Fighting Monsters

I work in the inner city and have since I did my first practice placement in the first year of my social work course almost 10 years ago now.  For as long as I have been working as a social worker , I have only ever worked in the inner city - different parts of it granted but its what I’m used to and what I know.

While most of the work is in the overcrowded tower blocks that circle the main business districts and higher class shopping areas of the city - neither mental  illness nor old age spare any income bracket or social class.

So yesterday, I found myself in a house that I had to seriously brace myself before entering - and not in the way I’m accustomed to. I am no estate agent, but the size and location would put a fair multi-million estimate on the property.

Inside though, the issues, pain and confusion were the same as those I see in the high rises that are less than a mile away.

Mr A has dementia and goes for his walk in the local area. Mrs A lives with the fear that every time he goes out he won’t be able to find his way home or he gets on buses and ends up the other side of the city.

She surruptiously (as he won’t tolerate identity bracelets or pendants) sticks a label with his name and address on the inside of his jacket when he leaves - just in case. Every day.

They are and have been a very close couple. Now, Mr A won’t see anyone else. I got in because I said I work with the doctor (who had been to assess him previously and asked me to follow up)

Mr A with his confusion is still of an age that equates ‘what the doctor says’ as being irrefutable.

But Mr A won’t let his family visit anymore. He doesn’t like Mrs A going out without him and she doesn’t like leaving him alone.

She told me about the loneliness she felt. Not being able to have her family visit. She told me of a completely different Mr A before the dementia  had taken hold who used to love chatting with his daughters and having the grandchildren and great-grandchildren come to play in the garden.

She wanted him back but over the years had become resigned to the reality of the current situation.

Now, she just wanted to a break.

When I explained to her about the provisions of regular residential respite care she almost snatched my hand off. I ran through a list of the local carers groups and user-led groups that I felt would be helpful. Possibilities of practical things that could be done and help that could be offered.

We ran through the possibilities of domiciliary respite care (where someone comes into the home and provides a sitting service)  and various telecare devices which can provide some reassurance.

This is a situation that is far from uncommon for me and often, when I visit following a medical assessment or diagnosis of dementia, I will be the first ‘face’ of social care than a family have ever been presented with.

And as I was talking, I was aware of my own assumptions - going into a truly palatial home isn’t what I am used to. Perhaps I used to make more assumptions about the way people live and what needs are there.

But really, the work is exactly the same. The needs are still there and the pain and confusion is still there.

I know I wasn’t really expecting it any other way, but sometimes when you walk through those kinds of houses in those kinds of areas and you glance into the windows and wonder what it would be like to live  that way, usually with some wistfulness  - the people inside the houses do live, breathe, worry and feel in the same way - they get old and grow ill in the same ways.

They just probably don’t have to make the judgements about the loaf of bread or the extra winter heating so often…

The new president of the Royal College of Psychiatrists, Professor Dinesh Bhugra, will according to the Guardian use his inaugural speech to lament the problems caused by the shortage of acute psychiatric beds in the system.

This is something we hear a lot about, and indeed, something described on There and Back Again’s blog about waiting for a hospital bed as an inpatient on leave when the ward is running a 150% occupancy rate recently.

Image via Wikipedia

Bhugra suggests that

No ward should ever be more than 80 per cent full if patients are to be safe, properly treated and cared for.

and while the sense of this can be obvious, it is rarely, if ever, the case in practice - or certainly isn’t in my own, admittedly limited, experience.

So something has to be done and Bhugra has a suggestion

‘ (Bhugra)..  is calling on the government to introduce a compulsory kitemark system of accreditation for all acute, inpatient psychiatric wards: ‘Until there is a compulsory kitemarking scheme, my prediction is that, as overcrowding increases, funding becomes more stretched and morale of patients and staff fall, overall conditions are likely to continue to deteriorate.’

Interesting. I know I rant against target-based practice but in can work in some areas. Perhaps if Trusts are told that funding will be cut or increased on the basis of their ability to find these beds - or that the levels of occupancy will be monitored by the Mental Health Act Commission and there will be financial penalties for applying poor standards - there will be more incentives to hospital managers to actually work on a solution - which doesn’t seem to be being done at the moment.

