Fighting Monsters

Today is the 60th anniversary of the founding of the National Health Service.

There has been a lot of coverage over the last week in every kind of media source to commemorate this.

From finding people born on the same day to relive their lives through access to the health system to much polemic and debate about restructuring and restructuring again.

A look at the past - and a look at the future in the face of the recent reviews that have come out.

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I don’t think I can add anything new to what has already been said - but in some ways, having been born into and grown up with the system as is, I find it hard to imagine things any other way.

I expect to go to the doctor without thinking of cost.

I expect to get a prescription for medication that I need (and still pay my fixed fee for it!).

I expect to be referred to secondary medical services if and when I require.

I am fortunate to be and to have been in good enough health that I can’t  ever remember  having been in a hospital overnight - a few visits to casualty here and for minor stitching ups really is about as far as it goes.

I have family members who have been recipients of a great deal of care of an exceptional quality - and of course, now, I work within (although not for) the health service.

There are likely to be many changes in the future as the health needs of the population change. Introduction of ‘market forces’ has already started. Management layers are added and exist to increase the drive towards efficiency.

Always new restructuring, always new developments.

Expectations of what a health service can and should deliver are changing too - and this monolithic structure - oft-quoted as being the third largest employer in the world - does need to adapt.

But I think she’s not been doing at all badly, when all’s said and done.

And here’s to another 60 years and many many more beyond.

Happy Birthday - and at some point today, I’ll raise a glass to Nye..

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And in other, marginally connected news, The Guardian in its Work and Careers section, spotlights a Social Worker (marginally connected because she is a hospital social worker!).

There is an interesting article published by Geriatrics entitled Does Alzheimer’s really exist?. It consists of an interview with two authors of a book called The Myth of Alzheimer’s.

I thought it raised some crucial points. Of course, biologically, Alzheimer’s exists and that isn’t the issue that is being made, but the book seems to try to approach the onset and development of Alzheimer’s from a different angle.

Rather than focusing on the scientific search for a cure, they emphasis the need to look at ways in which the development of Alzheimer’s can be managed within a sociological, cultural and community framework.

One of the authors,  Dr Whitehouse, states

‘Instead of asking ourselves, “What drug should I prescribe”? we should be asking, “How can I help my patient stay alive, enjoy a good quality of life and remain engaged in society”? We have medicalized aging to an extreme degree.’

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It seems like they are carrying out a lot of studies related to how older people with Alzheimer’s interact and what kind of interactions benefit them and in what ways.

I have to say, it was a heartening and inspiring interview and I thought it was a key approach to take as often we work, within our service, in a psycho-social model but sometimes it feels that we are battling against a tide of medication (which, don’t get me wrong, has its place but not by any means exclusively).

I sometimes feel frustrated that age has so many negative connotations in our society. It is not seen necessarily as a part of the life as a whole or the aged, confused individual as a part of who they were, are and will be.

Daniel George, the other author, writes

‘We are all going to grow older. We are all going to die. That may sound somewhat negative, but it is reality, and it carries a message of hope. No matter what we do, we can’t fix all the problems of aging. But we can foster a sense of solidarity. We are all in this boat together. And we can’t throw anyone overboard just because they’re unfortunate enough to be labeled with a mental illness such as AD.’

In a society that sometimes seems to eager to throw those that don’t fit the ‘model’, overboard, it is good to see the work being done.

Dr Whitehouse and Mr George continue to update their blog in relation to their research and ongoing methods. I’ve found it useful to keep track of.

Reuters reports that lower levels of Serotonin can lead to increased anger.

There is a scientific reason why people become more grizzly when hungry, namely that

‘the essential amino acid needed for the body to create Serotonin is only obtained through diet.’

It did make me think though, about how much emotion and feeling is governed by chemicals in the brain. Probably more than we’d like to admit.

Image via Wikipedia

It’s quite interesting to link this report to an article in the Independent which asks if drugs can be an answer to all manner of behavioural problems.

The article goes on to list a series of ‘behaviours’ that are being medicalised and says, for example, of temper that

‘Losing your temper could lead to a diagnosis of intermittent explosive disorder (IED), a condition that is acquiring its own family of drug and other therapies. Just what IED includes, and excludes, is not clear, but  Mayo Clinic  doctors say: “Road rage. Domestic abuse. Angry outbursts or temper tantrums that involve throwing or breaking objects. Sometimes such erratic eruptions can be caused by a condition known as intermittent explosive disorder.” Some 8 per cent of adults suffer from IED, and doctors at Chicago University are using divalproex sodium, a drug used for epilepsy and bipolar disorder, to treat it.’

I am no scientist (although I did get a GCSE in Chemistry..) but something about medicalising behaviour seems to move away from personal responsibility.

Maybe I just need to make sure I keep a cereal bar on me at all times for those days when I don’t have time for lunch..

