Who has the key? Locked v Open Mental Health Wards

I haven’t written for a while, I guess I was busy doing other stuff.  I also had this thing that my blog posts needed to be perfect and not a free flowing thought writing thing, which hindered the progress of this blog somewhat (more on the perfectionism another time!).

So I found myself this evening thinking about writing some more blog posts.  After all, those who know me know that I’m never short of words.  Those who have had the pleasure or not of receiving an email from me definitely know this!  I read somewhere today that emails should be no longer than 140 words (incidentally the same number as a tweet) well at this, I definitely fail!

I also read today about a study that explored the results of a 15 year study looking into the outcomes of people who spent time on an open vs a closed mental health ward.  For those of you who don’t know – an open one is where the door to leave the ward is not locked, a closed one is the opposite, when it remains locked.  This reminded me about my stay on an inpatient unit, almost 5 years ago now.  It definitely does not feel that long ago – its still very raw for me.  I miss the time I spent with the amazing other ‘inmates’ who had a profound impact upon me – without them I would definitely not be here today.  They were my rock, better than any medication or therapy.

Anyway, back to the study, which can be found @TheMentalElf here: http://www.nationalelfservice.net/mental-health/suicide/locked-wards-vs-open-wards-does-control-safety/

Basically, without complicated research terminology people on open wards had a lower probability of suicide attempts, a lower probability of absconding with return and a lower probability of absconding without return.  The probability of completed suicide was not decreased in comparison, but was not increased either.

I’ll let the results speak for themselves (and my tweets).  At some point I will also speak in more depth about my own experiences on a locked (and sometimes closed) ward, from which I did abscond!  But that’s for another day.


Issued: 25th September 2014 by BABCP Board
Vulnerable patients are increasingly at risk from a growing ‘bullying’ culture in the NHS that is ignoring Government-backed minimum guidelines for effective mental health treatment. This is the claim made by an increasing number of members of the British Association for Behavioural & Cognitive Psychotherapies (BABCP) working in the NHS.

Now in its fifth decade, BABCP is the lead organisation and national charity for the promotion of Cognitive Behaviour Therapy (CBT) in the UK.

CBT is an evidence-based form of psychotherapy used in treating a wide range of mental and physical health conditions. From the alleviation of low mood and excessive worry, to cancer care and chronic pain, from soldiers returning from conflict zones to survivors of terrorist bombings, CBT has been shown to be effective in enabling people to reclaim and sustain their quality of life. The National Institute for Health & Clinical Excellence (NICE) recommends CBT in the treatment of depression, anxiety disorders and other conditions.

For CBT to be most effective, it is critical that the patient receives the appropriate number of sessions based on sound clinical judgement as well as evidence based protocols.

Concerned BABCP members working at all levels within NHS mental health services increasingly report that service managers are being forced or are choosing to ignore NICE guidelines in order to meet unrealistic service contracts and funding or misrepresent reductions in waiting lists and mask the impact of draconian cuts in services. With vulnerable patients left unseen or with an incomplete service, this could have serious consequences for their ability to recover.

These members also describe a NHS management culture of bullying and intimidation, preventing them from openly raising their concerns and undermining their clinical judgement. Frightened to speak out on the matter in their workplace, they have been contacting BABCP in increasing numbers pleading for advocacy on their behalf.

BABCP President Professor Rob Newell says: ‘Across NHS Trusts and services delivered in the private and third sectors the variation in mental health service delivery is considerable. In some areas the service provided is excellent and surveys report high levels of satisfaction, while in others low levels of successful outcomes have prompted politicians to get involved and voice their concerns about the level and competence of service delivery.

‘BABCP is alarmed by increasing reports that managers involved in the delivery of psychological therapies are limiting the number of sessions available to vulnerable patients, despite clear evidence of the numbers of sessions required for a successful clinical outcome. Concern is also raised that large group therapy programmes are being used as a substitute for individual therapy and less intensive forms of therapy as a substitute for CBT and other evidence based therapies as recommended by the NICE Guidelines. Judgements about the form and amount of therapeutic input should be made by clinicians based on assessment of need, rather than by managers concerned with arbitrary throughput targets.

‘BABCP also deplores the bullying and coercive environment that our members are describing to us. This kind of management culture was heavily criticised in the Francis Report. Based on what our members are telling us, the conclusions of this report are being significantly ignored in mental health services.

‘BABCP demands that that these concerns are examined at a high level, with clearer guidance provided to service managers who remove choice, use coercive tactics and undermine clinical judgement. We need to remind them of the consequences of such activities for the public whom they are supposed to serve, the service they represent and the clinicians they employ.’
To arrange interviews please contact Ross White, BABCP Company Secretary, on 0161 705 4304 (option 4) or email ross@babcp.com. Please quote reference PR/2014/Concern/01
Notes to editors

BABCP has been the lead organisation and national charity for the promotion of CBT in the UK since 1972. It has grown from 195 members originally to now in excess of 10,000 members, most of whom work in the NHS, social care, education and universities. BABCP is the only UK organisation providing accreditation to those who practise CBT in the NHS and privately. It is widely recognised by health and social care employers, training institutions and health insurance companies. BABCP believes that accreditation is important in protecting the public and raising the quality of CBT. In addition BABCP produces internationally regarded journals, organises world class conferences and provides research grants.