This Kitemark would measure against other standards such as staffing ratios as well and, indeed, in another article in the Guardian which focuses on current inpatient care, a spokesman for MIND says

‘A compulsory kitemark is a fantastic idea; these wards slip under people’s radar and that’s dangerous,’ she added. ‘When patients are sectioned, they literally have no choice at all about where they go. This makes it vitally important for society to be 100 per cent aware if these vulnerable people are ending up in wards where conditions don’t meet the minimum acceptable standards.’

Beds have been reduced as the focus has been on community care but the fact remains that some people need inpatient care and there isn’t always a reasonable substitute.

And with the incoming President of the Royal College of Psychiatrists in stating that

‘Acute psychiatric wards are now so poor, he (Bhugra) has admitted in an exclusive interview on the eve of his appointment, that he would not use them himself - nor allow a member of his family to do so.’

That is, perhaps, the saddest indictment of all.

Its pleasing that at least the situation is getting some more attention and will get even more when Bhugra actually makes his speech on Wednesday but one of the criteria that I have consistently tried to work on when considering placements for residential care is ‘would I be prepared for a close family member of mine to go to that home?’ and if the answer is no, I at least look for alternatives as I won’t use a home that I wouldn’t be prepared for a family member of mine to go to - or at least without offering the families and prospective residents an alternative option (which isn’t always taken or perfect for other reasons, like location but that’s another discussion for another day)

However as far as psychiatric wards go, that’s another matter.

Running acute wards at a 100% + occupancy doesn’t do anyone any favours in the long run and can lead to possibly longer or more frequent inpatient stays.

Where I work, I am fortunate in that I have a lot of faith in the psychiatric wards I normally use when people I work with are admitted.

Certainly on the over 65s wards where I know the staff much better, I can confidently say, I would be happy to spend time on those wards and would, without doubt, be happy for my father (only close family member I have that is over 65!) to go there. Because I know the wards are well-managed by an excellent nursing and medical team.

The other wards in the hospital, that I’ve had a bit less interaction with, have given me at least some faith in my interaction and observations of the interactions between patients and nursing and medical staff. I do know that this hospital is perhaps ‘one of the better’ ones.

Until I was on my placement in a different borough in my ASW course, my current hospital was the only psychiatric hospital I’d been to - I know that people had said it was a pleasant enough hospital but I didn’t know what to compare it to.

On placement I assessed and organised  an admission for a patient to a hospital I had heard about but never been to. We arrived. I was genuinely shocked myself about the look and feel of the ward. She was taken to her room and I honestly didn’t realise that there were wards like that around still. I think and have thought about it a lot. It has to change.

And the more publicity and public attention that is focused on the quality and care that is provided on some (but by no means all) of the psychiatric wards, the more hope that there will be for some change.

As for the running at over-capacity - the only solution in my own, simplistic mind, is more beds which means more money. Not very popular, I fear.

I read in on the Times website that a letter has been written to the British Journal of Psychiatry,  in which 36 signatories complain that

‘patients with serious problems are often referred to psychologists and social workers rather than clinicians and do not receive the medical therapies they need.’

Now, I don’t have access to the British Journal of Psychiatry so have to rely on the Times reporting.

Apparently, this is a great disservice to the patients who are in need of medical treatment (a position that I can understand as far as it is the case) I’m a little baffled though, as all the referrals we take into our service are referrals to our team which includes a consultant psychiatrist, a  Specialist Registrar (I know, they’ve changed the names - but I can’t remember what grade they equate to now!), a clinical psychologist, some CPNs, Social Workers and an Occupational Therapist. None of us accept direct referrals to individual professionals without the team being involved first.

- and, according to the Times article

The changes came about under a scheme, New Ways of Working, established in 2005. GPs now refer patients with symptoms of mental illness to a team of up to eight people, which will include psychologists, nurses, social workers and a psychiatrist

Now, I reserve the write to be completely wrong here - it wouldn’t be an unusual position for me to take, but my understanding of New Ways of Working initiative is that although a report was published back in 2005, it is still in the consultative phase and was being discussed in 2005 then rather than being ‘established’. Some tentative steps might be being taken in that direction in some trusts but it by no means ‘up and running’

Multi-disciplinary Teams - these ‘teams of up to eight people which  include psychologists, nurses, social workers and a psychiatrist’ have been in play for many years - certainly prior to 2005.

