Day 585

Posted by kidsaregifts20

The Dragon Café is starting to feel like second home. Every Monday morning I look forward to going there for a cup of tea (and homemade banana bread) after work, meeting interesting people and being introduced to new dimensions of mind, body and spirit. Now I know some of the names and faces. I am turning into a regular and people are getting to know me too. It feels great.

This afternoon I attended a very simple but smart chess workshop and an art display by a Child and Adolescent psychiatrist and some of his patients. He talked about one of his patients with Selective Mutism, Megan Winton (self portrait above) who could not speak at all outside of her home but now does public talks on her artwork. He discussed their creativity process, the positivity of art and wellbeing and the crossover between service users and providers.

I also met with a passionate artist from a group called ‘Mental Spaghetti’ that brings together marginalised groups of society and the general public to help reduce stigma, enable social interaction and to encourage artistic practice in people of all abilities. They are working on an exhibition titled ‘Cross Pollination’ with the aim of blurring the lines of ‘Us vs Them’ (ie. service providers vs service users).

All those years I spent stuck inside a hospital building seem like such a waste now. We all are the same humans, yet there is a such a wide gap between the social model and the medical model of illnesses. I am intrigued to step out of my little world and see all these imaginative, inclusive and heart felt ways of dealing with people.

I wonder if Saagar would have enjoyed any of these things. I think he would have been a stunning percussionist and a very funny mimic. I think he would have had fun if he would have got this far. Oh! There I go again…

Day 579

Posted by kidsaregifts20

Hospitals can sometimes be a problem rather than a solution. They cannot provide the collaborative information sharing needed to care for today’s typical patients who may have multiple problems. This is especially true for the elderly and the mentally ill. Royal College of Physicians has proposed the concept of “hospital without walls” which aims at providing continuity of care for patients, coordinated and delivered by a single consultant-led clinical team. The hospital ceases to be “somewhere”. It becomes everywhere.

The little market town of Geel in Belgium is well known for its early de-medicalisation of care of the mentally ill. For at least 7 centuries, it’s inhabitants have been taking the mentally ill or disabled into their homes as ‘guests’ or ‘boarders’. These are people who, whatever their diagnosis, have come here because they’re unable to cope on their own, and because they have no family or friends who can look after them. When they meet their new families there is no clinical diagnosis. During the Renaissance, Geel became famous as a place of sanctuary for the ‘mad’, who arrived and stayed for reasons both spiritual and opportunistic.

A boarder is treated as a member of the family, involved in everything and particularly encouraged to form a strong bond with the children, a relationship that is seen as beneficial to both parties. They call it ‘family care’, possibly the best form of therapy. Often the boarder lives with the family till they die, first as a child, then a sibling and later on as an uncle or aunt. Doesn’t that fulfil a basic human need of relatedness with other beings? The tradition still exists albeit to a limited extent due to faster paced city life, fewer farms and more double income families. However, the main reason for its longevity is not just tolerance, but pride. “Half of Geel is crazy, and the rest is half crazy,” runs a local joke.

Today, in London we aim to provide ‘Community Care’ in the absence of a community and no understanding of the word ‘care’. It’s obviously not working because the basic values on which it is based are wrong ie. cost saving.

We, the people need to educate ourselves, open our hearts and develop a deeper understanding of our human condition.

To kick off the Mental Health Awareness week, here are a couple of attempts on my part:

18 Months on…

Podcast from Croydon Radio

Day 574

Posted by kidsaregifts20

It’s official. Core Psychiatry Training is on the ‘shortage occupation list’ which means there are not enough resident workers to fill all the vacancies.

“Catastrophic is the word I would use for the shortage we are now facing. We have always struggled to recruit significant numbers but this year is particularly acute. It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill” says Prof Robert Howard, dean of the Royal College of Psychiatrists (RCP) in the Telegraph. He goes on to say that due to the lack of competition, jobs are given on the basis of ‘appointability’ rather than great ability. This means that the standard of competence of those selected is just above the basic minimum rather than excellent.

