Angles on Stigma

A couple of unrelated articles that I turfed out today that both refer to stigma attached to those with mental illnesses in vastly different settings.

Firstly, an article in the Times Higher Educational Supplement by an Australian lecturer, Caron Dunn, in which she urges other lecturers to pay more attention and give more respect to students (and colleagues) who have mental illnesses. She explains her experiences that have seen students labeled as unmotivated when they have diagnosed mental illnesses and urges more attention to be given to students who may need additional support.

So look around: if you teach 100 students a year, it is statistically probable that 19 of them will be affected. Look at your colleagues, too: if there are 50 lecturers in your faculty, nine or ten of them could have been mentally ill or are suffering right now.

Of course, the figures refer to all types of mental illness, from minor and fleeting problems to major and chronic ones.

Despite the best attempts of governments and health authorities to destigmatise mental illness, in many cases it is still not treated with the same seriousness as purely physical conditions.

I have talked to a student in tears because another lecturer had accused him of being a malingerer, despite being registered for his mental condition with the institution’s disability unit.

Extraordinary as this seems, it still happens.

She goes on to explain that often in a university setting, a tutor may be the first port of call for help with a student who is having difficulties and that it is important for tutors not to stigmatise or alienate students who may need medical attention.

I always believe students who blame mental-health issues for poor academic progress – a few might be lying, of course, but I think that in most cases, it is a genuine cry for help and understanding.

Food for thought for the academic community.

image david55king @ flickr

The other article is from a university newspaper  but it is from a religious Jewish university (Yeshiva University)  in the States that talks about mental illness in the process of arranged marriages!

I have to say, it isn’t an angle I had considered but it makes for an interesting story because the discussion is how does it affect the prospects of ‘making a match’.

The article works through the processes that guide the decision to meet someone who you will be potentially marrying as a sum of the whole rather than a blanket decision that can be made on the basis of one aspect (mental illness) of the whole.

They also recommend that the ‘potential mate’ is informed and that if professional help is being sought, that this is also shared and that it should act as a reassurance.

Ending on the note that

Mental illness as a dark secret that must be hidden at all costs is rapidly becoming a relic of an era long gone. With guidance, courage and mutual understanding, mental illness can be handled like any other disability; as a small part of who the person is, not something that defines him or her beyond all else.

Nicely put. If only it were so easy in practice..

Bed Blocking

I hate the term ‘bed blocking’ but it’s something that came up a lot when I was working in the Adult Community team. It seems to imply some kind of intent or purposeful wish to disrupt the smooth-running (or not) of hospitals.

The term is used in relation to hospital beds and the need to ‘release’ those beds when the occupant is ‘medically fit’.

Perhaps because we are based at the psychiatric hospital and we (the community mental health team, that is) pop onto the wards with frequency, we are not put under the same amounts of pressure to discharge as happens on in the general hospital but it’s also an issue of ‘demand for beds’.

image oskay at Flickr

As well as that, there is the issue of payment. The Community Care (Delayed Discharges) Act 2003 allowed for local authorities to be charged by hospitals for patients whose discharges were delayed by ‘social care needs’.

Currently, mental health wards are exempt from these charges although there have been rumours and mutterings that this might change at some point.

Why do I mention this now? Because since Christmas, I have been asked to arrange two assessments for two patients in the general hospital who are medically fit to be discharged. In both situations there are reasons that the discharge cannot be a straightforward discharge home. In neither cases did I feel that the risks and the degree of the mental disorder necessitated a compulsory admission into the psychiatric hospital.

Sectioning someone is not an answer to a blocked bed. In both situations, there is no way we would have considered admission to hospital had these people been exhibiting the same symptoms in the community.  Actually, in one of the cases, the patient had been experiencing the same symptoms for a number of years prior to admission to hospital.

It’s not that I can’t understand the pressures that are faced on the wards, especially at this time of year, but I found it vaguely worrying that a psychiatric admission (especially a forced one) seems to have been considered as a first choice rather than a last choice option.

Method in her Madness

Over the weekend, the Guardian printed an excerpt from a book which is about to be published by an author called Nora Vincent titled ‘Voluntary Madness : My Year Lost and Found in the Loony Bin’.

Apart from squirming at the title for a number of reasons, the premise of the book also  makes me uncomfortable. This is a woman who has made a decision to enter a psychiatric hospital.

image tahitianlime at Flickr

It is not a pleasant experience, unsurprisingly. The author had spent time previously as an in-patient and had wanted to come back with a journalist’s eye to present the wrongs that were being practiced in these institutions.  As she says in the extract

In November 2004 I had checked myself into a locked psychiatric ward as a patient. I was in that zombie parlour for four days, and returned home a wreck, swearing that I would never willingly go into such a place again. And yet there was the lure of the spectacle, and what I saw as the outright wrongs of the insanitarium, wrongs I longed to write about and hold up to public scrutiny. Which was how I now came to find myself back in a big city public hospital – this time as a journalist.

It is clear that the hospital in which she was treated was without doubt practising the type of ‘care’ that belies the meaning of the word itself.

She rails against the situation that she is forced into as a patient

There was so much you weren’t allowed to do. There was little exercise – we were taken up to the roof for 15 minutes a day – no smoking and a no-touching rule between patients. A necessary rule, in some ways, in a world where people had few boundaries, but to deprive desperate human beings of the healing comfort of a hand on the shoulder or a kindly hug was, at times, just another reason the place made you feel less than human.

Definitely food for thought but everything has a layered value and risk and hospital is and really should be a place for the people who are most acutely unwell that care cannot possibly be provided by any other means.

I am somewhat sympathetic to Vincent’s view and experiences. It is something I think about a lot when determining the need for someone to be detained on a compulsory section in hospital.

I read a little more about Vincent’s background and the book as I had not come across her.

Her first bestselling book was called The Self-Made Man : My Year Disguised as a Man which pretty much does what it says on the tin, so to speak.

According to US News, the experience of disguising herself as a man for a year, instigated a period of depression and Vincent’s first admission to hospital which she revisited for the purpose of writing this book.

Vincent …  decided to have herself voluntarily committed to three different institutions. (She declined to provide their real names to protect the privacy of doctors and patients she met there.) She first faked her way into a big city public hospital by pretending to have a recurrence of her previous depression. She then intentionally caused a relapse of her depression by going off her antidepressant, which led to her being admitted to a small private hospital. Finally, she tried a recovery facility replete with yoga classes, gym, and facials.

This book hasn’t been published yet so naturally I haven’t read it. I did feel a little uncomfortable about having the luxury of writing about a situation that you have chosen to put yourself in, but on the other hand, I would absolutely not want to condone inhumane treatment on any level and perhaps attention and discomfort are needed to draw attention to poor practice.

Or perhaps it is just the name of the book that makes me feel uncomfortable. I am relatively curious to read it  but probably not curious enough to buy it. I suppose some of my discomfort also comes from the choice to be ill which is not present to the other patients with whom she is living and about whom she is writing.

Meanwhile, Time Magazine print a review of the book (provided by someone who has read it!)

As for a possible alternative, I read Poppy Shakespeare a couple of months ago after missing the TV programme. I was hugely impressed by Clare Allen’s take on the system. I know it’s a difference premise and it’s fiction rather than non-fiction but to  me it had an absolutely genuine ring to it. Unsurprisingly, as Clare Allen is a very engaging writer with personal experiences which include admission to hospital.

I am definitely intrigued as to what the reception will be to Vincent’s book here and will try and chase some more reviews when they emerge.

If the attention does garner an introspective into the running of some hospitals that engage poor practice and care then that will, indeed, be a fine achievement but I am not entirely convinced by the motivation (possibly again relating to the title).

Happy Birthday, NHS

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.

London Ambulance on Hamilton Terrace

Image via Wikipedia

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 there 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..

A decorated birthday cake.

Image via Wikipedia

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!).