Day 886

Ministry-of-Justice1-678x381

“More people are being detained by police under the Mental Health Act as Psychiatric services struggle to cope” says Jacqui Wise in the cover story of the British Medical Journal of 18th March 2017.

Statistics tell us that deaths in custody are up by 21%.
Self-inflicted deaths are up by 13%.
In the female estate, the number has doubled from 4 to 8 in this 12 month period.
Self-harm incidents up by 26%.
Individuals self-harming up 23%
Assaults up by 34%.
Assaults on staff up 43%.
Natural cause deaths up 17%, explained by the ageing population.
5 apparent homicides, down from 7 in the same period of the previous year

Could there be a co-relation between the facts stated in the first and the second paragraph?

“The police to an extent have always been used as an emergency mental health service” says Michael Brown, a police inspector. He adds that police receive little formal training in managing patients with mental health problems. “A highly agitated person may be experiencing Serotonin Syndrome due to the mismanagement of their antidepressant medications. The signs are subtle and most police officers won’t be able to pick up on that. We need to have a proper debate about the role of the police in this area.”

Ref:

Safety in Custody Statistics 2016: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/562897/safety-in-custody-bulletin.pdf#page=6
Blog about Mental health and the Criminal Justice system:
https://mentalhealthcop.wordpress.com/
Serotonin Syndrome:
https://patient.info/doctor/serotonin-syndrome

Day 811

Her Voice – a short story

‘I hear her. Her voice is in my head’ says Joe.
“How long has the voice been there?” asks the trainee psychiatrist.
‘Since I was 12.’
“And you are now 18.”
‘Yes.’
“Is it really upsetting for you?”
‘Yes. Distressing. I feel terrible.’
“What does the voice say?”
‘Different things. Often cries desperately.’
“How often does this happen?”
‘At least 3-4 times every day. It’s painful.’
“Hmmm. Let me speak to my senior and come back to you in a few minutes.”

A few minutes later.

“We think you might have Schizophrenia. Let’s start you on Quetiapine and see how it goes.”
‘Okay.’

Joe waits at the pharmacy to collect his medication. A trainee nurse is also waiting there to collect some meds for a patient on the ward. They talk. He tells her why he’s there. She asks him who is ‘she’? Whose voice does he hear?

‘She is my little sister. When we were kids we shared a bedroom. At night, my mum’s boy friend would come into our room and trouble my little sister behind a curtain. She cried. I could hear her but I was powerless. I could hear her then. I can hear her now.’

‘Do you think these pills will work?’

Day 795

As I read this piece of research, I could see Saagar and me reflected in it. It rang true. It gave me a deeper understanding about myself, my humanity and the precious fragility of our closest relationships. This qualitative research by Prof Christabel Owens et al tries to understand the needs of concerned family members and friends that can better equip them to intervene when their loved one is suicidal or in distress. It focuses on micro-social systems, like families or a group of friends as opposed to macro systems like nations and societies. (http://www.bmj.com/content/343/bmj.d5801)
Microsociology is the study of thoughts, feelings, moods, behaviours and forms of language that serve to maintain or threaten bonds between individuals.

Life is lived in small units – husband and wife, mother and son, boy-friend and girl-friend and so on. This is the level at which suicidal crises unfold and are managed, very often without any help from clinical services.

Family members and friends are the real frontline of suicide prevention but little is known about what goes on in these settings. A series of narrative interviews with the next of kin of 14 young people lost by suicide were analysed : What did they see and hear? What did they think was happening? What actions did they take and why? What additional knowledge, skills and support would have been useful?

Findings:

  1. Warning signs were rarely clear at the time. For example, one dad of a 19 year old boy said,“He had a teddy bear hanging from a light cord in his bed room.” In retrospect, the signs were clear but at the time, they were offset by countersigns or were difficult to decipher, open to a range of interpretations.
  2. Significant others engaged in normalizing and legitimizing their behavior. For example, a mother of a 29 years old man said, ”A few times he rang me in the early hours of the morning absolutely piddled out of his head and he’d be gabbling on but I couldn’t understand a word he was saying because he was drunk. I’d say, “Look, I’ll come and see you tomorrow and we’ll talk about it then.” I’d go there and nothing would get said and he’d seem alright.” In almost all cases, more weight was given to countersigns. The boundaries of normality were stretched to accommodate a loved one so as to avoid ‘pathologising’ or labeling them as that may be perceived as rejection.
  3. Fear (of loss) prevented them from saying or doing anything that might have prevented tragedy. For example, the partner of a 26 years old woman said, “I was trying to find the right words to persuade her to go to the GP. It’s bloody difficult and I was afraid she’d react badly. The situation was delicate and I had an awful lot to loose. And I ended up loosing it anyway.”

The article concluded that these are highly complex decisions. Due to a deep emotional involvement, we often cannot think and act in a rational manner. These findings are now being used to devise emotionally informed suicide prevention efforts, as opposed to cognitive ones which are most commonly used. These methods will help people like you and me to acknowledge and overcome our fears and act appropriately.

So far this leaflet had emerged as a result of this study:

https://www.exeter.ac.uk/media/universityofexeter/ref2014/documents/UoA2_leaflet.pdf