Saturday, 27 September 2014

Muddling Myths and Diagnosis Dilemmas

There are many forms of treatment for the mentally ill now and a few do not involve medication at all; they require changes to lifestyle and how we approach life. However, it is still more common to need medication of some kind to help start this process off at the very least.

If you think in terms of mental health medication as being in two distinct categories it should help everyone be less afraid of them. There are medications used in an emergency situation, just as you might have if you are whizzed into an Accident and Emergency Department following a life threatening accident or ailment; and there are those used to prevent emergencies and help us to recover from dire events and ailments in our lives.

There is a problem though and that is diagnosis. All too often people who are not qualified at all to diagnose try to do so. Even among mental health care professionals the temptation to say that this person is presenting this symptom therefore they are suffering from this condition is huge and nigh on irresistible. To describe the symptoms to a doctor is the right thing to do, but to tell a doctor in any field of medicine that a patient is suffering from a condition you happen to be familiar with could result in that patient's death. You might think that the more experienced a member of staff is the less this would happen but during our research we have found that sadly archaic attitudes have still not left us even among medical staff.

The most common complaint of all from the mentally ill is that their thoughts and feelings have not be correctly relayed to their psychiatrist at all, and there are even examples of test results not reaching them either. This is alarming in the extreme as how can any doctor in any field of medicine be expected to diagnose and prescribe accurately if they do not have the correct information to do so? The effect on their patients is one of anger, frustration and a lack of faith and trust not only that they will be diagnosed correctly, but that they can ever be cured. There is fear that if they show such feelings they will be subjected to even more medication that is unwarranted too.

Luckily there are many diary entry and mood chart devices to help avert this happening and in the UK at least there are organisations like Mind, Rethink, Saneline and PALS for patients to find an advocate if things do go wrong. There is also the Care Quality Commission and (albeit only a handful) solicitors who specialise in representing the mentally ill. Such processes add to stress levels rather than alleviate them and things can be further complicated when the condition the patient suffers from is some form of paranoia or delusion.Additionally cases of misdiagnosis for the mentally ill can be long standing if their conditions are never reviewed. What was modern medicine 50 years ago is not the latest thing now. Shockingly due to time constraints and particularly since the recent 'austerity drive' it is all too easy for a patient seeing a new psychiatrist being assumed to suffer from the same condition as their last episode. With physical ailments we seldom have this happen unless it is for conditions such as cancer, but even then no one assumes the cancer to be in the same place, the same type or to be affecting the patient in necessarily the same way.

Patients are seldom aware of any discussion over whether their brains are misfiring due to predominantly genetic, physiological or environmental conditions, but in all cases patients can learn to manage their own health if supported sufficiently well. It will still mean a life-time in care in some cases, but for most it could well lead to a fully functioning life.

This is where we at Mindwalking firmly believe mental health care professionals need to change. A broken arm sustained as child does not lead to everyone assuming the arm is still broken once deemed healed, but a mental health condition on your files will remain uppermost on your files even if you need no medication at all. This leads to many a human resource professional and manager treating the mentally ill unfairly, denying them work in the first place or treating them as fantasists if they report problems or in any way become emotional.

Different situations cause different illnesses and given that mental health covers such a vast spectrum of maladies it seems rather odd that this attitude has not changed yet. The mentally ill have enough to contend with regarding strangers, colleagues at work, friends and family trying to diagnose them with no training whatsoever without mental health teams themselves being lazy or assuming goodness knows what. There are dreadful cases of deaths being caused because such professionals missed signs of brain tumours, brain injury, autism and many other easily identifiable conditions were it not for the assumption that they already knew what the condition was before they started and therefore the patient never got referred for the appropriate tests or to the appropriate specialist.

It can seem at times like a miracle that patients get diagnosed and prescribed correctly at all but as the decades roll by more and more mentally ill patients thankfully are. The reasons behind this are:

1. Patients are speaking out more for themselves
2. They have advocates to protect them and their rights
3. There is greater awareness of all manner of symptoms and conditions
4. Psychiatrists confer more and more with psychologists
5. Psychiatrists and neurologists are learning more about how the human brain functions
6. Medications are becoming more refined to have just the right effect on precisely the right bit of the brain
7. Medications are beginning to become less addictive and with fewer side effects
8. Many more patients than ever before are able to cope with lower doses because of complementary therapies which leads to greater success in diagnosis for others
9. Psychologists and mental health care staff are becoming more aware of the traumatic effect treatment regimes themselves can have on the mentally ill
10. Awareness of what is happening in these illnesses from those directly involved with mental illness is ever increasing.

Sadly we are still waiting for the rest of the human race to catch up with all of this. It takes years of some of the toughest and most intense training imaginable to become a psychiatrist, psychologist or neurologists so why does everyone else think they could possibly know more or better than they do? The answer lies in that part of our brain that houses our nagging doubts. It's the 'what if' pest again (see previous post last month). Yes, medical teams can and sometimes do miss things which is why it is always important to keep talking to them. If you don't tell a GP that you vomit morning, noon and night and go into see them complaining that your neck hurts, what are they likely to look at, your neck or your digestive system? Mental health conditions are notoriously difficult to diagnose precisely because the same symptoms can be present in very different health problems - hence why a person in a rage might be a victim of crime, a perpetrator of crime, bereaved, have learning difficulties, a brain tumour or a long-term mental health condition.

Please, do yourselves and mental health teams a favour (especially the psychiatrists and psychologists) assume nothing, keep sharing your symptoms and take their advice just as you would for any other form of malady.

It remains an absolute truth that to help both prevent any illness as well as aid any recovery fresh food, exercise, sleep, relaxation and laughter will always pay dividends in the end but the greatest comfort of all for the mentally ill are people who believe them to be able to be well, do things and to share their experiences with not least what they can and do accomplish so regularly and so bravely.

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