Patient safety

Day 487

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An independent task force overseen by Mr Paul Farmer, Chief executive of Mind recently reported that

“Mental health services have been underfunded for decades and too many people have received no help at all, leading to hundreds of thousands of lives put on hold or ruined, and thousands of tragic and unnecessary deaths.”

Mr Cameron has ‘promised’ putting mental and physical health care on an equal footing and committed himself to making sure that happens. This means that if anyone is struggling with a mental health condition they will get the help and support they need. The planned reform will be funded by an extra £1 billion a year from the NHS by 2020-21. Bulk of this money is to be spent on providing therapy for patients with anxiety, depression and stress, ensuring the presence of Mental Health teams in all A&E departments and support for pregnant women and new mothers.

This sounds like a very determined effort to improve things and finally acknowledge that for decades Mental ill health has been treated as a poor relation of physical illnesses . However, there is a vast gap between aspiration and reality.

As long as the strict compartmentalisation of services continues, the care of mentally ill patients in unlikely to be comprehensive. The interface between primary and psychiatric health services needs to be completely reformed and renewed. Presently it is poor and ineffective, costing many their lives. Education of GPs is essential as they are often the first port of call. Proper engagement with the patients and their carers is imperative to achieve better results.

However, the politicisation of health care may drive away the doctors and young professionals who are required to deliver on the stated aspirations.

Not only personnel but the entire culture within our society and the NHS in particular needs to undergo a fundamental change.

 

 

 

Day 480

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stay_alive_urban_art-2

Stay Alive – A suicide prevention pocket resource for the UK that offers help and support both to people with thoughts of suicide and to people concerned about someone else. The app can be personalised to tailor it to the user.

This app has been developed by Grassroots, supporting communities to prevent suicide, one life at a time. They teach suicide alertness and intervention skills to community members and professionals. Based in the South East of England, since 2006 they have trained over 5,000 people in suicide prevention and mental health both locally and nationally. They have seats on several advisory committees in Brighton & Hove and have contributed to both local and national suicide prevention and self-harm strategies.

Key features of the app include:

  • Quick access to national crisis support helplines
  • A mini-safety plan that can be filled out by a person considering suicide
  • A LifeBox to which the user can upload photos from their phone reminding them of their reasons to stay alive
  • Strategies for staying safe from suicide
  • How to help a person thinking about suicide
  • Suicide myth-busting
  • Research-based reasons for living
  • Online support services and other helpful apps
  • Suicide bereavement resources

Aside from Breathing exercises, grounding techniques and lots of useful tips and contacts, it has a section called ‘My Life-box’.  Here I can add pictures that remind me of my reasons to stay alive. I uploaded a funny photo of Si, one of my Mum and Dad celebrating their 50th wedding anniversary and one of Saagar and I, happy together. This is the next best thing to a friend sitting with me, holding my hand when I am down and out.

 

Day 475

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A family doctor said to newly bereaved parents, “Now that he is dead I can tell you that he had attempted suicide once before.”

Information sharing and Suicide prevention is a clear and concise consensus document that was published in January 2014 by the Department of Health together with the GMC, Royal Colleges of psychiatry, nursing, psychology and social workers. It clearly states:

“We strongly support working closely with families. Obtaining information from and listening to the concerns of families are key factors in determining risk. We recognise however that some people do not wish to share information about themselves or their care. Practitioners should therefore discuss with people how they wish information to be shared, and with whom. Wherever possible, this should include what should happen if there is serious concern over suicide risk.

We want to emphasise to practitioners that, in dealing with a suicidal person, if they are satisfied that the person lacks capacity to make a decision whether to share information about their suicide risk, they should use their professional judgement to determine what is in the person’s best interest. It is important that the practitioner records their decision about sharing information on each occasion they do so and also the justification for this decision.

Even where a person wishes particular information not to be shared, this does not prevent practitioners from listening to the views of family members, or prevent them from providing general information such as how to access services in a crisis.”

This must be the best kept secret.
Let it be known to all that there is no confidentiality when it comes to suicide.

Day 469

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This afternoon one of my junior colleagues mentioned that his wife had just finished her 3 years of GP training. During those 3 years she has not spent any time in psychiatry.
It takes 7 years of training to specialise in any particular medical discipline. But it is expected that GPs should know a little bit about everything in 3 years. That seems rather disproportionate. Without any training, how can they be well equipped to look after 1 in 4 of their patients who will present with a mental illness?

It is not uncommon to hear GPs say that when they call specialist services, they can sometimes be left holding the phone for hours. They often don’t get the support and advice they need. Some general practices have doctors with special interests, such as gynaecology, dermatology, psychiatry etc. Others don’t. Some GPs work in isolation. Others have no interest in psychiatry.

Of late the news has been resplendent with the issue of ‘hospital deaths’ being more over the weekends. It is almost illegal to die in a hospital as it brings a bad name to the organisation. However anyone can die unnoticed in the community and it seems to be nobody’s problem.

No health without mental health : a cross-government mental health outcomes strategy for people of all ages’ sets out six shared objectives to improve the mental health and well-being of the nation, and to improve outcomes for people with mental health problems through high quality services. The strategy was produced in collaboration with many of the Department’s partner organisations. It will enable more decisions about people’s mental health to be taken locally, and stresses the interconnections between mental health, housing, employment, and the criminal justice system.

For those who only understand the language of money, Knapp et al at London School of Economics studied the economic benefit of GP training and concluded that investment in GP suicide prevention training is cost ­saving overall from year 1. The intervention appears highly cost­ effective from a health system perspective alone.

Hence there is a strong case for suicide prevention training for GPs.

 

 

 

 

 

 

Day 461

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‘Parity of Esteem’ is best described by The Royal College of Psychiatrists as: ‘Valuing mental health equally with physical health’.
More fully, parity of esteem means that, when compared with physical healthcare, mental healthcare is characterised by:

  • equal access to the most effective and safest care and treatment
  • equal efforts to improve the quality of care
  • the allocation of time, effort and resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status in the measurement of health outcomes.

At the Coroner’s court, when the (Honorary) Consultant Psychiatrist was asked why he did not have a conversation with me, the patient’s mother, about his diagnosis of Bipolar Disorder when he made that diagnosis , he said that was because the patient ie. Saagar was very averse to me (his mother) at the time. It is eminently possible that his hostile attitude was a symptom of the illness.

However, the doctor felt comfortable sending him home to live with me.

If Saagar would have presented with a Hb (Haemoglobin) count of 5 (normal being 14-16) due to blood cancer, would he have been told his diagnosis, put on medication and sent home? No. The family would have been informed and educated about the illness and given clear instructions on a possible hospital admission and where to go if things got worse. The patient would have been offered counseling services to deal with this potentially life threatening disorder. They would have informed them about the 5 year or 10 year mortality associated with the condition and the expected desirable and undesirable effects of the medications.

With all due respect to the Psychiatrists who work under tremendous constraints and do a lot of good work everyday : if they, as custodians of the mentally ill, are unable to give mental illness the parity of esteem it deserves, how can we expect anyone else to?