So I’m a little confused by the issues and the facts - although not being able to read the original letter of course, means that I’m relying on the second-hand reporting of the Times.

It seems that the main area of concern is that people with severe and enduring mental illnesses will see one of the team that provides ‘psycho-social’ support rather than ‘medical’ support.

So

‘“If a GP suspected a patient had cancer, he wouldn’t dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That’s what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there’s every chance that mental illness, or underlying physical illness, will be missed. Patients are getting a bum deal.”

winnie the pooh mbbp at flickr

Of course, I am not a doctor and nor do I want to take the role of a doctor. I don’t want to diagnose or prescribe - but I’d also take issue that people that I work with ‘get a bum deal’ when I am involved in their care - not least because there is not a single person that I see that I don’t discuss in a team setting with our consultant psychiatrist on a regular basis. As I said earlier, all allocations come through a team discussion which includes the presence of doctors initially.

And as I work with someone, when there is any change or concern, he is the first person I would contact to discuss these concerns with.

I can’t say I speak for all multi-disciplinary teams in the country but although I’m not a medic or medically trained, I’d like to think I can recognise areas of concern and bring a psychiatrist in very quickly when required (and sometimes when not required - I tend to play safe) . I don’t need to diagnose in order to recognise.

A part of the multi-disciplinary team structure is to work towards strengths. I would also hope that I provide a little more input than ‘jollying along’ but sometimes you just take what you can get and what you can work with.

The New Ways of Working, is, as far as I understand it, is a way of delivering a wider range of services by a broad group of professionals - but not about training others to do the job of doctors or about deskilling specialists. It is, as far as I could understand, about providing a higher skilled professional with more training , into the picture.

Noone wants to see a poor service being delivered or any kind of practice that would detract from medical treatment being provided when necessary. I would never consider myself a replacement for a medical professional but as a different branch of the same tree - because that’s where my expertise lies. I don’t want to be a ‘poor man’s doctor’. I want to be a social worker and not a doctor and to do the job that I am trained and expected to do and I want to do it well.

If that includes ‘jollying along’ so be it but not at the expense of clinical need. Social circumstances and considerations do have a very important role to play within Mental Health services though and to ignore those needs too can be an issue for concern for the patient.

Last week was quite a difficult one for me, work-wise. I’ve already mentioned a couple of the Mental Health Act Assessments I did a few days ago. There was another one yesterday and it was the most troubling I have been party to.

At the moment, I’m still a little raw. I’ll say is that, even though I was not alone in the process (I’m still at that stage post-training, pre-warranting when I am supervised), the supervision really is back-seat as I need to establish that I am able to carry out the role without the supervision. Yesterday felt like that, but the difference was, I knew the person I was assessing well, and he knew me. I’ve visited him and his family many times - offered help and assistance according to a good strengths-based model - worked on needs as he presented - all very fine and admirable person-centred work if I do say so myself!

I even persuaded him to come to hospital as an informal patient when I saw he was deteriorating to what I considered to be a critical level. I saw him and his family through that initial period of his first experience of a psychiatric hospital. And then, after a few days, he decided he wanted to leave.

boliston @ flickr

During the Assessment, I still had to take that formal role, introduce the assessment, explain the process to him. He first asked me not to section him. Then he pleaded with me, and then he begged.  Please don’t do this to me. He said. Repeatedly. You can’t do this to me. He said, sobbing. How can you do this to me.

Before the assessment, in my heart, I’d wanted him to be a bit better. To come back round to the informal admission route. I actually really really didn’t want to write out the papers (n.b not sign them - I still can’t sign them.. ).

You can’t do this to me, he said.

But we did. And I told him after the decision had been made. According to the training, that is a part of the role of the Approved Social Worker.

His wife was with him during the assessment and she handed me a piece of paper afterwards, asking me to phone the children and let them know. I did that. They, along with his wife, agreed that it was what he needed. The interview established absolutely no doubt that  he was desperately unwell and needed to be in hospital.

To me, it was a difficult day.

I have considered, pondered, reflected on it a lot.

