had to appear in the Coroner’s court. This will be a first.

Talking of firsts, since he’s been gone, everyday is a first in one way or another. Today is the first 27th May without him. This is the first spring without him. Last night was the first night I spent at home all by myself since Day 0.

If he was around he would say, ”Let it be Mamma.”

In medicine, we often speak of the ‘mother principle’ that means when we see a patient we think how we would treat him or her if that person was our mother. We are more likely to make correct decisions and treat patients well if we use this principle in our everyday practice. I wonder when doctors see a strapping young 20 year old man, how many of them think of him as their ‘child’.