CBT is a talking therapy. It has been proved to help treat a wide range of emotional and physical health conditions in adults, young people and children. CBT looks at how we think about a situation and how this affectsthe way we act. In turn our actions can affect how we think and feel. The therapist and client work together in changing the client’s behaviours, or their thinking patterns, or both of these.

NICE provides independent, evidence-based guidance for the NHS on the most effective ways to treat mental and physical conditions. It recommends CBT in the treatment of anxiety disorders (including panic attacks and post-traumatic stress disorder), depression, obsessive compulsive disorder, schizophrenia, psychosis and bipolar disorder.

The Francis Report was the result of a public inquiry into the role of commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation NHS Trust between January 2005 and March 2009. It followed on from two previous inquiries into events at the Trust which uncovered a lack of basic care in many of its wards and departments.

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Hanging on the Purse Strings

Warning: The content of this blog may be triggering. Please contact a health professional involved in your care, a family member or friend or visit the Samaritans’ web page if you are in crisis / feeling suicidal.

Recently, I fear the painful emptiness of an existential crisis.

You may think this dramatic, but I experienced an existential crisis almost 12 years ago. I was 19, and had just embarked upon my 2nd year in university. Rather than hedonistically making my way between the Student Union and the occasional lecture, I was severely depressed and close to death.

Things had been progressively wronging in my mind for a very long time, and I eventually broke.  I found myself lodged in a painful purgatory between the futility of a hedonistic lifestyle and the realisation that God was more than dead.  He had never existed.  My mood permitted me from engaging in anything pleasurable or vaguely hedonistic – I didnt deserve happiness.  In my mind, If God did not exist, what was the point in living?

This was no crisis of faith. Despite being a Theology undergraduate, I was not religious; My study was purely an academic affair.  However, I was plagued to  preoccupation with the question of existence. The pursuit of happiness was dead and so was a purpose divinely ordained. Staring into the meaningless abyss of my existence, I saw no reason to continue.

I clung to the cusps of life for over the duration of a year, as gradually I reasoned a justification to exist.  Indeed, rather than continue to torment my mind contemplating something that I had no means of proving (God) and without the presence of even a flickering leap of faith, I realised that what was most important in life was how people acted in this world: what good people could do.  I discovered that I could make my own meaning, through my actions.  I could act with purpose, aiming to impact positively on the lives of others.  Through this, I felt my continued existence justified.

As a profession concerned with meaning-making through doing, I began training as an Occupational Therapist 2 years later.  My ambition was to work with others who had mental health conditions, and enable them to find meaning even in the darkest of places.  However, I find myself faced with the question of existence yet again.  This time it is different. I am not severly depressed neither am I suicidal. Furthermore, the non-existence of God (in my mind) has been a given for many years, I have surpassed the hurdle of a God that is dead.  However, as someone who has justified existence based upon the good we can do when we act, and akin to the sentiment of many other health professionals, I despair at the constraints continued cuts and lack of resources have upon the good we can do by acting.

Indeed, despite the prevalence of mental health conditions (1 in 4), only 14% of the NHS budget is spent on mental health.  Healthcare professionals are leaving their professions, due to increased concerns that they can no longer act and do safely in their roles. An anonymous Midwife has recently shared her story of why she decided to resign from the NHS after 10 years.  Despite our best endeavours, we hang on the purse strings.

Furthermore, following successive heart-breaking, damning reports and public inquiries, including Mid Staffs, it is apparent a culture that ”…delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies…” (Prior, Chairman CQC, cited here)  is tragically only beginning to self-fulfillingly execute its own crisis of existence.  Far too late for those who have lost their lives to power and procedure.

Yet the cuts and culture prevalent in health, are symptomatic of a wider cutting culture. Indeed, the very individuals who rely on services provided by the NHS are also at Welfare Reform’s mercy.  This is most definitely not my crisis alone.  It inequitably impacts the poorest, most vulnerable, the sick and the disabled inproportunately.  This is a crisis fuelled by the existence of acute injustice.

Yet this is not merely a crisis of injustice. It is a crisis of existing in the face of injustice.   Ann Wilcocks (1999) description of the power of doing and the impact it can have on peoples lives by: ‘Doing, being, becoming and belonging’’,  inspired me whilst training as an Occupational TherapistHowever, the everyday struggle to meet or have needs met can be tortuous and lives have tragically been claimed. Many are confined to existing, barely doing, let alone being, becoming or belonging.

