Day 436

Posted by kidsaregifts20

Compassion is defined as ‘a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate their suffering.’

NHS administrators now see the value in ‘teaching’ compassion to nursing and medical staff. Obama emphasizes the need for compassion amongst people in his Christmas message.

Research has shown that when we feel compassion, our heart rate slows down, we secrete the “bonding hormone” oxytocin and regions of the brain linked to feelings of pleasure light up which often results in us wanting to approach and care for other people.

Compassion makes people more resilient to stress. It lowers stress hormones in the blood and saliva and strengthens the immune response. Compassionate people are generally happier as their mind does not focus too much on what has gone wrong in their lives or might go wrong in the future. They make better parents, friends and spouses as a they tend to be more optimistic and supportive when communicating with others. They are more socially adept, making them less vulnerable to loneliness. Employees who receive more compassion in their workplace see themselves, their co-workers and their organization in a more positive light, report feeling more joy and contentment, and are more committed to their jobs.

Stanford University’s Compassion Training Programme’s top tips are:

Look for commonalities: Seeing yourself as similar to others increases feelings of compassion. A recent study shows that something as simple as tapping your fingers to the same rhythm with a stranger increases compassionate behavior.
Calm your inner worrier: When we let our mind run wild with fear in response to someone else’s pain (e.g., What if that happens to me?), we inhibit the biological systems that enable compassion. The practice of mindfulness can help us feel safer in these situations, facilitating compassion.
Encourage cooperation, not competition, even through subtle cues: A seminal studyshowed that describing a game as a “Community Game” led players to cooperate and share a reward evenly; describing the same game as a “Wall Street Game” made the players more cutthroat and less honest. This is a valuable lesson for teachers, who can promote cooperative learning in the classroom.
See people as individuals (not abstractions): When presented with an appeal from an anti-hunger charity, people were more likely to give money after reading about a starving girl than after reading statistics on starvation—even when those statistics were combined with the girl’s story.
Don’t play the blame game: When we blame others for their misfortune, we feel less tenderness and concern toward them.
Respect your inner hero: When we think we’re capable of making a difference, we’re less likely to curb our compassion.
Notice and savor how good it feels to be compassionate. Studies have shown that practicing compassion and engaging in compassionate action bolsters brain activity in areas that signal reward.
To cultivate compassion in kids, start by modeling kindness: Research suggests compassion is contagious, so if you want to help compassion spread in the next generation, lead by example.
Curb inequality: Research suggests that as people feel a greater sense of status over others, they feel less compassion.

Day 427

Posted by kidsaregifts20

It’s done.
The facts have been established.
Not all, but a few important ones.
It would have taken a few weeks of deliberation to get all of them out in the open.
I was not looking forward to it and wanted to jump to the other side of it asap.

The inquest was once again conducted in an open and investigative manner. Everyone was given time to say what they wanted to.
The verdict was:

“Took his own life while of unstable mind.”

Contributory factors identified were:

Poor communication with the family about Saagar’s illness, the seriousness of it and the side effects of the medications he was on.
Poor discharge summary and handover from psychiatrists to the GP – diagnosis and warning signs for a referral back to the psychiatrists not clearly mentioned.
Poor judgement on the part of the GP to have not sought specialist help for him on seeing his highest possible PHQ-9 score, possibly causing him to prescribe inappropriate medication which might have added to Saagar’s suicidal ideation.

All the things I have been going on about!

The one person that struck me most was the witness from SLaM (South London and Maudsley) Trust who was in-charge of patient pathways and improvement in services. He had been a nurse but now is a ‘manager’ of sorts. He uttered nothing but jargon, office-speak, absolute rubbish, completely devoid of any heart or clinical sense. He claimed to disseminate the lessons learnt through ‘business meetings’. I don’t understand how the two things are connected. That is the true face of modern NHS.

While the verdict was what I had hoped for, I don’t have much hope for change as the people responsible for improvement are nothing but pimps.

I feel completely scooped out, as if my insides have been hollowed out with a blunt knife. It’s time for some rest.

Good night.

Day 419

Posted by kidsaregifts20

While in the general population, men are 3 to 4 times more likely to complete suicide than women, it is quite the opposite amongst doctors. Women doctors are more than twice as likely to complete suicide than their male colleagues.

