MY GUEST BLOGGER – MORE FROM THE NEW PSYCHIATRY

“Therapeutic and Anti-Therapeutic Staff Interventions”
Excessive seclusion is “an abomination before the Lord”, doing much more harm than good. Seclusion in isolation should definitely be used only until “unmanageable derangement” has subsided for around 5 to 10 minutes, and should be followed by “seclusion” with the company of a single member of the staff team who is up for the job of “talking the client down” into a place where the “seclusion” can be ended, with PRN “medication” being given “as part of the deal”, but only with the consent of the client.

Ideally, “restraint” (legalised assault{?}, especially if injury results) should only be used when a client is so clearly “unmanageable” that “restraint” is seen as necessary to get the client into seclusion.

When “restraint” is used, but then seclusion is seen to be unnecessary, the client should be “talked down” in a private room by a single member of the staff team who is up for this job. And, again, PRN “medication” should be offered, but not imposed, as a matter of informed consent.
And, PRN “medication” should be offered (not imposed) when it believed that it may help the client, and it should never be offered for the benefit of anyone else, or because some “rule” says it should, or to serve the needs of staff, or of any system. And, all “restraints” should be regarded as staff team “failures” because it’s always possible to “talk people down” if one’s individual and group de-escalation skills are good enough. All staff should have a “de-escalation skill grading”, and when any member of the staff team feels out of their depth they must be expected to get help immediately from staff with a higher “de-escalation skill grading”. So, when an “incident alert” is activated, the most experienced staff members should be expected to take charge of the situation. And, all such “failures” should be reviewed with a view to learning what should be done in future similar situations to avoid harm, avoidable distress, and unnecessary alienation.

Also, in any environment which is supposed to be therapeutic, the concept of “punishment” should be avoided as much as possible. One should go out of one’s way to avoid any client feeling “punished” for any reasons other than ones that are not completely sound. When clients feel “punished”, their thoughts and feelings should be acknowledged, and appropriate sympathy and/or apology should be found.

Also, contrary to common belief, putting excessive downward pressure on environments being “stimulating” is actually anti-therapeutic for everyone (see “the only way out is through”, above, and the problems of “interference” below).

When “restraint” is used, but then seclusion is seen to be unnecessary, the client should be “talked down” in a private room by a single member of the staff team who is up for this job.  And, again, PRN “medication” should be offered, but not imposed, as a matter of informed consent.

And, PRN “medication” should be offered (not imposed) when it believed that it may help the client, and it should never be offered for the benefit of anyone else, or because some “rule” says it should, or to serve the needs of staff, or of any system.

And, all “restraints” should be regarded as staff team “failures” because it’s always possible to “talk people down” if one’s individual and group de-escalation skills are good enough.  All staff should have a “de-escalation skill grading”, and when any member of the staff team feels out of their depth they must be expected to get help immediately from staff with a higher “de-escalation skill grading”.  So, when an “incident alert” is activated, the most experienced staff members should be expected to take charge of the situation.

And, all such “failures” should be reviewed with a view to learning what should be done in future similar situations to avoid harm, avoidable distress, and unnecessary alienation.

Also, in any environment which is supposed to be therapeutic, the concept of “punishment” should be avoided as much as possible.  One should go out of one’s way to avoid any client feeling “punished” for any reasons other than ones that are not completely sound.  When clients feel “punished”, their thoughts and feelings should be acknowledged, and appropriate sympathy and/or apology should be found.

Also, contrary to common belief, putting excessive downward pressure on environments being “stimulating” is actually anti-therapeutic for everyone (see “the only way out is through”, above, and the problems of “interference” below).

Furthermore, another factor in the exacerbation of “emotional disturbance” is the suppression and/or repression of anger and aggressive feelings, even when these feelings are expressed in safe ways.  And, a massive problem affecting recovery adversely is that of the suppression and/or repression of swearing as a result of a social conspiracy to keep a lid on other people’s expression of anger and/or aggressive feelings, even when they are expressed in safe ways.  Therefore, in a therapeutic environment, there should ideally be no anti-swearing interventions, unless it’s clear that failure to intervene could result in unsafe expression of anger and/or aggressive feelings.

The correct response to anger, aggression and swearing is to establish their cause, and to do one’s best to address the cause, in ways that everyone can be okay with.

