The what if challenge

The role of a psychiatrist is midway between the remit of neurologists and psychologists which are specialist areas in their own right. A neurologist looks as the genetics, physiology and how the brain actually functions in the body; whereas psychologists concentrate more on what that leads to in terms of behaviour. 

Given the human brain has over 86 billion connecting points that we know of so far, it is not surprising that it's taking a while to fathom how a brain should be functioning as the number of possible ways it could misfire, be mis-wired or be malformed it quite staggering. We should count ourselves lucky that it can function at all. Recently scientific research has revealed that the fats in our bodies produce hormones to add to the complexity of organs all contributing toward our well being or ill health. 

Psychiatrists are not the only ones to be playing piggy in the middle while neurologists try to fathom what it is that makes a person mentally well as opposed to ill - general practitioner are there too - so are we. Each and everyone of us, healthy or ill is on the receiving end of the results of all medical discoveries. We play an important part in informing medical teams about what we are experiencing even though we are hindered in that task by not using their terminology to explain things very efficiently. Even among the medical profession the same term gets interpreted in a myriad of different ways while all agree on the overall concept behind each label or phrase. 

It soon becomes apparent that medical care can and often is a very hit and miss, trial and error way affair. As patients, as human beings this is quite alarming to realise until we remember that actually life is and has always been like that and that our best option is always to go with what we know to be safest and which we know to work just as a starting point. It is far better to go with the best we know rather than to rubbish all we know and be left with nothing surely? It is better yet to build on what we know to be true which we largely do.

Here though, as many a mentally ill person can testify, lies a problem. It's the "What if" mindset that is both useful and dangerous to all.

What if previous theories are wrong? What if current forms or treatment are wrong? What if what seems to work now will be proven to cause us problems in the future?

'What if' can lead us into not trusting in anything or anyone including ourselves and our own judgement. What if includes scenarios such as "what if I am imagining the whole of my existence and what if I am an imaginary character myself?" You see the trouble it can lead to? As human beings we often get scared and confused by using 'what if' the wrong way. This results in more and more unhappy thoughts piling up on top of each other to multiply and magnify our confusion and distress - it doesn't help to use 'what if' for things that we cannot change or to speculate on how bad things could get if we don't also use 'what if' to help us.

In many forms of talking therapy this constitutes a large portion of the work undertaken. In effect, it's aim is not to give answers but to enable us to find the means by which we can find a sense of balance between all the possible outcomes there can be. Outcomes are merely the events of our lives which are made up in equal measure from the actions of others and ourselves as well as our own genetics and physiology. No outcome need be a permanent 'answer' or 'conclusion' and it is far better that it never is for something better might emerge from a disastrous situation or something truly marvellous could happen from an already stable  and nice situation.

When we dwell on analysing past events which we cannot alter we can often find ourselves missing out on the present. While it is helpful to find out what went wrong and why, it is less than helpful to dwell on such things if we learn nothing from them. 

Many a mentally ill patient finds it difficult to let go of past events when they have been traumatised by them, but sometimes some patients can be destined to be traumatised by events simply because their brains are made that way or fire off the wrong signals to produce the same effect. It becomes apparent why it is so important for neurologists, psychologists and psychiatrists to be as aware of the differences between the causes of illness as possible. While on a quest for causes though it can happen that these highly knowledgeable medical professionals can end up finding only what they expect to find or are looking for in the first place missing out on other causes which can range from social factors to simple vitamin deficiencies. 

The only way for mental health care to avoid that pitfall is for all those disciplines to always communicate and for each to challenge each other with 'what if' the cause is not just this but also a smidge of this and a dollop of that. That challenge sadly is not often seen as a call for objectivity when it comes to a mentally ill patient voicing a doubt or concern. More commonly it is seen as symptomatic of illness and a resistance to trusting their medical team. 