Breaking completely unsurprising news.. Men and women express different symptoms of depression according to a study from Cardiff.

But there are some interesting points that I wasn’t aware of. The breakdown of the symptoms is quite interesting. According to the study

‘Female patients reported certain depressive symptoms more often than men, namely diminished libido (62% vs 35%) excessive sleep (19% vs 10%) self reproach (96% vs 87%), and diurnal variation (46% vs 32%).’

There don’t seem to be any symptoms listed though that men suffer more from than women.I’d be interested though to know if there are any symptoms that men express more than women.

Perhaps I’m not reading this correctly, and I’m certainly no academic, but does this mean that women just suffer from more of everything in relation to depression?

There is a higher propensity to depression in women. That is fact. There are more women who suffer from and seek help with depression during their lifetime and many arguments, discourses and studies including ones here and here.

I’m no medic either and certainly not one to fly in the face of scientific evidence, but instinctively, it seems that our society is more able to accept the model of female depression. It fits into a stereotype very easily. Would that mean that doctors are more likely to prescribe anti-depressants to women? Well, without actually conducting any research I can’t say, but a quick search on the subject (Google is a wonder resource!) seems to indicate that

More women are prescribed anti-depressants than men as noted by the WHO who say

‘Female gender is a significant predictor of being prescribed mood altering psychotropic drugs.’

and yet

male GPs are far more likely to do the prescribing

Of course, the first point would come as no great surprise if more women are actually suffering from depression (which is, I think, undeniable) - it makes sense that they are assisted pharmacologically, if that is what’s needed, of course - and more women are diagnosed with depression after all.

The second study though, if anything was more interesting in that female GPs were more likely to favour talking therapies.

Perhaps we have become more used to self-diagnosis and are asking GPs for particular medications, as The Times highlighted last year saying

‘Research on doctors’ habits also revealed that many felt they were prescribing the drugs too often, but did so because patients wanted medication. They said that funding was often not sufficient for alternative behavioural therapies and other counselling treatments, despite NICE guidance that they can be as effective as antidepressants for those with mild to moderate depression.’

So funnily enough it leads back to funding.

The likelihood of male GPs to prescribe more than female GPs remains a little baffling in the light of this discourse. Perhaps some female GPs have more sensitivity to the subject. Perhaps, became in general, women are more likely to want to talk about feelings, they can transfer some of this approach to their patients.

Or are women with depression more likely to want to talk to a female GP about their problems in the first instance so female GPs take some of the initial consultations when the depression is less severe?

I don’t know really, but I’d be interested in more information about that study. There must have been some more answers and reasons offered than just gender.

I spotted this story on the BBC today which reported that anti-psychotic drugs are being used, perhaps too much, perhaps inappropriately, in residential and nursing care homes for residents with dementia.

This is an area that is fairly close to my heart as I have worked with many residential and nursing homes, many service users who have dementia and one or two psychiatrics who have appeared to be a little ‘prescription’ happy.

Having moved to a multi-disciplinary team, from a pure social services setting, I couldn’t help but notice the hierarchical structures within the NHS where the consultant is king.

I wonder if there would (and should) be more of a role for social workers in these teams to question the use of medication and both its relevance and need. I think it is very easy to slip into the mentality of the team within which one is based, but when the emphasis on social care is lost to medicine then all the teams become truly generic to the extent that they make little sense.

I’ll certainly take an active interest in the National Dementia Strategy which is due to be published later this year. Particularly the mentioned twelve week reviews. That would, indeed, be a wonderful safeguard of the quality of services which are provided - but it just doesn’t seem possible within a system that struggles to provide annual reviews.

One of the things that was emphasised strongly on the course, is that someone should never be admitted to hospital under compulsion because they ‘refused to take medication’. That just isn’t a reason to apply for an admission.

It seemed to be almost natural to comment on that in the assessment papers but, as our tutor pointed out, not wanting to take medication which may have horrific side-effects, does not, in itself prove anything if you have no idea what the background to that refusal is and why the medication might be refused.

Our tutor felt it was a part of the move towards the medicalisation of the social work profession (if that’s a real word!) that we were accepting what the psychiatrists were feeding us - namely by refusing medication that would make you ‘better’ you must be crazy.

That thought, combined with one of the more powerful and useful lectures, by a man with a diagnosis of schizophrenia who spoke in the most powerful terms possible, of the pain that the side effects of medication had given him and his fear of being medicated, made me consider how I have approached medication in the past and the emphasis on it.

There is no doubt that medication is important. It is more than important - it is vital. But there’s usually more than one way to skin a cat, so to speak. It is only one of a range of therapies that can be useful and valuable and productive.

I hope that it is not a lesson I forget in a hurry as sometimes, we can be caught up in doing what we think is the right thing to do and stop listening to what the difficulties actually are because we are superimposing what we imagine them to be.