Doctors are more likely than the general public to:

– be divorced
– have addictions – to alcohol or other substances
– suffer a burnout
– have a psychotic episode

Not surprisingly, they are extremely good at hiding their mental state.

In the NHS, 25% of doctors are from other countries but they form a disproportionate 40% of those seeking help for significant problems such as depression and excessive alcohol consumption.

The document ‘Understanding why doctors present late’ from the 1^st European Conference. PAIMM 2001 states:

“Doctors are one of the most unattended populations in terms of health care.”

This is a generalisation but these are said to be common traits of doctors: perfectionists, narcissists, compulsives, denigrators of vulnerability and martyrs.

Given the combination of the above traits with the current TOXIC work environment of the NHS and the high emotional burden that doctors have to carry by nature of their work, is it any surprise that their mental well-being is seriously jeopardised?

Myths:

Doctors are invincible
Sick doctors always know when they are sick
Sick doctors who know they’re sick always know what they need to get better
Sick doctors always get excellent treatment
Doctors always follow doctors advice
Doctors look after themselves

I am sure some of these are applicable to other professions. I also hope that I am not being too much of a martyr here!

Are we kind enough to ourselves and to each other at work?

Posted by kidsaregifts20

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Daksha Emson was a young psychiatrist who had been diagnosed with Bipolar disorder when she was a teenager. When she got married, she wanted to have babies hence she stopped her medications.

She and her husband were lucky. They were blessed with a little girl in June 2000. They called her Freya. On the 9th of October 2000, Daksha ended two lives – her own and Freya’s.

The investigation report highlighted a few things :

– Failure of professionals to communicate effectively and to co-ordinate care appropriately contributed to the adverse outcome in this case – no liaison between psychiatry and obstetric services.

– Care Plan was not generated as she had informal consultations with her psychiatrist for fear of being stigmatised by her colleagues.

– A ‘Closed loop’ of care was not established for her. Although she had a Community Psychiatric nurse, she was not being closely monitored and links with other members of the multidisciplinary team were not established.

– The nature of Daksha’s illness could have been predicted if her ‘relapse signature’ (collection of warning signs) had been identified. It wasn’t.

Postnatal Depression continues to be a major cause of death of young mothers. Joanne Bingley Memorial Foundation does a good job of de-stigmatising it and raising awareness.

Same old tragedies. Same old themes.

Day 404

Posted by kidsaregifts20

Tutors and staff at universities struggle with the issue of confidentiality with regards to their students who are suffering with mental distress. While they are not trained counselors, they have the best interest of their students in mind. Yet, they are not allowed to take the parents of these students in confidence in the name of confidentiality.

Confidentiality is a foundational ethical standard for health professionals. It is the ethical duty to fulfill the promise that client information received during therapy will not be disclosed without authorization. It becomes a legal concern if broken, whether intentionally or not.

What if not breaking confidentiality leads to harm?
There are exceptions.

Confidentiality does not apply when disclosure is required to prevent clear and imminent danger to the client.
Protecting the client from harm must supercede the harm to the relationship that may happen due to a breach of confidentiality.

BACP (British Association for Counselling & Psychotherapy) Ethical Framework says:

“Situations in which clients pose a risk of causing serious harm to themselves or others are particularly challenging for the practitioner. These are situations in which the practitioner should be alert to the possibility of conflicting responsibilities between those concerning their client, other people who may be significantly affected, and society generally. Resolving conflicting responsibilities may require due consideration of the context in which the service is being provided. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. In all cases, the aim should be to ensure for the client a good quality of care that is as respectful of the client’s capacity for self-determination and their trust as circumstances permit.”

The GMC reiterates the importance of confidentiality in good medical practice but does not talk of suicide in particular.

Courts usually consider two fundamental issues:

did the professional adequately assess the likelihood that a patient was suicidal?

if an identifiable risk of harm was determined, did the professional take sufficient precautions to prevent suicide?

In general, the therapist is protected from liability if they have conscientiously performed and documented a thorough evaluation, followed by carefully considered, appropriate interventions.

Early diagnosis and treatment of mental illness is key for better outcomes. Hence the staff at schools and universities should be equipped with skills and knowledge to identify such illness in students. They should be empowered to get appropriate help for them at the earliest.

In case of disclosure of severe suicidal ideation, the safety of the ‘at risk’ person should be the only concern.