A good phrase for patients to use when this happens is "Excuse me for wanting you to get to root of my illness so you can get the treatment right." It must always be remembered that the mentally ill while lacking in objectivity do have an abundance of insight as a consequence of their experiences both in and outside of medical treatment. They therefore are the most important source of information to discern what the problem is and where the root causes might be. They have a voice and it is after all them who have to bear the consequences of errors in judgement from all they encounter. Nothing is of greater concern to any patient (be they mentally ill or not) than whether or not they can be well, yet how often is a focus placed on what they view as well? How often is it that any mentally ill person is encouraged to believe that they can be well? If we are brainwashed into believing ourselves incapable of improvement, what is the likely outcome in any situation?

To put it another way, if a person is never going to be responded to as if wellness is a possibility the probability is that individual will always be ill because no one ever acknowledges how much of them is well. Building upon the aspects of ourselves that are functioning healthily is vital to aid recovery from any form of illness or disease. Regrettably when it comes to mental health care, few in the field advocate let alone put this into practice. The reason is because mental health professionals are paid to concentrate on the bit that needs fixing but to the mentally ill it often comes across to them as an archaic institutional attitude that sucks is insulting and worst still, causes them more damage. The fact that most mental health teams mean no harm in some respects only serves to add to the frustrations and distress of those they care for. 

A future for what if

What if there was a greater understanding of what it is like to be on the receiving end of all these decisions about a person's mental health? What if neurologists, psychiatrists, psychologists, GPs and the patients themselves discussed and agreed upon the things that caused their illness. What if every patient was assessed by a neurologists, psychiatrist, psychology and a GP before a joint diagnosis was made... wouldn't that lead to possibilities of quicker and ever less intrusive treatments in the future? 

Here at Mindwalking we are conscious that although making steady progress, treatment and diagnosis when it comes to mental health still lacks much of what is already taken for granted in the rest of general medicine. In the future we hope diagnosing will become a joint effort to pull treatment even further away from the risk of mere opinion for such decisions. It does not help patients of any kind to be confronted with differing opinions as to what ails them - it leads to confusion and distress. Luckily most in the mental health care profession do consult and confer to agree, make sure this happens if you are ever ill.  

'What if' offers a world of possibilities but it is only really useful when it is used to aid understanding rather than generate fear and prejudice and a failure to learn or act responsibly. 

We hope you use it wisely. 





 

Preventing errors = preventing illness

Recently I had to see my new GP in a different practice as I swapped, to seek advice. Just like last year I had to battle with the receptionist to stress the urgency of my need as I was aware that I had been angry for over a week, couldn't sleep, wasn't eating properly, hadn't washed or changed my clothes. I was tempted to let rip and in retrospect perhaps I should have because I am so weary of battling to get access to the support I need when I need it most. I was almost at the point of just giving up altogether and trying to heal myself entirely on my own for things I have no way of knowing how to heal myself on rather than endure the humiliating, distressing and extremely stressful ordeal of trying to get to see the doctor of my choice i.e. the only one I felt comfortable with talking to.

Perhaps I should have yelled at the top of my lungs that I was mentally ill and for all she knew I was about to commit murder. I finally did got a phone call from from my GP who openly admitted to his lack of knowledge on mental health, so I was able to instruct him as to exactly what I required and he carried out my instructions but how ludicrous! Would a cancer sufferer be expected to do the same, or someone with tonsillitis or any other type of ailment. On the other hand it is no surprise that I know more than him as you will see if you read on.

Fortunately he followed my instructions and everything is in hand again because luckily for me I can articulate my needs because I know what they are, but... what would have happened if that had not been the case or I was a first time sufferer? Why is it that mental health conditions are continually shoved to the bottom of the queue by an unqualified receptionist for emergency appointments at the first point of contact and that General Practitioners still know so little about mental health themselves?

As sufferers we need to be responsible enough not to waste a doctor's time, but as sufferers when we are in a state of crisis that is a totally unrealistic expectation to impose upon us. As sufferers are we any wiser than a GP in prescribing which medication to use? 

It is neither ethical nor helpful if the medical profession to be working in the dark in this way, however, it's not really surprising that first line services (Primary Care Trusts/GPs) are ignorant about what patients need when the whole of the health care profession itself is so woefully lax in preventing mental illness among their own staff.

