What could be different in mental health care, what helps, and what have you found to be useful reading?

[OwFriggingOw]

First off - this is a thread inspired by another thread - not about another thread.

I am a lecturer who teaches mainly MH nursing students, but also Adult, Child and Learning Disability field nurses about MH, and also occasionally medical students. I have no agenda for this thread bar a genuine desire to listen, share ideas, and have an open discussion about what is helpful / less so. I worked in NHS MH for 13 odd years.

In case anyone links the other threads that inspired this thread - I have been comissioned to edit a book about people's experiences (service users and carers / family / friends) within MH services and with MH issues. NONE OF THE POSTS HERE WILL BE USED IN ANY WAY, SHAPE OR FORM FOR THIS BOOK. You have my ABSOLUTE word on that. Similarly, NONE of the posts here will be used in any of my teaching.

My aim in starting this stems from several PM's and several on-thread comments about how this would be useful/ I hope it can be a helpful, supportive and productive meeting place for thoughts and ideas about what people have found helpful with regards MH care / services / support (statutory and non statutory) and what has been less helpful. Most importantly with regards the less helpful - what can be done differently?

And - beacuse I like books - maybe we can share reading ideas :)

Would it be helpful if I shared parts of my long thread from earlier regarding what I see as needed, without any other details from the thread?

My dh feels there is not enough emphasis on recovery in mental health.

He has a back problem, and after various investigations etc was referred for Spinal Rehab with specialist physios. Very good and effective course giving advice on life choices, pain managment, exercises and ideas how to cope with a relapse. Notable that as soon as they were given permission to exercise more after the third week, the entire group overdid it and relapsed! he still uses all the ideas more than 4 years later.

Mental heatlh? see a psychiatrist, fiddle with meds all of which have brutal sideeffects, learn to live with it. Not much help with how to do the latter.

Now that he has had 25 years in the system, to be fair, he's allergic to nearly every aspect of it - to history-taking, to the professional cheerfulness of staff, to the lack of options for help, to every idea being based on 5 sessions and you're done. I'm not sure there is any way for him to get better except on his own - but he struggles so much with it. He feels abandoned but also turns on anyone who offers help on the NHS's terms.

Just popping in to get on the thread.

checking in :) thank for starting it ow.

Hello!

That sounds really hard Joan.

The recovery movement and policies that are currently guiding certainly MH education look at promoting people's return to a state of wellness that they find acceptable, promoting hope, acceptance of changes and challenges and support to engage or re-engage with work, education and / or social opportunities, among other things. Some of this is incredibly positive and being worked through in certain services - which may be a beneficial way forward, particularly for people who encounter services for the first time? I.e. Less paternalistic or institutionalising than people have found things previously?

Hi , would like to check in too as think this will be incredibly helpful .

Sorry brain seems to have gone to bed already but will return tomorrow ... very sorry your DH feels there are no real options , joanofarchitrave - that seems just the sort of worrying situation I think we might try to explore here to promote further recovery as Ow hopes to do < waffles sleepily >

Good examples: GP and then psychiatrist who treated me like an intelligent human being who hadnt suddenly become worthless and brain dead because of MH issues.

Bad examples: GP and then psychiatrist who treated me like an stupid human being who had suddenly become worthless because of MH issues.

GP saying: 'now youo just need to calm down. Have you thought about ringing a friend and watching a nice DVD

CPN who was meant to be teaching me CBT but who said things like 'You cant possibly not have slept at all last night - you would be dead by now. You're just making up how bad it is' . I have never hated anyone in my life but I really did despise that woman for a while. She was totally and utterly useless and really set me back.

Thanks future - I'm a tad concerned it will spiral into something less than helpful but hopefully, maybe, we can contain this thread to something more productive and supportive?

kizzie - great that you have had positive experiences, not that you've had the negative ones too. Respecting people's thoughts, feelings and experiences - and communicating that - can be a massive part of initially engaging people within a supportive relationship - sometimes forgotten perhaps by us old timers?

Sorry kizzie , cross posted . at the examples of bad practice ... I can imagine that did set you back a bit

( reminds me of the doctor years ago who snapped " can't she lie down & listen to some classical music " when I was too anxious to stay seated ... was an older doctor so maybe needed to update her skills

... and example of helpful practice : the GP partner who had looked at my records < reluctantly edits identifying info > and said simply - " I can see it will be very hard for you to trust medical professionals again , but we hope you feel supported here " and proceeded to treat me as having valid concerns like any other patient - especially not treating emotional health difficulties which did crop up as a symptom of having a wider issue ... realise this may be unavoidable in some cases but can be handled with care

if it doesn't get invaded then it could be a very positive thread imo. will be back later when sprog finally settles :-o

I don't think it takes very much - I have had (over the past thirteen years or so) two amazing community workers (one asw, one cpn) but all that made them so amazing really was listening to my point of view and expressing their own respectfully where we differed. It was infinitely more helpful to me to be given an opportunity to withdraw from medication (lithium) with support than to be stuck in hospital or bullied into taking it, even though I ended up in hospital and on lithium again. I think they put the time in too, spent lots of time with me and made an effort when, for example, I didn't understand the mood rating scale at all (how do you put a number to a feeling?) the asw developed a sort of behavioural checklist that was specific to my life whether I was elated, depressed or euthymic. It was much easier to tick yes or no to things I had or hadn't done and this laid the foundations for a self management course and later CBT which am sure have helped to dramatically reduce frequency and severity of episodes.