The most difficult thing, I think, was that the role seems to conflict with all the values that I have worked with in the.. oh.. 8 years, since I qualified (I feel old now!). I have spent years working to a person-centred model on the basis of consent (as far as possible) - persuading, building therapeutic relationships, working to empower people - and then this. It seems to conflict with all that. It is an area of Social Work so different from any I had been party to previously - I spoke to one of the managers about it yesterday, and he reminded me that it is sometimes the same in Child Protection work, or in Forensic work. I reminded him that although that might be the case, I haven’t worked in those areas so FOR ME it is something new. Sure, I’m not the first social worker in the world to experience these feelings, but they are new FOR ME.

The other aspect I considered was about the role of power in our job and relationship.

The assessment was very much an obvious and opaque display of my power over him. The different levels. When I visit at home or in other capacities, I chat and I smile. I try to pretend that although I’m there to help, it is all consent-based.

In the Mental Health Act Assessment, it’s about power. I can detain you. Whether you consent or not. It jumps out at you. You say the words, explain the legal positions and all of that contributes to the power imbalance. You try and do the best you can to establish a relationship after that to get the information. But the power is obviously disproportionate. And it feels uncomfortable.

I am confident in the decision that was made. But holding onto the implications of that decision to detain or not, is something that is crucial to the process. It was not and is not done lightly. Not by any means.

Of course, the power imbalance is always there in the relationship and has always been there. You can hide it in ‘person-centred’ words but in the end, I’m still an ‘agent of the state’, even with scruffy shoes and jeans.

It just became all the more obvious yesterday.

This week I completed two Mental Health Act Assessments (not on my own, of course, I’m still not warranted!). So I probably don’t need to elaborate on the fact that it’s been quite busy.

Just a few aspects as I saw them.

I spoke to one patient’s mother before first assessment as is required by the Mental Health Act. She was his nearest relative. I needed to ensure that she knew was what going to happen and although we were looking for an admission to assess and therefore consent wasn’t required, I needed to consult and obviously wanted to make a very hard and difficult situation as smooth as was possible.

She was sobbing audibly as I spoke to her. I explained with as much gentleness as I could muster that we would be visiting and who would be there, how long I expected that we would be there and some of the things that we would be doing and saying.

I explained that we may bring her son into hospital - and she agreed that she felt he needed it. She was worried and concerned but repeated to me that ‘I never thought it would come to this’.

She was present during the assessment - still sobbing. I’m glad we didn’t need to use the police. She helped her son pack his bag. Fortunately she lives near the hospital. Her son actually thanked us, as we left him in the hands of the wonderfully sensitive nursing staff who were able to address his concerns and worries - one by one without rushing him through the admission process. That took me aback a little bit. Of all the reactions I have seen, I never really expected to be thanked.

The other assessment, we couldn’t locate the patient’s mother. But she was very clear she wanted no contact with any members of her family to be made so apart from checking with GP, hospital, back through all the records we had - social services as well as health, we couldn’t really do anything more. We didn’t even have a name to go on.

But as it happened we didn’t admit her anyway. It was an interesting assessment as both medical recommendations had been signed. It wasn’t the first time that I haven’t admitted someone following an assessment but it was the first time that I hadn’t in the face of two medical recommendations.

I think in some ways the assessments that don’t result in an admission need a lot more consideration as the risk assessments need to be very clear. Especially if the medical recommendations are in place.

The new Mental Health Act Code of Practice is going to be (so I’m told) far more explicit about not using the threat of an admission under the Mental Health Act as a way of trying to affect behaviours, so, for example, it will not be acceptable to say

‘We have two medical recommendations and while we won’t admit you now, we can come back and take you to hospital if you don’t take your medication’ (i.e. sign the admission papers).

This is something I was very mindful of during the second assessment as we spoke, specifically about coming back the next week to see how things had developed but we (myself and the ASW there) spoke about how we could present this without it being a threat. I’m quite confident in my mind and regarding the reaction that it was not presented and perceived that way.

But I am going back next week..

I am still constantly learning about coping mechanisms and ways of dealing with stress in the workplace - I would like to think I manage the stresses better now than I used to but its been a slog to get to this point at times.

Yesterday morning as I arrived at work a good couple of hours before my official ’start’ at close to 7am (to get some work done before a 9am meeting), I was considering some of the things that were annoying me at work. Mostly it is due to a particular issue at the moment where I feel the support should be there but is thunderously obvious by its absence.

And I considered packing the job in, thinking through the implications.

On the one hand - I am in a reasonably fortunate position of having a fairly good range of experience - I’ve just completed a course which has been very expensive to  my current employers and I work in London. All of which contribute to the fact that I think it wouldn’t be difficult for me to get another job.

On the other hand - I actually like where I work. I don’t always like some of the politics but I have grown attached to the area and the idiosyncrasies of the borough. The geography has its own history and its voice and I feel that I’m getting to know about the community and feel almost a part of it.

I also, in a more selfish way, feel I’m moving into a point in my career where I might actually be able to affect some of the things that are annoying me about the organisation - and that perhaps that would be a more responsible thing to do.

At this point, I’m not feeling particularly stressed or anxious at work, just irritated and a bit annoyed with some of the structures and management. Changes are afoot though, with some restructuring and in the end, I think its definitely worth hanging around at least for that as they’ll be a change in my management which I think will be for the best.

I did once hand in my notice though - it was at the beginning of last year. And as I was on my way to meet a colleague for a joint visit yesterday, I was trying desperately to remember why I retracted the resignation. There must have been a reason but I couldn’t (and still can’t) for the life of me remember why I didn’t go through with it!

Last time though, I was stressed. I was so stressed I was worried about my own health and sanity, and my family and friends were too.  I would feel a physical sickness in my stomach as I walked into work and was actually sick on a few occasions on my arrival.

I felt completely overwhelmed by the work I was being asked to do and when I mentioned this, I was met by a sympathetic smile and nod, before being handed another file. Which would led me to sit, sobbing at my desk, feeling completely unable to do the kind of work I wanted to be doing within the timescales I was being asked for.

I desperately wanted to do a ‘good job’ but felt I wasn’t because I was spreading myself too thin. Simple tasks got pushed to one side because more urgent work came in and then the simple things ended up not being done because there were other things to prioritise.

My life became my work. I didn’t meet friends anymore in the evenings because I just wanted to be at home. From about Saturday morning, I’d be worrying about going to work on Monday morning. I was far more grumpy and grouchy at home (than usual, that is!).

And I wanted to leave the job before the damage became permanent.

I remember speaking to my manager and his manager about it. That was when I said I would leave.

I still can’t remember why I agreed to stay.

nammer @ flickr

But yesterday when I met my colleague, who works in the same team as me, she related to me that she was feeling in a similar way. Her eyes welled with tears and she told me how she had been pushed to the edge by the amount of work she had been asked to do and the timescales she had been asked to work within.

Of course, I advised her to look for other work. Work shouldn’t be making you feel that way, I said - remembering my own experience and how I had non-managed it.  I also told her to take some time off if she felt that way - go to the doctor if necessary. We are supposed to be working in the field of mental health - why are we so complacent with our own?

I feel far better equipped to say ‘no’ now because noone will thank me for the extra time or work I put in. I’ve worked some time-management skills into my arsenal.

I know what I can do generally regarding paperwork anyway, and within what timescale - so I make more realistic targets rather than targets I think my managers would like me to have or targets I would like to  have myself as nothing is more demotivating than missing another self-imposed target.

I make lots of lists. Lists follow me everywhere. Handwritten, typed, online - everywhere.  Mostly though in my diary under particular days but more recently I’ve taken to using Outlook as well.

Anything from one list that doesn’t get done, moves to the next day and the order is very important - being able to prioritise and the order does change frequently.

I write down everything from people I need to phone to documents I need to update. I like having things to tick off, mostly!

I’m also far better at telling people what, realistically, I will do within what time frames. I give myself more time that I think it will actually take, if necessary, so I can allow for ‘emergencies’.

I tend to play down expectations - even if I am fairly confident (although not certain) of positive results. Telling people what you think they want to hear is, I think, one of the worst things you can do in the job. Even if you have the conversation in good faith, it can end in tears if things don’t work out.

