If all the world’s a stage…it has props.

downloadIn the background stands a majestic Palladian structure in brick red. It’s nearly 400 years old. The artistic roof displays beautiful finials, turrets and cupolas. It’s easy to imagine the large atria and sweeping staircases on the inside. It appears as if this building emerges from an expansive lush green sea.

The cricket nets are placed to the right of this building. Many hours have been spent here, laughing, picnicking, practising, talking, spectating and playing. Multiple recordings of his bowling action have been made here, each scrutinised to the nth degree by him. Each one distinct to his discerning eyes but all identical, to my lay ones.

In the fore-ground sits a TV screen with ‘Friends’ playing. He likes Rachel. I think she plays the role of who she is in real life. Not much acting ability required for that. He doesn’t understand that. He thinks I don’t like her. I like Phoebe. We both love ‘Smelly cat’. He watches it when he is down. I see why. However feeble, it always brings a smile to his face as it does to mine now. However predictable, it doesn’t fail to amuse, to lighten the heart. The impression of a head is clearly formed on the red velvet cushion resting at the corner of a black leather sofa.

At centre-stage, a pink and silver drum-kit sits atop a hand woven black and white Moroccan rug.  2 goblet drums wait in the wings – a Djembe and a Darbuka. A set of initialled drum-sticks read ‘SN’. Big round black bags lean against the wall. They weigh half a tonne. They encase special cymbals – presently silent but given half a chance, fully capable to raising the roof of not just our house but also that of the neighbours.

A fake snake coils on the study table with its tail realistically hanging off the edge. It has been used successfully to blow the living day-lights out of people of all ages, shapes and forms, on many occasions. It took me 2 years to immunise myself against it.

An unwieldy ragged cricket bag with wheels at one end lazes against the wall. One entire shelf in the cup-board is dedicated to cricket gloves, balls and other paraphernalia.

The sun streams in from 2 big sky-lights and the space is lit like a sanctuary. A silver Apple Mac laptop lies gaping on the study table with funny cat-videos playing. It’s connected to the dome of Harman Kardon speakers which hide under the table.  An assortment of coins, head-phones and keys splash across the dark wood table top. A few coffee mugs are scattered around the room with various shades and degrees of dry brown coffee lining the insides.

Behind the door is an overflowing willow laundry basket. A pair of union-jack boxer shorts shine through. The space smells of an unkempt temple with a male caretaker –  hints of incense, musk and testosterone. From the door hook hangs a towelled maroon dressing gown.

All the props are here, tell-tale signs of a life. Where’s the main man? At a subtle level, his absence is only physical. His essence is present.

It’s in all the props, in the air around them, in the luminosity of the room, in everyone he touched, made jokes with, played music with, was kind to and loved. In the glow in my eyes, the light in my heart. In me.

His essence is here. I only need to close my eyes. This must be immortality.

“Do you not know that a man is not dead while his name is still spoken?”                              – Terry Pratchett

(Ref: A fully referenced, peer reviewed article published in an educational, medical  journal for GPs; a case study of a young man called SN to demonstrate the importance of Suicide prevention training and the role of human factors in patient safety: http://journals.sagepub.com/doi/full/10.1177/1755738017724183.)

Day 993

Ruth

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Broken glass

“You are well enough to safely go home now”, said the panel.
“But I can’t! I need one more day to complete my church!”, said Di, who was being treated at Bexley hospital for Postnatal Depression in 1966. She had a brilliant occupational therapist who took them to the swimming pool, organised hair-dressing days and helped patients to make things. Di made a church with bits of shattered wind-screen glass, put together with resin but the spire wasn’t on yet. This beautifully tactile piece of art was named ‘Faith’ by Ruth, her daughter.

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Ruth was a talented young lawyer. She was an actor and singer. She was kind, generous and gorgeous! She travelled extensively. She was diagnosed with Bipolar Disorder in her late 20s. She coped well with the help of health services, her friends and family but tragically lost her battle at the age of 47.