It feels negative to have a much longer list of unhelpful things, both as a patient and as carer/parent of a patient so I might come back with that later.

Alameda that sounds fantastic - really individualised, with necessary care, respect and support.

Individualised, person-centred care seems to crop up a lot when people feel treated en masse. As does time?

future - that also adds another theme - genuinely listening, leading to people feeling heard?

it might help that the CMHT moved to premises practically opposite my house, so two of them would call in before work each day (this predates home treatment, in my area at least)

they do leave me alone too which is even more important - it was quite adversarial to begin with because I hadn't gone the GP > >CMHT > > hospital route, I had passed go and somehow got scooped up and taken in with no idea that there was anything wrong so that was a big adjustment which I don't think I have fully made. I still deep down am not entirely convinced but most of the time it's a compromise and compliance seems to pay in more ways than one. I also love my family and think I should try, where I can, to do whatever keeps me out of hospital. Although sometimes it can't be helped?

Compromise is a word I use a lot, as is collaboration.

You shouldn't ever feel bad if hospitalisation is occasionally necessary - we all struggle to varying degrees with different situations. So glad you've had positive experiences and felt able to share those - you never know who (staff and people who use MH services) may take something really positive from that :)

Agree Ow we can all encourage each other to focus on positive suggestions .
As to whether you old timers might feel you don't always cover all those aspects of engaging your clients you mention , I think we're all aware of the pressures on workloads etc which might limit the opportunity for working as you 'd like - but most people who ask for support with their mh can tell the difference between a professional who is "aware" & listening rather than using a more formulaic approach - which I am sure is now uncommon compared to the time when I first sought help < hopes spending cuts don't bring back this approach >.

There is one topic which often comes up on this board , the handling of which I think we might explore, but I keep wording it wrongly and don't want to trigger anyone so will retire to bed and wish this thread well

Is this thread confined to people who have been in hospital? I wasn't hospitalised but I had a v bad breakdown after birth of DS.

Boring, but the one improvement I would make to the system is to inject it with much more money. Don't get me wrong, I was seen on the same day at GPs whenever I asked. They were all superb. Meds are free here in Scotland so no worries there (I've been on US meds forums and its truly scary, people not getting the drugs they need as they're not covered by health insurance etc), but it still isn't enough.

For many, its talking therapies that are needed, and for this there is a waiting list. I had CBT privately, it was v interesting although not a direct factor in my recovery.

I made one visit to the pnd place here in Edinburgh. Christ, it was depressing. If I win the lotto, I will give them a huge bung. They could do so much if only they had the resources.

Thanks future for both parts of the post - maybe it's something to do with the difference between listening and hearing?

Very interesting about the individually - tailored checklist/s , Alameda and I too think feeling listened to and respected are at the core of the process, Ow < nods enthusiastically >

.... as is , I feel , giving the client "space" as you also mention , Alameda

Hi Morris - no, not all confined to hospital experiences :) The funding is SUCH a massive issue - not only for the NHS but the massive support provided by ReThink, MIND and a load of less well known charities. It seems to me to be really short-sighted to withdraw forms of MH funding when it's SUCH a fundamental factor in physical health and wellbeing, work and productivity, social and community wellbeing and a whole raft of other areas. It impacts massively on sinkage things.

And yes to more talking therapies and maybe more choice too - tho I totally accept that long term psychotherapy may not be suitable for all, and ditto x number of CBT sessions may not help someone with longer term, complex issues?

am sure it is not confined to people who have been inpatients morris, sorry to learn of your difficulties in accessing the best treatment for you on the NHS - was this before IAPT or does that come with long waiting lists too?

Just dropping in to say hello and thankyou to Ow for setting the thread up. I hope it provides useful and insightful information for all concerned.

Ooh yes Ow , I feel the client loses trust in the professional if there is a hint of her not genuinely hearing at all times - a hard task for the therapist ! Hearing not being the same as "agreeing with" , of course ...

Sorry garbled < collects nightcap & candlestick >

Thank you - hope it can stay a helpful, supportive and positive place :)

I do remember a fantastic nurse I worked with years ago who would always acknowledge if she, for whatever reason, lost focus - because we're all only human - and would refocus and ask the patient to repeat their last point or put it back to them to check they'd heard it correctly - she was awesome :)