Day 634

beds

Total beds available for Mental Illness in England

The total number of beds available for mental patients has steadily declined in recent years in response to acute funding pressures in the NHS and a latent preference for physical illness over psychosis. This is creating intolerable pressure on families and care in the community resources and frequently results in young people being sent for treatment hundreds of miles from where they live. This is unacceptable.

iapt

Access to Psychological Therapy (IAPT) in the NHS

The demand for psychological treatment has escalated dramatically in recent years. Whilst Improving Access to Psychological Therapy (IAPT) treatments has risen, it has not kept pace with demand and increasing numbers of referrals are being refused. The net effect is that treatment thresholds are rising – sufferers have to be in ever deeper crisis before they can access care. Those accepted for treatment are then faced with weak pathways and absurd waiting lists, leaving sufferers, families and communities in despair and anguish. This is unacceptable.

(Source: The MindEd Trust)

Day 612

Posted by kidsaregifts20

Edward was 18. He had recently been offered a place at Cambridge University following 12 A*s at GCSE and 100% scores at AS level. He also excelled at playing the piano. He was a popular and friendly young man who now has the heartbreaking legacy of having played all of the music at his own funeral. He ended his own life in February 2015 following the unexplained, rapid and catastrophic onset of depressive illness.

He sounds so much like Saagar. His father, Steve Mallen strongly believes Edward was let down by the health services, just like Saagar was.

“Sometimes they call depression the curse of the strong. In other words the stronger, more resilient, more intelligent and more capable you are, the better you are able to conceal the difficulties you might be experiencing,” said Mr Mallen.

He has set up a The MindEd Trust with this mission statement:

“We mind what happened to Edward Mallen and we will do all we can to avert similar tragedies through the prevention and alleviation of mental ill-health amongst young people.”

Speaking to a friend in Bristol it emerged that CAMHS there now refuses to see youngsters who have attempted suicide. The charity Mind says on its website that the types of problems CAMHS is meant to help with include violent or angry behaviour, depression, eating difficulties, low self-esteem, anxiety, obsessions or compulsions, sleep problems, self-harming and the effects of abuse or traumatic events. CAMHS can also diagnose and treat serious mental health problems such as bipolar disorder and schizophrenia.

How have we come to this? In the light of the fact that the incidence of mental health problems in the young is on the rise, does the graph below on expenditure (in billions) on mental health services offer an explanation?

expenditure-on-mental-health

Day 602

Posted by kidsaregifts20

Victoria and Adam are Elaine’s little kids. Her husband Martin is an airline pilot. In March 2005 Elaine went into hospital for a routine operation on her nasal sinuses. Unfortunately things didn’t go as planned and she died after 13 days due to an anaesthetic mishap. Just a routine operation turned into a tragedy for this lovely family.

The inquest brought out the fact that the anaesthetist was unable to establish a patent airway on her after anaesthesia was induced. He was helped by a surgeon and another anaesthetist and still they were unable to keep the oxygen levels in Elaine’s blood at a safely high level.

At the inquest it was also evident that in that situation the anaesthetist ‘lost control’ and it was unclear as to who was in charge. Awareness of time and seriousness of the situation were lost too. There was a clear breakdown in communication between team members. The decision making ability, situational awareness and ability to prioritise were all inadequate.

It was interesting to note that the nurses in attendance knew what the next step should be and they brought the appropriate kit into the room but they were not paid any attention by the doctors. There was a clear lack of assertiveness on the part of the nurses. The inability to listen and be open to suggestions on the part of the doctors possibly contributed a great deal to Elaine’s death.

Human factors are responsible for 75% of aviation accidents. If we were to look at the mortality caused by human factors in the medicine, it would be equivalent to 2 plane crashes per day.

“In short, human factors, not technical inability led to my late wife’s death” says Martin. He went on to set up the Clinical Human factors Group in 2011, working with health care professionals and managers to make healthcare safer.

Thanks to Martin, the awareness of human factors has come into the forefront of medical practise and training. I have huge respect for the man. Victoria and Adam will know that although their mother died, many others will live due to the lessons learnt.

Day 601

Posted by kidsaregifts20

‘Never let an aircraft take you where your brain didn’t get to five minutes earlier’ – this is a commonly understood concept amongst pilots.

While none of us can predict the future, the ability to anticipate problems that might arise given a particular set of circumstances is a basic requirement for many high risk jobs such as fire fighting, policing, armed combat and medicine. Doctors do have a licence to kill and they inadvertently use it when they can’t or don’t anticipate problems. Working backwards, if we don’t think the worst might happen, we don’t actively look for it and definitely don’t plan for it. Before we know it, it’s too late and the adverse outcome is inevitable.

Four days into it’s maiden voyage, the largest passenger liner of its time, the Titanic sank. It received six warnings of sea ice on 14 April 1912 but continued travelling near her maximum speed when her lookouts sighted an iceberg in its path. Unable to turn quickly enough, the ship suffered a killer blow and slowly sank over the early hours of 15^th April. 1635 of the 2224 people on board died. The vast majority of the crew were not trained sailors but were either engineers, firemen, or stokers, responsible for looking after the engines or stewards and galley staff, responsible for the passengers. They were taken on at Southampton on short notice and had not had time to familiarise themselves with the ship. Knowing what we know now, is it surprising that the ship sank?

Saagar gave us warnings but we didn’t pick them up. Shouldn’t alarm bells be ringing nice and loud when a young man with a recent diagnosis of a mental illness is discharged in a hurry from Psychiatric services and he scores 27/27 on his PHQ-9? Whose responsibility is it to join up the dots?

When a plane goes down, the pilot goes down with it. When a patient dies, often nothing happens to anyone else. There is no black box. Tracks get covered, mothers over-react, things get forgotten and life goes on….

Day 592

Posted by kidsaregifts20

Today’s question at Re-create Psychiatry was: What is therapeutic?

Everyone’s reality is different. Their stories are diverse. People have many thousands of different types of experiences. So, a generic label eg. depression, has to be false. Are diagnoses a western construct, enabling us to put people into neat and tidy little boxes? ‘What is happening to you?’ is surely a more appropriate question as opposed to ‘What is wrong with you?’

Medics need to extend their frame of reference beyond medical to social and psychological dimensions. We need to have various ways of understanding illness, not limiting ourselves to the biochemical imbalance model. When we hold very tightly to one way of thinking, then conflict arises.

For some horticulture is therapeutic, for others homeopathy or acupuncture or meditation or yoga or art therapy or music. However modern allopathic medicine has rubbished all other ancient modalities of treatment. The fact that these practices still exist could imply their value through many generations. There is enough evidence in their favour but unfortunately they do have the influence of the pharmaceutical industry behind them.

‘Connectedness’ is definitely therapeutic. Modern medicine doesn’t have time for that. It is much quicker to print out a prescription but often that is not what the soul needs. The ‘evidence base’ for the needs of an ailing soul may be a little bit harder to gather than that for a broken arm.