Talking to people - colleagues in particular. Depends on who I’m working with, but I’ve identified a couple of people and they wouldn’t necessarily be the people I would immediately class as friends, but we can talk about work together and just mull over things. I wish there were a more formal mechanism in the work-place to ’share’ some of the issues we come up with but actually a lot of the time, we work alone.

Those are just some of the things that I’ve taken to doing - but I’d be interested in any other stress management mechanisms that people find useful!

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..

Yesterday I was called to an ‘emergency’. Well, as I don’t operate strictly in a crisis setting, it was more to act as a gatekeeper to the ‘real’ emergency services.

In essence, did Mr A need to come into hospital?  It wasn’t a formal assessment - more like  a pre-assessment and an attempt  to establish levels of risk.

Mr A was homeless. Not ’street’ homeless but as near as possible to that as could be. He had been evicted from one hostel following allegedly ‘disturbing’ behaviour. He had been moved by the Housing Department of different council to another hostel  in our area where he had been for a few days, and was due to move to a more permanent place (a bedsit) but it was again in a different local authority.

The housing officer was concerned about him. She was concerned about how he would manage in a more independent setting as he felt that the hostels had been providing more informal support. So she called us to see if Mr A needed to come into hospital.

Mr A appeared unwell. It would, of course, be wrong as well as unlawful to use the Mental Health Act to solve housing issues. Mr A was unwell enough to need support though.

He was agitated but I’d also be agitated if I had strange people trooping in to see me when I didn’t know where I was going to be spending the night. There was no way he could be said to lack capacity, at least from the history and interaction that I had access to.

So what to do?

I told the housing officer that we couldn’t refer for a compulsory admission as Mr A did not warrant it. Yes, he probably needed to see a doctor and could definitely benefit, possibly most of all, from some kind of care coordination, someone to help him and guide him to tie some of the pieces of his life together, possibly some medication - but not compulsory admission to hospital.

But I felt a bit empty on my way home. It’s likely that Mr A moved to a different area overnight. I don’t know if he would have got into the taxi to take him or not (he was fairly adamant that he wouldn’t when I left), but I think it’s one of those situations that might be on its way to deteriorate.

The housing officer will contact us later to tell us where he is, and we can contact the local team there to try and ask them to make contact. I think its unlikely that he’ll want anyone related to Mental Health to go and see him. Already when I told him (and it was the first thing I did ) that I work in a Mental Health team he became visibly more anxious (again, understandably - he has had a string of compulsory hospital stays in the past).

I have a feeling things will get worse for him before they can get better - and that is frustrating.

Sometimes, I just want to -do- something,  but have to walk away. I think those are always the hardest situations and those are the people that sometimes I think about when I’m going to sleep at night.

I know I shouldn’t. I’ve been given and have given out the advice a million times about not taking work home with you - but I suppose there must be a way to stop thinking without stopping caring.

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.

A lot of discussion exists around mental illness and disorder but while I was reading the Oxford Handbook of Psychiatry yesterday, I came across an interesting passage about good mental health.

‘Good mental health is more than simply the absence of mental disorder, it requires:

• A sense of self sufficiency, self esteem, and self worth
• The ability to put one’s trust in others
• The ability to give and receive friendship, affection and love.
• The ability to form enduring emotional attachments.
• The ability to experience deep emotions.
• The ability to forgive others and oneself.
• The ability to examine oneself and consider change.
• The ability to learn from experience.
• The ability to tolerate uncertainty and take risks.
• The ability to engage in reverie and fantasy’

I don’t think I had ever seen ‘criteria’ for good mental health before as a lot of the literature seems to focus on the negative so it made for an interesting read.

The list makes it much clearer how tentative the line is between the health and the illness.  I’m not sure many people could tick all those boxes with a clear conscience on a daily basis.

The Secret Life of a Manic Depressive discusses very eloquently, the relation between mental illness and self and by looking at the list it seems that a lot of factors that are very much fundamental to who we are as individuals are included. Surely some people are more forgiving than others, more thoughtful and reflective than others, but does that make them less sound of mind.

I thought it was an interesting guide, in any case!

(and the book seems to be available free in electronic form on Google Books - the above text is taken from page 7 if anyone cares to investigate!).