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.

A question of trust

You know the phrase, "you can't make an omelette without breaking eggs" - it's similar when it comes to trust. At some point, if we want to benefit from rewarding relationships we have to take the plunge and risk sharing something of ourselves that is personal - we have to trust. This can be an extremely difficult thing to do if you have ever been mentally ill, harder still if you have been hurt or abused.

As with many things we learn whether or not to trust others in our early development as children, and whether or not we learn at all depends on our own view of our own safety. We establish a sense of real safety the first time when we confided in someone over something that is emotionally important to us. As children most of us are told to be honest when we've made a mistake, broken something or done something naughty; it is often our initial foray into trusting another to do so and what happens next begins to shape our future - the response to that confession. Good parenting will acknowledge that you have owned up, bad parenting will not.

Whenever our best efforts go unacknowledged it can cause damage to our mental well-being. If we also then find ourselves punished for being honest, taken advantage of for being considerate, kind or generous or rejected for displaying affection that damage could reach very serious levels. Emotional abuse can be as devastating as physical abuse, much depends on what else we may have in our armoury to help us cope or recover. When we no longer wish to take the risk of trusting others at all we can end up making do with a socially deprived existence which is not the natural or healthy life of any human being. 

As a species we are a social animal, we need to engage with others and share our experiences for us to be happy within ourselves. As individuals though, we can all too easily count up all the bad experiences and not note at all any good ones when we encounter others. We are all equally vulnerable to the same level of risk when it comes to trust, but we must always strive to remember that one relationship that has been abusive doesn't mean that all will be.

It is well worth noting that it is seldom the case that in an emotional dispute or disagreement one side is entirely right and the other entirely to blame. Such instances are very rare and are at the extremes of abuse and the only option in those circumstances is to leave that relationship and go and seek a better one. It sounds simple but, for victims of serious levels of abuse it most certainly isn't. For them trust is a huge issue and it is rare for them ever to be able to recover without intensive levels of help from professionals.

What we can do for ourselves

Most people seek intimacy of some kind from someone else, but we can help ourselves by ensuring that we protect ourselves from danger by sharing who we are bit by bit. Even within families we can never know everything there is to know about each other, as to do so would require us to follow someone around 24/7 and quiz them endlessly about every thought, feeling and reaction they had. It's not something any of us would like. 

What we share by way of experiences with siblings is never the same as what we share with parents, friends, partners, work colleagues, acquaintances or complete strangers. Everyone in our lives starts as a stranger at some point, even as babies we are busy working out who and what these strange people are that go with the label of parent. Just as we learn about our family gradually, so too should we do the same when we encounter new people in our lives.

Problems can arise though when we have been isolated or alone for any length of time for whatever reason as we can either end up too nervous and shy to communicate or the reverse and download everything that's in our heads. I've done both at different periods of my life. The trick is to not only share who we are but take time to learn who the other person is. If you are not interested in what someone else finds important, why would they be interested in what you find important? However, we should never go about prising information out of people or cut to the chase. Instead we can help ourselves by taking smaller steps.

Easy does it

Learning about others is rather like peeling away the layers of an onion, in the process getting closer and closer to the centre. Likewise we should hold back on what we reveal about ourselves until we are absolutely sure about moving on to share the next layer of who we are. At any point we can stop sharing any more if ever we feel nervous. At any point we should also have an escape plan should things become threatening. 

When I was in my late teens I would test new people out by sharing my poetry with others - those that ran a mile I dismissed, while those that stuck around were put on my potential friends list. While there is nothing wrong with sharing an interest you have with others, it was a daunting one to be on the receiving end of as my poetry revealed too much too soon and I swamped people with it. Looking back now I'm surprised anyone stuck around!.

Far better to start with something simpler and less meaningful such as what a person likes to eat, watch on TV or what music they like. In other words something a little more neutral. Later on you can start sharing a particular favourite and when it feels right explain why that's a favourite - there might be a personal memory attached but if so, try sharing a happy memory before any sad ones as that way you will not only be keeping yourself save, but also be coming across as a person who is capable of being happy and therefore not a vulnerable person others can take advantage of.

With the passage of time I have toned down how I approach people, but given my own childhood was fairly intense I still haven't mastered it. These days I rarely share even a single poem, but I do share my more positive experiences first unless I have reason to share troubles e.g. some problem that prevents me getting to work. It takes practise but I feel I've made good progress. Here are a few rules of mine that have helped help me gauge who to trust and who to be wary of.

I never trust anyone who cannot laugh as freely about themselves as they would others. Nor do I trust anyone who is keen to be critical of others or who gossips a lot. People may appear to be considerate but can be devious and manipulative, so I watch their behaviour more than take their words as gospel. Nor do I trust those who continually sit in judgement of others, or who preach as if they are the world's authority on who anyone else is. I also ask myself things like "do they listen and hear everyone else? Are they able to put themselves in someone else's shoes and talk about what that person might be feeling if asked? Do they only talk about themselves and if so why" - it could be because no one has ever listened to them, or it could be because no one else matters to them. "Are they able to forgive and forget genuine mistakes made by others?"

There is no doubt about it, relationships of any kind can be complicated, but the more at ease we are with ourselves the easier it becomes to form worthwhile relationships with others. We may never want to enter into an argument, but sometimes we might need one to clear the air. In a good relationship such things should be possible without it ever seeming like the end of the world as it should hurt both parties to be arguing. Misunderstandings and differences need to be resolved quickly to prevent emotions escalating out of proportion and resentment or bitterness setting in. Likewise being able to be silent without it feeling uncomfortable is only possible if there is a strong bond between two people.

That special one in your life

The strongest bond most of us strive for is a partner. Someone once told me that "your partner is the one whose faults you can accept." It doesn't mean though that their quirky habits won't annoy and irritate you, it merely means that on balance the things you like about them outnumber the things you don't. Nor does it mean you should ever negate yourself, your worth, your friends, interests or family for them to end up as their slave. 

When it comes to the physical intimacy you have with a partner the same step by step process over getting to know them is a wise safeguard and that can be tricky when your hormones are aroused and telling you to just go for it. A hand being held, a caress and a kiss are all elements of foreplay and there is no law that states you have to even go that far in the course of a year. Go at your pace, and if your partner gets annoyed - well maybe they shouldn't be your partner then. Only embark on intercourse when you are both ready.

Sexual intercourse is another form of communication and as such it can be extremely varied. You need to agree about likes and dislikes early on and it is wise to work out during petting sessions how to help each other when one or other of you is not in the mood. Sexual abuse is not something either party should be aiming for or be on the receiving end of and talking about preferences early on should help prevent any misunderstandings. 

It is not a woman's role to just lie there and let a man do with her what he wants, nor is anyone obliged to submit to sex on demand at any point. If you find your partner is not interested in sex, it may be for a myriad of reasons and only having a calm and sensible discussion will help resolve it.

I have met people who claim that they have sex 3-4 times a day, and others who say they have sex once a month with their partners. Don't try to emulate what others do, only do what is right for you. Sex can be as wonderful or as dull as you and your partner wish to make it, but again it never need be the only important aspect of you life.

Finally, whenever any relationship doesn't work out, try to think this... it's clearing the way for a better relationship that will work. By learning what we don't want or like, we also learn what we do. It's worth a certain amount of risk to keep trying albeit with due caution. Above all never get heavily involved with anyone who does not respect or acknowledge you and your worth. Stay safe.