Di is in her second year of missing Ruth terribly. She has created the most beautiful garden in her memory. Some of the plants there are from Ruth’s house. Her mediterranean wall is stunning.

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Being bereaved by suicide is a huge risk factor for suicide. Around 125 youth suicides a year occur soon after the person involved has experienced a bereavement. One in four (25%) of under-20s and 28% of 20 to 24-year-olds had lost a relative, partner, friend or acquaintance around a year or more beforehand. In 11% of suicides among under-20s, the person who those involved had lost had also taken their own life.

In a recent inquiry, bereavement was found to be an important theme in many deaths, said Prof Louis Appleby, the director.

People who have been bereaved need greater support to reduce the risk of them killing themselves. Agencies who are meant to help are not good at recognising this risk and need to improve.

This morning I caught up with Di over a cup of tea. We both believe that if Saagar and Ruth have met each other wherever they are, they must get on famously. The link below is a conversation with Di. She talks about her insights on mental health services over 5 decades. Thanks a lot Di!

Day 991

Light and day and night.

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The longest day of the year is behind us.

It’s well known that lack of sunlight has an adverse effect on our brains. It might stop a part of the brain called the hypothalamus from working properly:

  • Production of melatonin – Melatonin is a hormone that makes us feel sleepy. The hypothalamus may produce it in higher than normal levels.
  • Production of serotonin – Serotonin is a hormone that affects our mood, appetite and sleep. Lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression.
  • Body’s internal clock (circadian rhythm) – Our body uses sunlight to time various important functions such as the time we wake up. So, lower light levels may disrupt our body clock, mood and alertness.

A recent study by Klaus Martiny of the Psychiatric Centre in Copenhagen shows that people being treated for severe depression were discharged almost twice as quickly if their rooms faced south-west in comparison to those whose rooms had a north-west orientation. Depending on time of the year, the intensity of daylight in the south-west rooms was 17-20 times brighter. The results support findings in previous studies of the importance of architectural orientation providing natural daylight as a factor for improvement. “We don’t know the precise mechanism, but I think it’s to do with exposure to the morning light, which advances and stabilises their sleep-wake cycle,” says Martiny.

Light acts as a powerful reset switch, keeping the clocks in our brain synced with the outside world. This clock can weaken as part of ageing, Parkinson’s disease, strokes and depression. To tackle this problem several hospitals are installing dynamic ‘solid state’ lighting which changes like daylight over the course of the day : whitish-blue in the morning, growing warmer and dimmer through the day and turning orange or switching off at night.

Light can be a drug.

 

Day 989

Accidental findings

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In the mid 80s, Dr Vincent Felitti ran an Obesity clinic in America. Many people enrolled and hundreds of pounds were shed by them. But he found that the drop-out rate from his programme was as high as 50% despite good results. He did not understand this and went back to look closely at patient notes.

“I had assumed that people who were 400, 500, 600 pounds would be getting heavier and heavier year after year. In two thousand people, I did not see it once. When they gained weight, it was abrupt and then they stabilized. If they lost weight, they regained all of it or more over a very short time.”

The turning point in Felitti’s quest came by accident. He was running through yet another series of questions with yet another obesity program. How much did you weigh when you were born…when you were in first grade…when you were in high school…when you first became sexually active…

One female patient replied – “Forty pounds” and broke down in floods of tears, “I was four years old.” He found similar common themes emerging from various stories and went on researching this subject for the next 25 years.

The obese people that Felitti was interviewing were 100, 200, 300, 400 overweight, but they didn’t see their weight as a problem. To them, eating was a fix, a solution like IV drug user calls a dose a “fix”.

Eating made them feel better. Eating soothed their anxiety, fear, anger or depression – it worked like alcohol or tobacco or methamphetamines. Not eating increased their anxiety, depression, and fear to levels that were intolerable. For many people, just being obese solved a problem. In the case of the woman who’d been raped, she felt as if she were invisible to men.

Felitti went on to further explore the  impact of childhood trauma on people and coined the term – ACE, Adverse Chilhood Experience. He found a strong co-relation between the number of ACEs and early death.