The statistics on health and social care professionals suffering from mental illness and committing suicide show that they are at higher risk of problems than just about any other profession you can think of. You can either 'cut it' or you can't seems to be the universal perception when often the conditions under which they work are frankly unreasonable, e.g. long hours without a break, swapping from days to night shifts continually with not enough time for their body clocks to adjust, low pay, not enough time for the mountains of forms they have to fill in and log jams caused by often long winded and ill thought out, clunky, inefficient administrative systems.

When the Care Quality Commission (CQC) makes it's assessments of services it's remit does not have provision to look at the psychological needs of the staff that provide any form of care. This can result in the best staff burning out, leaving the weaker and less dedicated staff to 'hold the fort'. Is it any wonder then that abuse cases hit the headlines as without diligent alert staff there to protect vulnerable people, abusers have free reign to enter into theft, neglect, physical, sexual and emotional abuse for ANY kind of service at all.

In the three months that I was sectioned (over ten years ago now), three members of staff were suspected of abuse and suspended immediately pending investigation. The mental health facility I was in about eight staff for 40 patients on days and less staff on nights on the main ward. Three staff were also allocated to the Intensive Observational Unit (IOU).

It is a miracle to anyone can recover when surrounded by other distressed and sometimes very violent patients and with such unsavoury characters working there. One was allegedly grooming female staff into having sex, another was standing guard while their colleague (a female) had sex with a male patient in the Intensive Observation Unit. It is perhaps among sufferers of mental illness that the fear of whistle blowing and not being believed is highest but, we are there to get better, not to accumulate psychological problems.

In an emergency you could call the police, but I suspect if you are sectioned it's pot luck as to whether you would be believed. However, there is also the CQC (Care Quality Commission http://www.cqc.org.uk, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Phone: 03000 616161) for any form of abuse or concern you wish to report. They are duty bound to respond as they are the body that regulate health care services in the UK.

How do we prevent abuse from health care providers?
In my view, in order to safeguard against abuse and illness I believe we should ensure all health and social care employers have to abide by work time directives and Employment Laws as this is not at all common practice. This should be monitored by the Care Quality Commission as part of it's normal inspection process along with psychologists to do regular checks on the staff who work in health and social care. In addition regular surveys on staff morale and stress levels as well as surveys from service users regardless of illness or disability about their care would I think help.

All staff in all sections of health and social care desperately need to be educated about mental illness if only to safeguard their own health let alone be better equipped to help us and, they need to be vetted more stringently before entering embarking upon their careers in the first place. It is alarming that an independent care home or even an NHS service can have fewer mental health awareness induction initiatives or psychological checks on new staff than a charity such as MIND or AgeUK but sadly it is often true.

Such things cost money though don't they? Well, according to HMRC (the taxman to you and me) we as a nation are owed an estimated thirty billion pounds, but according to according to the Tax Justice Network and PCS we are owed £120 billion pounds by... tax avoided, evaded and uncollected. I think a slice of that pie should definitely go toward better training, better staff, more stringent safeguards and oh yes more education on mental health!

Perhaps if more of us were employed we'd be able to sort it including many a long winded, inefficient, clunky administrative system. Is it any wonder that I have trust issues to get sorted?

Just my opinion though, you don't have to agree.

PLEASE NOTE: Written in a calm mood, not an angry one. We can only sort problems by getting to the root of them and through collecting ideas for the best solution.

A soul-to-soul felt thank you

I would like to say a thank you to the thousands of honourable health care professionals who literally risk their health in order to help all of us, be it on mental health or for anything else. Without them I would not be able to pick myself up again and again and again. It is for you that I dedicate this article. This is no way alters the fact that we need reforms to educate, improve systems and safeguard your health.
Thank you for being there and THANK YOU for doing what you do under such trying circumstances. It really shouldn't be this way, I hope one day it will become easier and safer for all.

PS: Since publishing this there have been interesting developments but confidentiality forbids me to say what, but I can tell you that globally Russia and USA are taking more interest than the UK at the moment. Typical.