One reason trainees may be reluctant to apply for specialty training in psychiatry is because of the misconceptions and stigma associated with the speciality. For instance, a study presented at the Royal College of Psychiatrists’ 2013 congress found that 26% of medical students and 47% of the public said they would be uncomfortable sitting next to a psychiatrist at a party for “they would know what you are thinking.”

Another reason may be that medical students and other doctors often think that treatments in psychiatry are “unscientific,” and that they lack the same evidence base as treatments in other specialties. Other myths include a sense that psychiatric treatment is inhumane and that psychiatrists resemble those portrayed in films such as One Flew Over the Cuckoo’s Nest and Silence of the Lambs.

While speaking with a young Consultant Psychiatrist it was clear that the prospect of working with very limited resources and support is what makes a career in Psychiatry very unattractive.

A huge recruitment drive is on. Medical students and junior doctors are being introduced to various possibilities within psychiatry early on in their education. Let’s hope it works.

Day 573

Posted by kidsaregifts20

In the summer of 2012, Saagar attended a formal family lunch to which he was invited by his friend. His friend’s grandmother turned to him and asked, ”How does it feel to be the only foreign person to be sitting down?” (Hidden message: All the other foreign persons present there were waiters.) He was a bit shocked by that but just laughed it off. I wonder how many times he had faced such occasions where he had no choice but to do that.

Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalised group membership. This term was coined by social scientists at Harvard in the 1970s to describe an inequitable treatment of another person in a manner that is not overtly “aggressive”, yet which might stem from negligence, ignorance, or what we now call unconscious bias. Eventually, the term came to encompass the casual degradation of any socially marginalised group, such as the poor and the disabled.

Recently I watched a short film called STOP (trailer) by Green brothers. It very cleverly portrayed a vulnerable young black man’s position in his society.

Here are some other examples of microaggressions:

A White man or woman clutches their purse or checks their wallet as a Black or Latino man approaches or passes them. (Hidden message: You and your group are criminals.)
A female physician wearing a stethoscope is mistaken as a nurse. (Hidden message: Women should occupy nurturing and not decision-making roles. Women are less capable than men. Happens with me a lot.)
The outfit worn by a TV reality-show mom is described as “classless and trashy.” (Hidden message: Lower-class people are tasteless and unsophisticated.)

Microaggressions are active manifestations and/or a reflection of our worldviews of inclusion/exclusion, superiority/inferiority, normality/abnormality, and desirability/undesirability. Even though these biases are implicit, they can be deeply damaging. The deaths of African-Americans at the hands of the police in Ferguson, Cleveland and on Staten Island have reignited a debate about race.

Is it a pure co-incidence that people from black and minority ethnic groups living in the UK are:

more likely to be diagnosed with mental health problems
more likely to be diagnosed and admitted to hospital
more likely to experience a poor outcome from treatment
more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health?

Day 567

Posted by kidsaregifts20

In an office in the City, it’s time for the annual appraisal. The young man in question is a graduate trainee, about 22 years old. He is not considered quite up to the mark. His very sweet and steady girlfriend broke up with him by text out of the blue one day and it took him as long as 2 weeks to gather himself back together again. A definite cause for concern! Is his sensitive temperament suited to a career in the City?

Angad Paul, a 45 year old businessman killed himself in November 2015 while the balance of his mind was disturbed. Months prior to that his steel business, Caparo industries went into administration as a result of economic forces well beyond his control but he somehow held himself responsible.

As per an article in the Financial times on 2^nd May titled “Taboo over executives’ mental health issues needs to be challenged” by Jonathan Guthrie, senior executives at the apex of an organisation can feel tremendous strain from their isolated positions. In addition, depression and burnout can result from lack of control. However, they are ‘desperately afraid’ that people will know that they have a problem. Stigma everywhere.

However, in 2011 Mr Horta-Osorio, Chief Executive of Lloyds bank went on sick leave after 5 days of insomnia. After a couple of months of rest and medication he came back to steer the bank through an exceptionally difficult phase. 4 years on, he is still in the job.

Stigma gets in the way of sufferers asking for help. It is a huge obstacle to overcome but so worth doing.