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Film: https://www.youtube.com/watch?v=v3A_HexLxDY

 

Day 988

Transition is the cliff edge.

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Alas, poor Yorick…

Eighteenth birthday! Yay! No more a child. You are mentally, emotionally, socially, spiritually and physiologically an adult. That’s it. Over to Adult services now. Easy.  The number ‘18’ is completely arbitrary. It is designed for the convenience of the service providers, not in the best interest of children. There is a strong case being made now for raising the ‘transition’ age to 25 and rightly so. The recent publication “State of Child Health 2017” has recognised that the transition from Paediatric to Adult services is poorly organised and unsafe for mental and physical health conditions.

This is how one of the parents felt: “In my experience the teams did not work together. They each did their separate thing. When Rebecca left school, she was left with without regular support or advice. When she turned 18 we just stopped receiving information. Emails and phone calls didn’t get answered.”

Chronic conditions such as Epilepsy, Asthma, Diabetes, Juvenile Arthritis and Childhood Obesity are often associated with significant mental health problems. The budget for kids was 6% of the Adult MH services until recently. The government promised an increase and guess what! It has gone up to 7% now. Hurrah! Considering that mental illness most often begins in adolescence and early intervention is of paramount importance, the allocation of funds is highly disproportionate.

Piet Jansen, Director of International Relations, Yes We Can Youth Clinics, Netherlands, commented:

‘There was a lot of talk at the CAMHS congress about the Green Paper, but in my view the only green thing that matters here are dollar bills (in this case pounds). Without sound financial and genuine political commitment, structural changes are not to happen.’

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Day 978

Primum non nocere- First do no harm.

Doctors could save lives by breaking rules on privacy.

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This is a point worth making again and again and again and again and as many times as it takes. Few excerpts:

Hamish Elvidge, father of Mathew – “Before my son took his own life, he had only just been discharged as a low-risk patient, despite coming in as a high-risk patient that very same day after a suicide attempt. At no point were his family involved in any part of the process. There is a chance that, had the hospital decided to share information with his family, our son would still be here today.”

“Confidentiality is far too embedded within the medical profession. The default position has to be one where you have to explain why you haven’t involved the family.”

Prof. Appleby said: “Psychiatrists should feel able to use their clinical judgment on where the balance of patient safety and confidentiality lies. Families are devastated when they discover too late that their loved ones had been talking to professionals about suicide.”

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “In my experience, if doctors make well- justified, well-recorded decisions to share information in the best interest of a patient who is in suicidal crisis, consistent with their professional codes of practice, this will be understood, respected and upheld in courts of law.”

 (Source: The Herald_Congress17_suicide story.pdf)

 

Day 975

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Ben 

In conversation with a retired Paediatric surgeon today, the topic of premature babies came up. He said that the commonest type of surgery in new-borns has changed over the years. Unlike a couple of decades ago, the commonest operation now is for dead gut, essentially due to the rise in our ability to provide better care for premature babies. He thought that the incidence of premature births was almost double in London than anywhere else in the UK because of high stress levels.

According to one of the largest reviews of evidence, children born very prematurely are at greater risk of developing mental health and social problems that can persist well into adulthood. Children who weighed less than a kilogram at birth are about four times as likely as those born at term to have attention deficit hyperactivity disorder (ADHD), and significant emotional problems. This may be due to weakened connections in brain networks linked to attention, communication and the processing of emotions.

These findings are important because mental health issues that occur in childhood are a strong predictor of psychiatric disorders in adulthood. “There is a strong case for assessing, on a regular basis, the mental health status of these children, so that early intervention approaches might be implemented sooner rather than later, with a view to minimising future mental health problems,” said Prof Smith from Glasgow.

Sarah is a Registered General Nurse with 25 years’ experience. She worked as a Neonatal Nurse over the last 17 years prior to moving to The University of Salford where she is now a Neonatal Lecturer within the Midwifery Team.

Sarah became involved with PAPYRUS in 2013 after the loss of her 14-year-old son Ben to suicide. Ben was a premature baby.

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