Also, although pre-pubescent children should be protected from anger, aggression and swearing that could cause them to feel uncomfortable, anxious, nervous and/or unsafe, even children should not be intimidated and/or bullied into strict compliance with “social taboos” of this kind, because of the serious harm that anger does when it’s “bottled up”.

In fact, allsocial taboos” should be regarded with suspicion, as should any kind of over-reaction when any “social taboo” is flouted.

And, staff who have a problem swearing, hearing swearing, or being on the receiving end of swearing should not be employed as Psycho-Social Health Service workers, because their preoccupations will make it impossible for them to do the right thing in difficult, stress-laden, and/or complex situations.

Have you noticed the way some people “punish” others for “swearing” by refusing to listen until those others “comply” with anti-swearing dogma?  And, have you noticed that the reason people swear is because, when they don’t swear, others don’t listen anyway?

Having said all of this, I see no problem with not liking anything and expressing one’s dislike in assertive ways — i.e. politely, respectfully, and with due deference and diplomacy.  It’s only unassertive behaviour that can result in a proliferation of problems.

Unassertive behaviours include:

  1. Abandoning logic as a result of being in a state of panic or desperation.
  2. Excessive begging, and/or passive-aggressive behaviour.
  3. Excessive stubbornness, and/or not knowing when to back down temporality or permanently.
  4. Getting hysterical (or throwing any kind of tantrum).
  5. Bullying, and/or demanding with menaces.
  6. Getting violent for the purposes of bullying, “punishment”, and/or retaliation.

And, what is really not okay is intimidation and/or bullying inspired by “social conspiracies” regarding any so called “taboo”.

My guest blogger will be delighted to answer any questions.

I as a mother would like to see people like my guest blogger more involved in helping people like my daughter although as a mother I do not really like swearing as an example for my daughter!

Whatever people may think whether they agree or disagree with these comments it is clear that there are some very caring people (patients) under the mental health with intelligence who have a lot to offer and what is more could also be working alongside the police and MH professionals with the £25,000,000 awarded. I know some professionals agree with this but it is a fact that my daughter responded to fellow patients/residents and there are some who could also be included in such a project by way of open dialogue. All I have ever wanted was to see my daughter treated fairly and a fellow patient would have the full understanding of someone who is going through crisis and some are very good at helping others in such situations. Inclusion is important and equality. The problem is that all too often patients are not treated fairly and open dialogue is the way forward and also students should be given the opportunity where possible to come and meet the families and see the family background. If notes written about a family member are inaccurate how on earth can any professional do their jobs. For instance the consultant psychiatrist had read all about me in past files. Obviously it was far from complimentary and this is where judgement should be reserved unless the next team or new professionals come and meet the families and get to know them properly. It is wrong to base your opinions on assumptions. You need to hear and see things first hand. Not every family may welcome such involvement however I would as I have nothing to hide and prefer openness and honesty as this is the way forward in terms of working today, families, teams and patients. This is the system that has a high success rate in Tornio, Finland and it is no wonder why.

By the way if anyone thinks I am against all front line staff they are wrong. If someone is on call 24 hrs a day having to face distressing situations it is not easy but someone who has been through should not be underestimated and could play a huge part in helping others and I hope one day that Elizabeth will be able to do this.

I do not know yet what the future will be for Elizabeth – she will not be coming home and that is not because I have said no. It is the team who control her decision but the family do not get considered. The team will give options and none of us know what will happen next. Elizabeth will be 27 soon – I would like to see her have some normality in life. I do not see how she can work on this quantity of drugs – there are good days and bad and I have no control as a mother. The law is all about drugging and there is not one single facility in the country where someone can safely be reduced off these mind altering drugs with professional help. If a client complains of side effects they may be offered another drug – that is the care in the UK until of course someone has a very serious problem that could be life threatening and only then is physical health considered and someone taken off the drugs.

“You have to take these drugs for the rest of your life” said the consultant psychiatrist. Since then others have stuck by this decision whether right or wrong.

However there are very good people in the profession as well – I am not dismissing this at all.

If I was to re-write psychiatry then the first thing I would say is that the drugs should not be a long term solution or given to abuse victims. Proper tests and assessments should be done to see if someone can metabolize the drugs and this is something not being done properly and neither is a proper look at food intolerance and nutrition/diet. For this you need a specialist centre but it is not just the professionals that should be involved here but the wider community and former patients as peer support plus students as they could gain valuable experience from working with someone like my daughter.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: