Teens, suicide, self-harm and depression (BBC article 30.11.15)

'I was disconnected from everyone'
http://www.bbc.co.uk/news/health-34944454
BBC Melbourne 30.11.15 

An article focussing on teens from around the world fighting self harm and depression  with some alarming statistics about young suicide.

ITV Central News report on the Bradgate Mental Health Unit (26.11.15)

Bradgate Mental Health Unit (Possible) Ward Closure
Featuring myself and J.
Home recording with ipad (apologies for breathing sound)
ITV Central News (UK)
Aired: 26th November 2015 6.00 PM

Acute care ward closure at Leicestershire’s Bradgate Mental Health Unit - own thoughts

After being told by an ITV reporter, who had seen my tweets, that Leics NHS Partnership Trust was planning to close yet another mental health ward, I typed out the following thoughts.  J and I were also interviewed by the same reporter, more on this shortly.

(Not organised in any particular order, also these thoughts are influenced by earlier negative experiences with the wards, Crisis Team and the Community Mental Health Team)

The Leics Partnership NHS Trust is an organisation unfit for purpose, but they still have duty of care, they still have a basic role in providing essential care to mental health inpatients and outpatients.

A bed on an acute ward can be used fifty to hundred times a year for short term stays. Multiply that by the number of beds on a ward, 18 to 20, and that’s the number of very vulnerable people who will be put at risk, when they might have otherwise been helped. (Note, some of those will be readmitted several times a year bringing the number of total individuals down, but not admissions)

The LPT have a basic remit to keep unwell people safe and often they not able to do that.

There is no equivalent to acute care beds in the community. Hospitals and specialist units are the only places that an unwell person can be legally kept behind a locked door and their medication reviewed by a qualified psychiatrist.

Some of the wards at the Bradgate Unit are not fit for purpose and have probably been criticised (perhaps by Care Quality Commission regarding H&S), but to just shut wards instead of improving them is just walking away from the problem and creating more problems.

It’s neglect. The same offhand an short-sighted neglect which has allowed inpatients and outpatients to die (Google “Bradgate Unit death” and read the news articles). Usually we only learn a year later, when inquests have occurred. They think we don’t know. They probably hope we don’t read newspapers.

If it’s about funding, why aren't the managers pushing back against the funders? Why are they just treating this as a matter of course, is it just cold, basic, economics?

Ask anyone in the Trust, or anyone who has been on a ward recently, how they could save money and they will make suggestions. For starters, any manager should know not to waste money by continuously hiring round the clock bank and temporary staff, as well as the many locum doctors. They say this isn’t the case, when it clearly still is. Despite criticism, year after year, they are still sending patients out of county, we know this because we’ve talked to one very recently. They knock down and build new buildings and yet can’t fix leaks, which put whole areas out of commission for days (this happened at the end of last year, and we saw outstanding repairs and leaks this last Spring as well).  They built a pharmacy near the unit, but it still takes five hours for patients to receive take-home medications even when they have been prepared hours earlier (we have seen this first hand, again poor management of staff, in this case, porters and poor communication with wards).

Maybe it’s a dysfunctional organisation. Communication on the wards alone is poor, as is communication between the different teams, with the CMHT and GPs being the last to know what is happening.  Our letters and phone calls take months to be returned, with or without the help of Customer Services” (who have been renamed yet again, for the sake of inconsistency, I suspect).

In terms of support in the community, they can’t even provide a consistent out of hours phone line, something again the CQC requested (ongoing problems with this, complaints made).

This organisation is the shame of the county, it is just a matter of time before they become known nationally as a scandalous Trust. By closing wards (this isn’t the first) and shutting services down, or outsourcing them to the less qualified voluntary sector, they are absolving themselves of the responsibility of the tax paid role of looking after the most vulnerable mental health sufferers in the county. Maybe the decision makers worry more about lawsuits than lives?

The Crisis Teams are already overworked and jaded, and when there are a minimum of beds available they make outpatients feel bad for asking for help.  As if it's not difficult enough to ask for help when you suffer mentally.

What do we tell the paramedics, the policeman and the A&E staff who deliver the patients who are a danger to themselves, sometimes under Section (136), only to find later that they have been sent home? How will they be affected my these changes?

For an outpatient, two chats a year with a consultant in the community, and maybe the slim chance of being assigned a CPN, cannot replace the safety of an acute ward bed, even if it’s not long term. No amount of talking therapy can help a person in psychosis, someone who's meds need monitoring, or someone wanting to kill themselves.

The actual care and recuperative therapy within the Bradgate Unit’s wards is already extremely poor, but at least they have some experience treating patients, they have a pharmacy, and locked doors, which prevent patients leaving when they are unwell.

Don’t they also have a responsibility to other counties who also ring around the country when don’t have enough beds? 

(November 2015)

Osbourne - spending review - mental health

"More crisis care" - good! (Although, I'm not totally convinced that the money will get through)
"access to talking therapies" - not good if he means 6 weeks of CBT for all, especially when people need proper recovering focussed therapy and ongoing support (when recovering is not always possible).

More "access to talking therapies" for #MentalHealth patients - Chancellor #SpendingReview https://t.co/34YPjzWUep https://t.co/Edj22cee8r

— BBC News (UK) (@BBCNews) November 25, 2015

International Suicidal Caveman Day

I'm fascinated by "International Men's Day" and the sudden awareness of high male suicide rates.  From what little bits I've read here and there, suicidal thoughts and planning is not a gender issue, or at least shouldn't be.  My head is a jumble of stats and myth, with a jaded voice from the past telling me that women attempt suicide more but fortunately survive(!?), but men tend to kill themselves in much more dramatic and thus fatal ways.  But I'm not sure I want to believe that any more, since the context in which stats are recorded are subjective (depending upon the prejudices of the professionals involved), especially when it comes to self destructive acts. 

I worked at a mental health drop-in where the members were mainly male, and most of them were blessed with the ability to discuss their feelings.  They were self-identifying as sufferers by attending the drop-in, so I guess the taboo was lessened when it came to talking about fears and feelings, or even emoting in public.  Suicide is still a massive taboo, even amongst professionals, who seem to be without the language skills to even negotiate or explore and defer the simplest of suicidal planning.  

The main message I'm getting from International Men's Day is that men are emotionally stunted cavemen.  Is there really solid evidence that a death rate, in some cases, higher than cancer, could be reduced by men talking things over with a cup of tea?  (But we must do something! we cry)  I knew suicidal men who weren't getting crisis help because they were told their personality disorders were "untreatable".  Again, I must stress that the existing services generally fail in a crisis, at best scaring or isolating a person. The professionals J and I have met seem even more baffled by ongoing suicidal feelings.

It's so disappointing that we are all still at the "awareness" campaign stage, when so many people "talk" and scream for help, and at the very best there might be a volunteer on a phone line to talk to.

Happy International Don't-do-it-for-the-sake-of-beer-and-football Day.

BBC News: Mental health cuts 'put lives at risk' - King's Fund Report 12th November 2015

Today...
Mental health cuts 'put lives at risk'
http://www.bbc.co.uk/news/health-34790094
BBC News Health 12.11.2015

(Own thoughts: I'm really glad to see someone is joining up the dots to create a national picture here.)


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Luciana Berger: ‘We have a mental health crisis as the system only focuses on crisis’
http://www.theguardian.com/society/2015/nov/04/luciana-berger-mental-health-crisis-minister
The Guardian 4.11.15

(Own thoughts: In some ways I found this difficult to read, because years of cynicism from services reductions makes me think of twisted economics leading policy makers to take away crisis services in favour of early intervention. I'm sure that’s not the point Luciana Berger is making, because we will always need both the early services and crisis services, in the same way that we will always need first aid kits and A&E.)

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Government welfare advisor did not know about 2010 suicide 'triggered by work assessment'
http://www.itv.com/news/2015-11-09/government-welfare-advisor-did-not-know-about-2010-suicide-triggered-by-work-assessment/
ITV News 9.11.15

Crisis helpline problems

I’ve just lost most of Monday trying to help a very distressed and exhausted J, whilst working out why the crisis help line she is told to call didn’t even have a working answer-phone message. 

The Richmond Fellowship won a contract to provide out-of-hours mental health talking support for outpatients of the Leicestershire Partnership NHS Trust.  Recently the Care Quality Commission slammed the Trust for not providing such a service at night and at the weekends when the Community Mental Health Teams are closed.  We have had a lot of confusion about the exact hours this line is “open” and whether or not this means you get through to a human being, and /or if you leave a message a person will call you back.  Apparently last night when my (suicidal) partner (I am also her “carer” but we live in separate houses) called the line, she was met with an automated message along the lines of “Ext number ## is not working, please leave message after the tone.” Ringing twice to check the number was right, she left a message (sometime after 4 am).  No-one called her back.  These lines are also essential in terms of taking pressure off the 111, 999 and A&E services, as well as possibly talking suicidal people into staying alive for one more night.  This is the latest in a series of problems relating only to the helpline.

Emails have been sent. Complaints procedures triggered.

The Guardian "Having borderline personality disorder helps me in my NHS job" 26 Oct 2015

Having borderline personality disorder helps me in my NHS job

http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2015/oct/26/borderline-personality-disorder-helps-job-nhs

The Guardian newspaper / website.  Anon. 26/10/15