I question what meaning was ascribed to the actions that have perpetuated this current crisis to exist.  Were these actions underpinned by a motivation to impact positively on the lives of others?  Significantly, I recognise the innocence of my 19 year old self in this simple axiom. What is good or positive is individually defined, and positively dangerous when utilised by those who may be far removed from the consequences of their actions, through experience, circumstance or inability to recognise another’s humanity.  Moreover, the utilitarian spirit looks beyond personal crises, ensuring the good is the majorities. Yet, it is the minority who experience injustice most acutely.  Today’s existential crisis is collective: how can justice be for all?


Brooding for a Baby: Contemplating Conception with a Mental Health Condition


Having celebrated both the birth of a very close friend’s beautiful baby and my Big 30, I find myself for the first time brooding for a baby.

But what is it like for someone like me with a mental health condition to conceive, be pregnant and then nurture a child? Peri-natal and post-natal mental health have recently recieved much needed attention by the media and indeed, mental health professionals:

Louise Tickle’s article in the Guardian highlights how severe Post-natal Psychosis can be, and The Royal College of Psychiatrists have published comprehensive Guidance for Commissioners of Perinatal Mental Health Services.

However, the issue of conception for women with a mental health condition – or Mental Health Family Planning, is something we scarcely hear about. A Google search attests to this very fact – the top result is an article published in 1971. It discusses the impact an unwanted preganancy may have on the future mental health of the ‘unwanted’ child.

Significantly, the remaining top search results pertain to general Family Planning Services. However, for many women living with a mental health condition, the decision to have a baby is not as simple as ceasing to take the pill. Indeed, since knocking back my first mood stabiliser 8 years ago, I have repeatedly promised many a psychiatrist ‘don’t worry I wont get pregnant‘, like a contraceptive mantra.

Psychiatric medication can have profound impacts upon the growing feotus, including severe malformations and can result in long term neuro-developmental and cognitive difficulties. Sadly, the potential risks conceiving on psychiatric medication have been firmly inserted into my white matter like a trusted intrauterine device.

Consequently, to consider conceiving is to contemplate a life without medication. I do not know life or even myself without medication: I’ve been popping pills since 16.

The prospect of being medication free for as long as it takes to conceive and then throughout pregnancy is daunting. Given the chronic nature of my mental health condition, the fear that I may become acutely unwell during pregnancy without medication is a real one. I am faced with a guilt ridden dilema that not only I face: Do I continue consuming my daily cocktail of medication and potentially risk harming my baby?

Fundamentally, I quesiton whether I will be able to be the mother I want to be, or more importantly fulfill my babies basic needs. I struggle at present to meet my own needs. Indeed, having suffered from severe eating disorders during my life, from which i have never fully recovered, I worry I would be unable to to give my baby the nutrients it needs to grow. I immensely fear putting on any weight, let alone baby weight: having a food baby is anxiety provoking enough for me.

Whilst there are many genes in addition to environmental factors at play when considering the causative factors of mental health conditions, I have this nagging concern: Will I be resbonsible for any mental health condition that my child may develop during his/her lifetime?

However, my maternal instincts are kicking in – I would like to be a mum, and think my experiences would make me a good one (I hope!). However, the baby issue is a very real one for me: a decision to have or to not have could have long lasting impacts upon my mental health. Indeed, if I settle for the latter, will I be longing for a child in my future years. Will I live with regret or feel incomplete? Will I be lonely at the Christmas table?

Fortunately, I have an excellent psychiatrist whom I have developed a relationship with over many years. I also have a wonderful partner who is extremely supportive. I have people who I can talk to about my fears and anxieties. However, I know of no specialist Mental Health Family Planning Service locally and am concerned by the lack of support for women with mental health conditions contemplating conception.

Irrespective of whether I’m blessed with the gift of a child, the rights of all women with a mental health condition to be appropriately supported and fully informed when contemplating pregnancy and beyond, is now a cause I nurse close to my heart.

Read my friend Siani’s blog about her beautiful baby Ari here.

Hypomanic musings on the word ‘Disability’


This blog, includes a short extract from notes written when I was hypomanic several years ago! I had been contemplating the word ‘Disability’ and was certain that I had come up with the best alternative solution ever, that would be published in only the most prestigious journals (of course!)

Here were my thoughts…..

Following recent meditations upon the concept of ‘Disability’, I am proposing a new notion – ‘Diffability’ = Different Ability.

The concept of ‘Diffability’ aims to reduce the negative connotations associated with the ‘Dis’ in Disability. It focusses upon an individuals’ strengths and what they can do.

Furthermore, it does away with stereotypes and the subsequent exclusion / marginalisation of individuals classed as ‘Disabled’ since ‘Diffability’ is an inclusive concept – it refers to every individual, since all individuals have differing abilities.

It also challenges notions of a hierarchy of ability – no one is perceived as more or ‘normally’ able and neither is anyone perceived as less able, since all individuals have ‘Diffabilities’.

‘Diffability’ will hopefully enable people to look at what individuals can offer, challenge the traditional concept of disability and promote social inclusion.