Why I am unable to work

Anxiety makes it difficult for me to perform simple tasks. It is happening now because I am worried about the letter. I am finding it difficult to focus and concentrate, which in a work environment are key skills. When I am at home writing blogs or doing research I am able to stop and watch tv or go for a nap. I am able to switch off. This is not an option in a busy office.

 


2 hours later

The television has worked its magic. My mind is clear and my thoughts unjumbled. My creative juices are flowing again.

I have resolved not to edit the first paragraph as it was written in a moment where I was not at my best. I want it to stand as a reminder of what I am able to achieve. Reading it now, it’s not too bad. It is coherent and grammatically correct, but what is different is the feeling inside. It is difficult to explain. It is the like the difference between sailing on rough seas and sailing in calm waters. In rough seas you manage, you survive. You do what is necessary to bring you to shore but it is a constant battle between the elements and your own inner strength. In calm waters the boat practically steers itself. There is very little effort involved and the journey is filled with joy. (Ha, now I’m starting to worry about my sailing analogy.  But this worry is not like earlier, it is just a momentary thought rather than the all encompassing anguish of two hours ago.)

And this is the reason why I am unable to work. Yes, I can survive the rough seas and the work I produce during those times is acceptable. But the toll it takes on my mind and my body builds up over time until there is nothing left. I start to drown. This is a process which is endlessly repeated. The drowning man comes back to life and lives again. But inevitably the rough sees return, the boat sinks….

I worked for over 20 years. I don’t recall the total amount of weeks and months I spent at home, ill with depression. And the times I worked from home because I couldn’t face going in. At home I did actually work, but I was able to pace myself a little more effectively. At home it didn’t matter if I was still in my pyjamas and if I needed a couple of hours to revitalise myself I would make up for it in the evenings. This would have been a perfect solution but my job was office based – meetings had been scheduled, help from colleagues was needed, documents needed to be printed and signed. There was always a reason for me being there.

The letter I received from the Job Centre, the reason for my anxiety, tells me that one of my benefits will end in February. I will still have my PIP, but my income is being cut by about 50%. I have savings, I own my own home, I am nowhere near destitute. My family will step in if need be. So what am I worrying about? Are my concerns justified?

I don’t think I really know. At times I am able to accept the situation, it is the way of the world, it is as it should be. Then there are times when I feel a sense of injustice. Earlier today these contrary thoughts were raging simultaneously in my head. This is the curse of being able to see things from other peoples perspectives. It leaves me confused and lost.

My solution is to see if I am eligible for other benefits. This might help in the short term. The long term solution is less clear. I do not feel ready to return to work. The idea horrifies me. It isn’t that I can’t apply myself, I am able to do “work” on behalf of CMHS.  But the key point is that CMHS is my hobby. I choose when and how I devote my time to it. If there is a job out there that allows you to do as you wish and turn up whenever it is convenient, I’ll take it. Sadly I think that the person paying my wages would want a little more from me.

Citizens Advice has a page with information on benefits which may help if you are in a similar situation: www.citizensadvice.org.uk/benefits/

I enjoyed Christmas Day. Is that wrong?

My mother died in January. This was the first Christmas without her. And I enjoyed myself. I felt a wee bit guilty afterwards, so this article can be my self therapy. A way to tell myself that I am allowed to have fun.

Since my mother’s death I have found out a lot about myself and my family. I am accepting the fact that as children my sister and I lived in an atmosphere of control which continues to influence our lives. Together we are working through our past to understand our thoughts and behaviours and to change them. We are making progress.

This could not have happened, for me anyway, whilst my mother was alive. I remember that whenever I met a new therapist or psychiatrist I would be asked about my parents. My response was always that my family life was a loving and happy one. The only concession I would make would be to say that my parents were a little overprotective, but under the circumstances it was understandable. End of conversation.

And I believed it.

Until my mother died. By this time I had already repaired the fractured relationship with my sister. We had spoken about our childhood and things which had been said and done, and though my brain believed, understood and agreed, my heart always sided with my mother. I found excuses for her behaviour, but towards the end of her life these excuses were more difficult to hold on to.

My childhood beliefs, put there by my parents and which I am beginning to challenge, include:

Only perfect is good enough (and even then there’s something slightly wrong and it isn’t perfect after all)

There is only one way to do things, anything else is wrong

I am different

I am not important

I am not capable – of anything

I am responsible for other people (their feelings, behaviour, words, everything)

I am not likeable/loveable

I am not allowed to tell people my problems, because they won’t be interested/won’t want to be my friend

There are more, but you get the picture.

This is how Christmas used to be. A few weeks before Christmas my mother would tell me that I was invited to my sister’s for Christmas. My sister and I were estranged and communicated through my mother. I would send my acceptance in the same way.

Christmas Day would be, not awful, but moments of joy interspersed with moments of awkwardness and anxiety. And thoughts of “when can we go home?”. Drinking didn’t help me either. I would be on my best behaviour, a don’t show myself up in front of the family mindset. My alcoholic brain would be saying more, more, I need more. My anxious side was agreeing with this sentiment, get drunk so that nothing will matter any more. But I was fighting these feelings and trying to moderate my alcohol intake – it’s too soon to have another glass of wine, it’s not polite. It will look bad, mum will get upset. It was uncomfortable. And since my sobriety everything was the same except for the alcohol battle. This was replaced with trips to the garden to smoke. Which were similarly disapproved of. I still felt shameful.

This year was different. My sister and I discussed the arrangements together. I offered to supply the crackers and the chocolates. We agreed that Dad and I would get a taxi to her house and back home again. Which I arranged. (My dad’s driving is his lifeline, but I know that he struggles with it, even if he doesn’t acknowledge this himself). This also made things easier for my sister. She was concerned about having the family over and all the stresses that entails for her, so having a fixed time for us to leave made her feel more comfortable.

Christmas Eve was a late night for me. I was up till 2am finishing presents. Christmas morning I dragged myself out of bed, had a shower (I couldn’t justify not doing so, however hard I tried) and got ready. I was at my fathers house half an hour before the taxi was due. The taxi arrived early and the driver helped me load the presents in the boot. Once dad was ready we set off. And the taxi driver was so lovely. He was helpful and he knew where he was going and how to get there (believe me, this isn’t always the case). He also helped with the presents at our destination.

A little side note here. My father is hard of hearing. One to one conversations are generally not too bad, although if he can’t understand what I’m saying he sometimes says random things like “why are you talking about bananas?”. I wasn’t. In a group of people he finds it even harder to follow the conversation. He has a hearing aid for each ear, but doesn’t like to wear them because he says that the background noise is annoying. I could have suggested that he take his hearing aids, but based on previous experience this would most likely have produced an annoyed grumble which could have spoiled the whole day. So I didn’t, and the result was that he didn’t interact with us much. I feel a bit bad about this but he knows where they are and is capable of making his own decisions…..?

Where was I? Oh yes, at my sister’s house. The day was lovely because everybody was relaxed and happy. There was no tension, no doing what is expected of you. It was perfect because we weren’t trying to make it perfect.

Everyone helped my sister with the cooking (this is not normal) and my sister enjoyed her dinner (I don’t remember this happening before). And the best bit? The crackers. Inside each cracker was a wind up Santa. There was a board with starting positions and the aim was to release all the wound up Santas at the same time and see which one reached the North Pole first. It was hilarious!! Some of the Santas went everywhere but the North Pole, and the ones that did reach their destination carried on walking away from it. My sister and I were laughing hysterically.

 

If someone else were to tell me that they were worried because they had enjoyed their first Christmas after the loss of a loved one, I would say, “but you are allowed to enjoy yourself. It doesn’t mean that you are not sorry your loved one is not there”. Telling this to myself is hard. I know it is true but I have trouble believing it in my heart.

One day……

 

 

Why is my face a strange colour?

Hello.

Last night I noticed something about myself which intrigued me and I want to share my discovery. I have to warn you that the contents of this piece are quite dark and possibly a little disturbing.

My therapist spent years trying to get me to recognise my thoughts and emotions. When I first started seeing her I could tell her that I wasn’t feeling good, but I couldn’t tell her exactly how I felt or why. I can now recognise thoughts and feelings most of the time. Sometimes I am able to do this by myself and sometimes it takes a conversation with another person. This for me is a huge step forward.

I have now been able to identify 2 different states.

The first is where I am reacting to an event. An example of this happened a few days ago. I was feeling low but had arranged to go to the cinema with my sister. We watched the film (Paddington 2) which was funny and wonderful and sad and just plain brilliant. I was happy. Then my sister told me about a letter she had received, had I received one too, what did I think? My first thought was along the lines of “oh, it’s all my fault, what have I done?”. Over the next few minutes as my brain went into overdrive my demeanour changed to confused and scared. This is what is called catastrophising. My sister helped me to identify my feelings and after about an hour I was calmer.

The second state is what happened last night. And this is what is particularly troubling me.

During the day I had been feeling ok. I can’t say normal, because I don’t think I have a normal. But there were no overwhelming emotions, I don’t remember feeling particularly anxious. I was getting on with my day. But when I caught myself in the mirror my face looked a little scary. It is something I have seen before. My cheeks look sunken and my skin looks blue, especially around the cheekbones. My mother sometimes used to comment on my looking grey. Which I found particularly annoying because I would be feeling fine. Sometimes when she said this I was actually feeling quite alive and happy.

So yesterday I found that my face looked unwell but my mood didn’t reflect this.

Then in the evening I experienced an overwhelming sadness. It appeared to come from nowhere. And it was extreme.  It was after the feeling of desperation had overtaken me that I started to think sad thoughts. It was as if my brain said to itself, you’re feeling sad for no reason so I had better give you a reason. Which is weird, but I swear it is how it seemed to happen.

I felt as if I couldn’t live anymore. Life was too painful. For me, this happens frequently. Sometimes I feel driven to harm myself. Over the last few months (since February) I have succeeded in not acting on these thoughts. But last night I didn’t want to do anything, there was no urge. I just wanted to not be.

I managed to sit with these thoughts and feelings raging through me. It felt as if they were controlling me instead of me controlling them. I felt powerless and desperate and….. it is difficult to explain exactly how I felt.

I managed to distract myself and begin to calm down a little. It was when I was calm that my body temperature dropped. I was so cold. This often happens after an episode.

I feel the need to exhaust myself when I have had this type of experience. This involves staying awake for far too long, till I’m nearly dropping with tiredness. If I’m not completely exhausted by the time I go to bed the thoughts come back and I start sobbing uncontrollably all over again. Finally, I fell asleep. This exhausted sleep is never restful. It is filled with strange, troubling dreams and I awake hours later nearly as exhausted as I was when I fell asleep. Then I have a day of feeling numb and lifeless. Another spell in bed is often necessary, but this too can sometimes be overshadowed by strange dreams.

My question is, is this a phenomenon that other people experience? Having a strange coloured face and feeling sad for no apparent reason? Or is this an extension of not being able to recognise the thoughts that go through my head? Are they locked away so deep within my unconscious that I don’t know they’re there? Or is it some sort of chemical imbalance?

Yes, I know, that’s a lot of questions!

 

 

Me, Work and Mental Illness

BBC article – How mental health costs up to 300,000 jobs a year

I tried to do some research of my own, this proved quite difficult. So here is a report I found which had already done it for me! thriving-at-work-stevenson-farmer-review.pdf

This report mentions Aviva as having a support strategy in place. I would also like to add Unilever to that list.

My work life is littered with breakdowns, sackings and extremes of brilliance versus ineptitude. I realise that by posting this publicly I am shooting myself in the foot if I ever decide to go back to work, as my official CV glosses over the real reasons for changing jobs. But isn’t that just a reflection of the fear and stigma of owning up to being mentally unwell, and shouldn’t this be challenged?

After leaving school I went to college. I wanted to work with children and started a Nursery Nursing Examinations Board course. This involved spending a term at a local Primary pre School for the 4-5 year olds. I was an assistant to the teachers and got involved in the daily lives of the children. I loved it. But it didn’t like me. It involved a lot of creativity – having to plan and help with art projects. I love art but looking at it and trying to create it are not the same thing. Also, I wasn’t eating properly. I think at that time breakfast didn’t happen, lunch was an apple, and dinner was the least I could get away with eating in front of my parents. I don’t know why everything went wrong but it was probably something to do with the lack of food exacerbating my depression which combined to affect my concentration and performance.

So I found a job. It was local and my mother would drop me off in the car on her way to work. I was eating even less at this point and I remember one morning when I really didn’t want to go to work. Mum dropped me off, I waved goodbye to her and as soon as she was out of sight I went for a very long walk. There was no phone call from me to say that I wasn’t going in because at that time I didn’t understand what was happening and my eating disorder made it normal for me to hide the truth. The company I worked for put up with me for a year or two, but poor performance eventually lead to my dismissal. This is probably a direct result of weighing about 6 stone and being depressed. My brain was unable to function properly and I had memory problems and made frequent mistakes.

Then my mum got me a job at the company she worked for. She had worked there ever since I was 4 or 5 and I had visited her at work a few times during the school holidays. I already knew some of the people who worked there. They needed holiday cover for about 6 months. I was there 5 years. This was a job I excelled at, but I made it very difficult for myself. My drinking and sexuality “flourished” in this period. I was working in a family run business which employed about 100 people, 85% of them men. I knew everybody who worked there and they all knew me. Some better than others if you get my drift. Christmas parties were all day drinkfests until the pubs wouldn’t accommodate us any more. Then we just caused havoc in a local football club instead. I have memories of anxiety and over confidence at this time. To get to the ladies loo you had to walk through the shop floor. Sometimes this caused me huge anxiety. But at the same time I was flirting and bantering with everyone. One of my contradictory phases I think.

Possibly because of my mum’s relationships with the directors of the company, my absences due to depression and hospitalisation weren’t an issue. Until I got a new boss. I don’t entirely understand this, but I didn’t like my new boss. I’m usually a very easygoing, accepting person, someone who is not quick to judge. But there was something about this woman who rubbed me up the wrong way from the start. Then I needed time off for medical reasons. Whenever you were absent from work due to sickness you had to complete a form stating the medical reason for your absence. I didn’t want people to know, so I decided to ask for a day’s holiday. I thought that no one would ask questions that way. But my boss refused to let me take holiday that day and I didn’t understand why. I can’t remember how it got resolved, but I attended my medical appointment on a Friday and was back to work on Monday. I probably shouldn’t have been because I remember being in pain until the following day, but I soldiered on.

On the Wednesday I felt a lot better. And that is the day I had a huge argument with my boss. I had gone ahead with something without allowing her to check it first (maybe this was what troubled me about her, she didn’t trust me to be able to do things on my own?). I flipped massively. I made a huge fuss and said I didn’t want to work with her and I left. There and then, I went for a walk to calm myself (didn’t work).

I got myself another job. There was a similar pattern of mostly good work interspersed with weird, inept moments. A similar pattern of depression and drinking. I was made redundant, which I think is the only true reason for leaving on my CV. Another job followed, this time in the film industry. I was working in a support service in a film studio complex and loved it. I got an insight in to the world of film and we visited a couple of film sets. The team I worked with was small and very supportive. It was like a little family. Then one of my clients head hunted me. This was my opportunity to combine work and pleasure and get paid huge amounts of money. The film industry then was a closed, uncertain, stressful world. It was mostly about who you knew, and each project lasted a matter of months. I don’t think I thought about the between projects moments. My first film job was for a BBC production. I got on well with my new boss and we went on set a couple of times. I met the cast and crew. I was working hard but having a great time. Then we moved on to a Hollywood film which was being shot on location in England. I joined at the pre-production stage. The work was manageable to start with, but as the production moved forward I was asked to do more and more. I was under quite a lot of pressure and responsibility. I would start at 8am (I still don’t know how I did this, as getting out of bed in the morning is not one of strong points) and a 12 hour day was the norm. Then I would go home, get drunk, go to sleep and turn up at 8am the next day.

Then one Wednesday I arrived at my desk and burst in to tears. The pile of paperwork had grown overnight and I crumbled. Massively and publicly. The nature of the industry being driven by time schedules and money, there wasn’t the option for me to take a couple of weeks to recover, so that was the end of my dream job.

It hit me hard. I remember feeling broken for months. I would stare in to space for hours, I had the shakes and I felt constantly nauseous. I withdrew into myself and communication was difficult.

I was conscious that I needed to work. I had just moved house and bills needed to be paid. I had lived for a while on my savings, but knew they wouldn’t last for ever. So I got another job. It lasted a week. I wasn’t really ready to go back to work. I remember not really knowing what to do. I would look at the paperwork in front of me and it just looked like gobbledygook. Sacked again. Then I started temping. This was easier. Every couple of weeks I would have a new challenge and I was never in one place long enough to allow them to see my true self. I worked, got praised and moved on.

So now we come to Unilever. It started as another temporary role. I stayed 10 years. I think I was made permanent after about a month.

William Hesketh Lever started a soap factory in Warrington in the late 1880s. He was a forward thinking employer, he built a small village for his workers and was interested in their welfare. Now a multi national company, its emphasis on employee welfare has continued.

We had an on site nurse. Once a month I had to work in a small room with a very noisy, temperamental machine. We were given earplugs and all trooped down to the nurse for a hearing test. I became a regular visitor, but for other reasons.

I don’t remember exactly how my visits to the nurse started, I think I was told to go and see her. There was a redundancy scare. I reacted badly and found myself becoming ill and taking more and more time off. The nurse referred me to the company Doctor, who I also got to know quite well, and I was also referred for Cognitive Behaviour Therapy. All of these appointments were office based, I’d just go downstairs to the Occupational Health Department and then go straight back to work. I think this is the best thing that had ever happened to me. Over the years I had seen various counsellors, psychotherapists and psychiatrists, but it was sporadic. I would decide that I didn’t want to see them any more because it was too upsetting and I would be tearful and low for a few days.

But with Unilever it was different. Some of the sessions were still quite painful, but I had developed positive relationships with the whole team. I don’t know why this worked when everything else hadn’t, perhaps it was the support network and the understanding of my line managers. Maybe the ease of access had something to do with it.

I was also encouraged to use my private healthcare for psychiatry treatment. I had a whole team of people helping me to understand myself and create a way of living that worked for me. And at the same time I was working hard and creating a good impression. My psychiatrist decided that I had an alcohol problem. I don’t know how he reached this conclusion because I don’t remember ever discussing my alcohol intake with him. He suggested I go for treatment. No thanks.

But the idea stayed with me. I carried on drinking and after a series of alcohol related injuries I decided that perhaps I did have a problem after all. My psychiatrist arranged for me to be a patient at a well renowned private hospital and Unilever backed me all the way. In the end I was in hospital for 5 weeks and Unilever agreed to fund me through private healthcare for the extra week. Then there was about a month where I was on day release, a few days at hospital as an outpatient with a staggered return to work.

That was 2008 and they got 5 more years out of me. In that time I continued with CBT, continued with private psychiatry and continued to be supported and understood at work. My colleagues accepted me for what I was. Having been a party animal one minute and then coming back to work sober was hard to ignore. And my absences for medical appointments together with some of my mood swings and physical appearance were all too apparent. But I was accepted and supported by everybody. Even new colleagues who weren’t aware of my history were aware that I suffered from depression, but it never held me back in the workplace.

Then in 2013 a family event triggered an attack of anxiety. Taking time off work for my depression/bipolar/Borderline Personality Disorder (diagnoses changed from time to time) was nothing new. But this was different. I was unable to contemplate ever going back to work, and a couple of weeks became a couple of months, became a year. All this time Unilever were supporting me, for a lot of the time they were still paying me, and we had regular meetings to try to find a way to get me back to work. They never gave up on me. But I made a decision. I was feeling guilty that they were putting all this effort in for me and I was still feeling scared about the prospect of returning to work. So I was honest with them and the result was termination of employment on mutual grounds.

So now, here I am today. I still have no desire to work, I don’t think I could. Yes, I have moments of productivity, but they are interspersed with naps during the day and periods of low mood. I am able to be productive at my own pace. There are no deadlines or responsibilities and the only pressure is that which I inflict upon myself. This piece has evolved over 2 days. Yesterday was particularly difficult as there were a few moments of emotional overload. And I’m thinking that maybe once this has been published I might go for a little nap. I get drained quite quickly.

Writing this has shown me that a supportive work environment makes a huge difference. It didn’t cure my depression but it provided me with the tools to be able to cope. People with mental illness are driven, creative people. They just need an environment where they are allowed to flourish.


If you would like your employer to create a supportive workplace, here are some tools to help you convince them to sign the Time to Change Employer Pledge.

Health Committee One-off session with the Secretary of State

Link to video of debate

Yesterday the Health Committee met with the Secretary of State, Jeremy Hunt. I watched the broadcast and made comments on the Facebook page about my initial impressions. Here you will find a summary of the items related to mental health. It is not intended to be a word for word account but I have attempted to keep the context of the questions and responses. There are a few links in this piece to documents of interest.

To start, below are the members of the committee:

Health Committee

Dr Sarah Wollaston was elected as Chair of the Health Committee on Wednesday 12 July 2017.

The remaining members of the Committee were formally appointed on Monday 11 September 2017.

Member Party
Dr Sarah Wollaston (Chair) Conservative
Luciana Berger Labour (Co-op)
Mr Ben Bradshaw Labour
Dr Lisa Cameron Scottish National Party
Rosie Cooper Labour
Dr Caroline Johnson Conservative
Diana Johnson Labour
Johnny Mercer Conservative
Andrew Selous Conservative
Maggie Throup Conservative
Dr Paul Williams Labour

Overall I found it to be an interesting and constructive meeting. I sensed a few areas where Jeremy Hunt seemed uncomfortable and defensive, but I generally got quite a good impression of him.

To help with some of the acronyms used:

JH = Jeremy Hunt

CQC = Care Quality Commission

CCG = Clinical Commissioning Group

NICE = National Institute for Health and Care Excellence

The mental health questions start about an hour into the video:

Questions from Luciana Berger

Luciana Berger
Luciana Berger

Q According to NHS Workforce statistics there are 5,168 fewer Mental Health nurses and 106 more doctors. In a recent interview JH quoted 4,000 more people.

Response

There are 4,300 more people working in NHS Trusts than 2010 and 2,700 people in Talking Therapies

Q Who are these people?

Response

There is a whole range of skill sets involved in an NHS Mental Health Trust. The reduction of nursing staff is a consequence of the Francis inquiry into Mid Staffs. Nurses were put in to hospitals which had a direct impact on mental health nursing. But the NHS are treating 120,000 more people every year than 3 years ago which equals 1,400 more every day. There has also been an expansion in therapies.

{Later on in the meeting the Chair requested details about the extra mental health staff and the talking therapies}

Q Why are we seeing an increase in children and adults presenting at A&E in mental health crisis. There is a 47% increase in people being detained under the Mental Health Act

Response

Professor Sir Simon Wessely has been asked to review the Mental Health Act, how it works and whether it needs to be changed. {A copy of the details of the independent review can be found here.}

The Health and Social Care Act 2012 legislation regarding Parity of Esteem between physical and mental health requires that a mental health crisis is dealt with as seriously and quickly as that of a physical health crisis. The NHS are rolling out crisis care including liaison psychiatry across the country. Currently half of the total A&E departments have mental health liaison services. This is part of the Core 24 Standards.

Q Why are so many people are turning up to A&E in crisis who are often having to be detained, instead of being dealt with prior to this through prevention or community services

Response

There is a core responsibility to deal with both crisis and prevention. Resources are being put in to place to deal with preventing crisis

Q CQC reports have highlighted many issues at all stages of accessing mental health care. In regard to resources JH has been quoted as saying that there has been an increase in resources by spending over half a billion pounds more on mental health this year. Why is it that many trusts, including Liverpool, are cutting mental health services

Response

Mental health spending is up 1.4 billion in the last 3 years. Last year out of 209 CCGs 177 spent their mental health target and 32 did not. There are discussions going on with those that did not. The overall impact was that an extra half a billion pounds was spent last year.

Q Money comes in to the trust but there is nothing to hold them to account to make sure it reaches the front line. There is not a requirement for every CCG to meet the required investment.

Response

Last years CCG funding went up. There are ongoing discussions to sort out issues. There has been overall expansions but there are still problems.

Q Locked mental health rehabilitation wards. There are 3,500 patients across the country in 248 wards. The majority are in private hospitals. The CQC report has questioned this model of care

Response

There is a concern about people being locked away in expensive high dependency settings for longer than necessary. If they are far from home they may be forgotten about. JH has had a meeting with officials who are coming up with a recommendation. As an example of good practice, JH quoted that Sheffield have eliminated their dependency on locked rehabilitation by providing better community care.

Questions from Dr Lisa Cameron

Dr Lisa Cameron
Dr Lisa Cameron

Pathway of care from child to adult services. The transition is often fragmented and difficult to streamline. Are you making progress?

Response

This is an area we need to improve. We have a children and young people mental health Green Paper coming out.

Q Access to psychological therapies. How are you monitoring time logged as being access to treatment?

Response

The target is for treatment to start within 18 weeks. This has just started to be measured. Demand is increasing and there is also the implementation of the Mental Health Forward View.

Q Target monitoring and parity of definition

Response

JH will write a detailed response

Q Mental Health in older adults. In the transition from health to social care it is important that psychological issues are addressed. Especially around depression and loneliness in older adults,

Response

This is an important issue which is not always given the importance it deserves. 40% of older people in care homes suffer from depression or anxiety compared to 20% of the older population as a whole. Sometimes mental health needs are clouded by physical health needs. The NHS are planning an expansion in the capacity of psychological therapies in order to meet these needs.

Questions from Dr Paul Williams

Dr Paul Williams
Dr Paul Williams

Q Waiting times for Autism diagnosis in children. NICE guidelines state that a multi agency assessment of a child with suspected Autism should start within 3 months. In some parts of the country families are waiting for up to 4 years. Will you consider a Waiting Time Target for Autism assessment. Diagnosis requires health services to work in partnership with Local Authorities. What can be done.

Response

We need to do better. JH will look in to this and will discuss the issues with the NHS

Follow up question from Dr Lisa Cameron

Q Do you have a map of how many clinicians are trained to diagnose autism and where there are gaps?

Response

JH will find out


The next item to be shown on Parliament TV that I am interested in is on 3 November 2017 when the second reading of the Mental Health Units (Use of Force) Bill will be presented in the House of Commons.
A video link will be available on our Facebook page from 9.25 am.

 

 

 

Report of the House of Lords Committee on the Long-term Sustainability of the NHS 24 October 2017

Committee Video

As promised, here is a summary of the Long Term Sustainability of the NHS committee meeting.

Having only ever seen Prime Ministers Questions on the news, the prospect of watching a debate was not very appealing. The idea of watching people talking over each other and cajoling and being unruly isn’t my idea of fun, but I actually enjoyed watching most of it (there was a point where my attention wandered and I wasn’t following everything they were saying). The committee was made up of health professionals who were either current or previous NHS employees as well as GPs and surgeons. There were also members of the House of Lords who had medical connections. They were all very agreeable, listened to each other and actually answered questions appropriately!

Here is the background to the report.

The meeting lasted about 2 hours and I have summarised the points I found interesting and relevant. The timings I have used are approximate as I was stopping and starting the footage to write notes.

14.35 – Summary of report

The authors of the report summarised their findings by saying that all sectors of the NHS worked in a culture where only the short-term was considered – a sort of fire fighting the immediate problems. The only long-term thinking is the 5 Year Forward Plan. Here is a link to a document about the plan. Health Education England were attempting to plan longer term but were thwarted by clashes with other ministerial objectives.

The recommendation was that the 5 year plan was not sufficient.

The Government have not yet responded to the report. The reasons given were that the Election got in the way and there was an email from the Department of Health saying that a response will be given after the Budget.

 

14.40

They discussed the recommendation to set up an Office for Health and Care Sustainability which would look 15-20 years ahead. It would be an Independent Advisory Body which would produce evidence in data form. As this would be an independent body the public would have more confidence in its findings. The lack of long-term planning was partially because Health Ministers change quite frequently and therefore do not have the motivation to think to the future. Therefore an independent agency would be more effective as it would be non political. The body would focus on:

  1. Demographic population changes which might affect health
  2. Requirement for workforce planning
  3. Prevention

14.50

They discussed forward thinking about workforce needs. Regarding the length of time it takes to train doctors and nurses it was deemed necessary to plan ahead for what sort of skills would be needed in the future.

14.55

They discussed the role of GPs, the need for integration between Primary, Secondary and Social care and the need for change in working practices.

15.13

Current Regulation is a barrier to workforce reform and workforce planning. They discussed the need for existing staff to receive on the job training to keep up with new ideas and practices.

This part surprised me as I know a Physiotherapist who works in the Private sector. She goes for regular retraining sessions which I believe is a requirement for membership of the society.

15.17

A question was asked about the effect of Brexit on staffing levels. Figures were given about how many EU and non EU staff the NHS employs. It was agreed that the culture of relying on other countries to provide staff is wrong. An example was given that hiring staff from developing countries adversely affects their country of birth as it deprives them of medical staff which they desperately need.

Retention of staff, career structures and low morale amongst staff were also discussed and the report puts forward that these issues need to be addressed.

15.24

The training issue was broached again with two examples:

  1. A Mental Health nurse not being able to treat a wound
  2. A general nurse not being able to treat mental health patients

The conclusion was that the initial training of all staff should include basic training in disciplines other than those being specialised in

15.40 Funding

This is where I zoned out a bit, but I did understand that the current situation is that the funding of social care is with Local Government but Social Care Policy sits with the Department of Health. It was suggested that the two be brought together.

They also discussed a proposal for a Social Insurance system which would provide personal funding to be spent on social care when needed. Japan and Germany already have such a scheme in place.

16.20 Public health prevention

There is currently no central strategy for keeping people healthy. The UK is 2nd in the world league table for obesity behind the USA. It was noted that preventable diseases cost the health service a lot of money in care that could be used for other people

16.25

There was a brief discussion on a prevention strategy for mental health. It was noted that the idea that mental health being equal to physical health still had a long way to go.

The topic of Mental Health funding will be discussed on 21st November. 

16.33 Patient responsibility

The report also dealt with patient responsibility. This ties in with the area of prevention and it was deemed necessary that a mixture of Government Regulation and effective education could help to keep people healthier for longer.

I will watch out for any other items of interest, especially the Mental Health Funding discussion in November.

 

 

 

 

 

 

 

Shyness

I was incredibly shy as a child. But when I talk to strangers I have no problem communicating. This got me thinking. Does my childhood shyness have a link with my adult anxiety?

I found this article on shyness and I think I have come to the conclusion that shyness in a child could lead to problems in later life.

The article says that shyness can lead to:

  • Substance abuse
  • Damaging relationships
  • Difficulty attaining goals
  • Anxiety and depression

I can say yes to all of these.

I am a recovering alcoholic, have used drugs in the past, have a history of food disorders and can get easily addicted to just about anything, including writing blogs.

I have relationships with abusive people, people who are damaged in some way. I find relationships with “normal” steady, caring people difficult to maintain

I agree with the difficulty attaining goals issue, but only after having read the explanation. Withholding ideas and opinions and letting others take credit for any I might have is a definite yes. If I am congratulated on doing something well I will often offer up the fact that another person helped me and it was a joint effort. And I know I have anger issues. I know that I don’t always know how to express anger or annoyance and can sometimes appear to behave like a small child.

I can also agree with the causes of shyness:

  • A parent or guardian who is over critical
  • Over protective parenting
  • Traumatic life experiences

I had over protective, critical parents. I believe they were over protective because of my illness as a child (traumatic life event).

I mentioned in a previous blog that as a child I was instructed in what to do and say and what not to do and say. I was told I didn’t want things that I thought I wanted. It was all a bit confusing. But I have recently remembered something else. If I went to see a friend, when I got home my mother would ask all sorts of questions about the family and what they were up to. I could only ever answer “I don’t know, I didn’t ask”. It continued into adulthood. If I spoke to my mum and said that I had met a friend recently she would ask lots of questions. I had usually been talking about the things my friend and I were interested in so I was still unable to answer. I realise that this made me feel as if I had failed in some way. And I suppose that somewhere in my unconscious I was nervous about what I should say to people. Because I didn’t want to let my mum down but I invariably did.

In my anxiety blog I went in to detail about my childhood illness and the physical and emotional fallout that resulted. I believe this is why my parents were a little over protective. They would tell me that I couldn’t do things, I think, in the belief that it would shield me from disappointment. But this resulted in me believing that I couldn’t do anything and that I would be dependant on other people for the rest of my life.

This is not true. I can do things. Sometimes not very well, but I am able to look after myself and look after other people. I live on my own at the moment, and I’m not looking after myself properly, I’m not looking after my flat properly. But this is not because I can’t. It is because of my current state of mind which leaves me feeling anxious and unmotivated to do practical stuff like cleaning and eating. I have moments of activity, but just now I’m in “I can’t be bothered” mode. And this is ok. For me, now, I am doing the best I can and that is good enough. Anyone who tells me otherwise will soon know that they have said the wrong thing!

So what is the answer?

The trick is to try to determine if shyness is making life difficult. Children will not be able to tell us. Having been a shy child I know that I didn’t realise that anything was wrong, and even if I had, I would never have spoken up about it.

So the responsibility is with adults. Parents, teachers, friends’ parents, anyone who regularly comes into contact with a shy child can quietly monitor their progress. I would like there to be an atmosphere where one adult can say to another “I’m a little worried about your son/daughter” without the parent getting defensive or angry that someone has dared to criticise or judge.

Parents do not see how their child behaves at school or with their friends. Teachers do not see how the child behaves at home. Parents of the child’s friends may not be aware of shyness because the child is probably relaxed and “normal” when playing. So everybody has to talk to each other openly and honestly. Then maybe something can be done to try to prevent a shy child from developing problems in later life.

 

 

My research diary – The Citadel by AJ Cronin

20th October 2017

I’ve started reading the eBook I bought earlier. It is cited as being influential in the setting up of the NHS.

Published in 1937, I am hoping it will give me an insight to conditions before the 1940s. AJ Cronin knew what he was talking about:

“Born in Cardross, Scotland, A. J. Cronin studied at the University of Glasgow. In 1916 he served as a surgeon sub-lieutenant in the Royal Navy Volunteers Reserve, and at the war’s end he completed his medical studies and practiced in South Wales. He was later appointed to the Ministry of Mines, studying the medical problems of the mining industry.”

Cronin, A. J.. The Citadel (Bello) (p. 2). Pan Macmillan. Kindle Edition.

I also discovered that there is a 1938 film, so I watched it.

The story begins with a newly qualified doctor (Andrew Manson) arriving for his first assistant post in a mining community in Wales. The doctors’ sister (Blodwen Page) explains that the Mine has 3 doctors on its list, of which her brother is one. The miners have money deducted from their wages to cover medical costs. This money is paid to the doctors according to how many patients they have registered with them. But Andrew discovers that Dr Page is bedridden and he is expected to run the practice alone. The fees from the miners are given to Blodwen Page and Andrew works as a doctor on the salary of an assistant.

Dr Denny, the assistant  of a rival doctor, describes the conditions:

“There’s no hospital, no ambulance, no X-rays, no anything. If you want to operate you use the kitchen table. You wash up afterwards at the scullery bosh. The sanitation won’t bear looking at. In a dry summer the kids die like flies with infantile cholera.”

Cronin, A. J.. The Citadel (Bello) (pp. 13-14). Pan Macmillan. Kindle Edition.

After working for Doctor Page for a month, Andrew discovers the reality of healthcare in Britain:

“Denny at first had aggravated him intensely by his weary contention that all over Britain there were thousands of incompetent doctors distinguished for nothing but their sheer stupidity and an acquired capacity for bluffing their patients. Now he began to question if there were not some truth in what Denny said.”

Cronin, A. J.. The Citadel (Bello) (p. 28). Pan Macmillan. Kindle Edition.

Andrew and Denny discover an outbreak of Typhoid Fever, and they identify the source as being a well. The two of them advise all of their patients to boil the water before drinking it, and with treatment the epidemic comes under control. But their efforts to deal with the source come to nothing:

“It’s the main sewer that’s to blame. It leaks like the devil and seeps into half the low wells at the bottom of the town. I’ve hammered at Griffiths about it till I’m tired. He’s a lazy, evasive, incompetent, pious swine.”

Cronin, A. J.. The Citadel (Bello) (p. 21). Pan Macmillan. Kindle Edition.

There is an interesting section of the book which didn’t make the film. It is about a suspected case of madness. One of the miners had been:

“acting strangely lately, getting into trouble at the mine, losing his memory. He had turned quarrelsome and violent. ‘I don’t like it, Manson.’ Bramwell nodded sagely. ‘I’ve seen mental trouble before. And this looks uncommonly like it.’”

Cronin, A. J.. The Citadel (Bello) (p. 58). Pan Macmillan. Kindle Edition.

The patient had set upon his wife with a bread knife and Andrew receives a note asking him to attend as two signatures were needed to “certify a lunatic”. Andrew attends the patient and examines him:

“He went over to Emlyn and at first he hardly recognised him. The change was not gross, it was Emlyn true enough, but a blurred and altered Emlyn, his features coarsened in some subtle way. His face seemed swollen, the nostrils thickened, the skin waxy, except for a faint reddish patch that spread across the nose. His whole appearance was heavy, apathetic. Andrew spoke to him. He muttered an unintelligible reply. Then, clenching his hands, he came out with a tirade of aggressive nonsense, which, added to Bramwell’s account, made the case for his removal only too conclusive. A silence followed. Andrew felt that he ought to be convinced. Yet inexplicably, he was not satisfied. Why, why, he kept asking himself, why should Hughes talk like this? Supposing the man had gone out of his mind, what was the cause of it all. He had always been a happy contented man – no worries, easy going, amicable. Why, without apparent reason, had he changed to this!”

Cronin, A. J.. The Citadel (Bello) (p. 60). Pan Macmillan. Kindle Edition.

Andrew diagnoses thyroid deficiency and after successful treatment the patient is returned to his former self.

After a while Andrew has an argument with Miss Page over money. His frustrations about his assistant status lead him to give notice and leave the practice. He finds a post as a qualified doctor and applies for it. He is interviewed by a committee which is made up of medical experts and miners:

“About thirty miners filled the room, seated, and all of them smoking, gazing at him, with blunt, but not unfriendly curiosity. At the small side-table was a pale quiet man with a sensitive, intelligent face who looked, from his blue pitted features, as if he had once been a miner. He was Owen, the secretary. Lounging on the edge of the table, smiling good naturedly at Andrew, was Doctor Llewellyn. The interview began. Owen, in a quiet voice, explained the conditions of the post. ‘It’s like this you see, doctor. Under our scheme, the workers in Aberalaw – there are two anthracite mines here, a steel works and one coal mine in the district – pay over a certain amount to the Society out of their wages every week. Out of this the Society administers the necessary medical services, provides a nice little hospital, surgeries, medicines, splints, etcetera. In addition the Society engages doctors, Doctor Llewellyn, the head physician and surgeon, and four assistants, together with a surgeon dentist, and pays them a capitation fee – so much per head according to the number on their list. I believe Doctor Leslie was making something like five hundred pounds a year when he left us.’ He paused. ‘Altogether we find it a good scheme.’ There was a mutter of approval from the thirty committee men.’”

Cronin, A. J.. The Citadel (Bello) (pp. 96-97). Pan Macmillan. Kindle Edition.

Andrew accepts the job offer and the house that goes with it, on the understanding that he is engaged to be married. The miners prefer a married man attending their wives and daughters. Andrew proposes to his girlfriend and is able to take up the position of GP with immediate effect.

To be continued………….

Observations

If this is based in truth, it seems that the system is inadequate. The miners, or shall we say the end users, seem to have too much influence in the running of the practice. Andrews employer, Dr Page, is kept on as a GP despite the fact that he is unable to perform his duties. This is the result of his patients loyalty allowing him to stay on the company books. This in turn affects the status and pay of Andrew who is running the practice alone but not receiving the financial reward or professional recognition for doing so. There is also the possibility that Dr Page and his sister rely on the fees from the mining company and would not have the financial means to retire.

There are a lot of examples of incompetence by doctors and Public Health representatives. I have also picked up a sense that most of the GPs either don’t know or don’t care about the symptoms of their patients and are happy to fob them off with ineffectual remedies. There seems to be an attitude of “things have always been done this way, why change now?”. This distrust of new methods becomes more apparent later in the book.

Till next time.


As a footnote, the father in law of my Great Aunt was a doctor and surgeon from the late 1880s. He died in 1938. So I’ll see what I can find out about his career. The information I have at the moment suggests that he had a surgery in Yorkshire and also worked at the hospital. He left £21, 267 12s 11d to his daughter. The equivalent value is about £610,000. They were wealthy enough to have a governess, a cook and a private nurse (I’m not sure if she was just for the family or whether she also worked in the practice) and they could afford to go to Australia for a holiday (I think there were relatives there).

 

 

 

Patience, Positivity and Power

For anyone who is experiencing low mood, intrusive thoughts, concerning behaviours or heightened emotions, the 3 P’s – Patience, Positivity and Power – can be used to help, whether it be for yourself or someone else.

Over the years I have managed to put some coping strategies in place. But there are times when my logical brain stops working and my emotional brain takes over. This is when I need help from other people.

When I start to struggle I need to be patient with myself. I am very good at telling myself off for not being able deal with it. And this is where other people can help you. If you are confronted with someone who is struggling, saying “you’ve been here before, you know what to do” does not help. The point for me is that I know I have been here before but I can’t remember what to do. I’m giving myself a hard enough time, I don’t need others reinforcing the idea that I am useless. So be patient. You can say things like “you’ve been here before, what helped last time?”. Or “last time when you felt like this x, y and z helped. Do you remember?” You can even say this to yourself. I sometimes repeat mantras or pretend I am talking to a friend or therapist and I imagine the advice they would give me. By doing this you are offering positivity.

Positivity is key. I think I am an optimistic person, but when it comes to myself I only have negative thoughts. And they are invasive. They cloud my judgement and influence my behaviour. Negative thoughts spiral ever downward into deep dark places that for me become dangerous and scary. And when I am there, negativity breeds like rabbits. One thought leads to another and each thought reinforces my feelings of being useless, a burden to my family, why am I even on this planet?…..

Positivity is power. My negative thoughts are not me. They are part of a belief system that was instilled in me at a young age. I am trying to challenge these beliefs. So far I have had mixed results, but it is early days.

Power over my thoughts and behaviours, that’s a weird concept! But for many people this is normal. People who are confident and have self belief. I have moments of confidence, times when I believe I can do anything, but they don’t last and to be honest, they scare me. It is not natural for me. But I have to nurture myself. And when I can’t do this for myself others can help me. Other people can remind me that I am in control of myself. I am allowed to choose how to behave and how to think. Someone once told me that my anxiety is a monster, a being that wants to control me. I have the power to banish the monster. I realise that I have heard this before. In a support group I used to attend, people would talk about their illness as a separate being – a monkey on their shoulder – and they would describe their power struggles with the monkey.

The last few days have been difficult. I isolated myself from people and wanted the world to go away. There are many reasons for the way I felt. A series of events, thoughts and emotions. But yesterday I started to climb out of my isolation and today I feel more positive.

There is hope. And with the help of other people I will get through this.

 

 

Asylums

I have a hobby: researching my family tree. It is a very addictive hobby which keeps me busy when I’m not writing about mental health. My two interests came together when I found where a very distant relative by marriage had died. She died in North Spring House in 1953 at the age of 75. She had survived her husband by 32 years and had one son who was a weaver by trade. She left her son £515 15s 4d, which in today’s money is about £8,900. In 1953 that would have been equivalent to nearly a years’ wages for a tradesman. Or two horses!

When I googled the address it came up under a different name – an asylum which later became a mental hospital.

North Spring House appears to have been half a mile from the main hospital building. The area is now partly used as a campus for students at the University of Huddersfield.

“Storthes Hall Mansion, built in about 1788 as a private house for the mill owning Horsefall family and located closer to Kirkburton centre, was converted into an asylum in 1904, renamed The Mansion Hospital and run independently as a hospital for people with learning disabilities. It closed in 1991 and was eventually converted back to a private residence.”

wikipedia.org/wiki/Storthes_Hall

“In the early part of the 20th century, part of the Kirkburton hospital was devoted to treating shell-shocked World War One soldiers, but most of the patients were ‘pauper lunatics’ who were detained under the Lunacy Act 1890.”

“The hall was also home to women who were locked up for having children out of wedlock. Many had to spend the rest of their lives there.”

examiner.co.uk/news/west-yorkshire-news/plea-memories-storthes-hall-hospital-8592761

In 1967 and 1968 a committee appointed by the Leeds Hospital Board deliberated over accusations against staff at Storthes Hall and another hospital.

“The allegations which covered a thirty-two week period, were of serious violent assaults, with fists or weapons, against male patients of all ages, committed by four of the five named Male Nurses; and condonation, indifference and apathy on the part of the fifth Male Nurse; against unnamed Doctors and Charge Nurses, that they colluded and conspired to subject patients to physical violence; and against those responsible for the running of the Hospital—(the Medical Superintendent was specifically excluded on the fourth day of sittings at this Hospital)—that they had a mentality only slightly better than that of those responsible for Belsen Concentration Camp; that the Hospital was like Belsen because it was a “brutal, bestial, beastly place”—it was a “hell-hole”.”

sochealth.co.uk/national-health-service/democracy-involvement-and-accountability-in-health/

Due to lack of evidence it was found that none of the accusations could be proved. The recommendation of the committee was:

“We recommend a review of the nursing staff establishment; and, in addition, the making of improvements in the methods of selection and early training of those recruited as Nursing Assistant. We further recommend that, wherever possible, bed-complements of wards should be reduced.”

sochealth.co.uk/national-health-service/democracy-involvement-and-accountability-in-health/

This BBC documentary provides an interesting overview of mental health treatment in the UK:

Continue reading “Asylums”