I just love this stuff

Today I was in Halifax in beautiful W. Yorkshire. It was great.
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I arrived last night and met up with a former colleague for a catch up over a curry (& beer of course).

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Then today was spent with around 20 of Calderdale’s finest mental health & social care workers talking about psychosis and interventions for people who hear voices. It’s amazing what a really enthusiastic group can get through in a single day. We covered basic principles of psychosis, a little philosophy of mental health care, models of understanding and normalisation in the morning. This afternoon was devoted to meaningful activity and validation, socratic dialogue, delusions and perceptions and principles of risk. These people really got their money’s worth today!

The group was great fun to work with and they really seemed to enjoy the day. Hopefully they’ve got some useful new skills to take away too.
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Even better, I think a few of them will be contributing to Care To Share Magazine before too long as well.

All in all it’s been a really successful day. And now it really must be ‘beer O’Clock’!

What a cracking day!

Care to share magazine issue 7

Just a reminder. Care to share magazine issue 7 is out today as a series of blog posts or downloadable PDF.

Get your free copy here.

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Nursing is a family

Today I had a really brilliant experience. I’m currently working as a locum community psychiatric nurse as part of the NHS team close to my home. It’s a trust I worked for before. In fact I spent several years as a permanent staff member on the wards and in the community early in my career. That’s the background to this story.

Back in 1999 I was working as an E grade staff nurse (remember those?) on a psychiatric acute ward. At that time we had a fresh-faced 18 year old student who clearly had potential. In fact she was one of those students whom you just ‘know’ will go far. She had ‘talent’.

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But she had an issue to resolve. I won’t go into details except to say that I worried that (through no fault of her own) she may become disillusioned and abandon her training. I did what I could to help but I couldn’t be sure that it was enough – though I certainly did my best. You see nursing is a family and like all families we really should look after our young.

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Eventually she moved on from the ward as all students must. Nurse training involves many clinical placements. She went to another ward and I never saw here again. Until….

Today, 15 years later, I had occasion to request help from another nursing team. I needed a specialist. Guess who that specialist was….

The slightly hesitant 18 year old student is now a confident, competent and compassionate professional. Far from losing heart and leaving this wonderful profession she has blossomed into the fine mental health nurse we all knew she could become. I know this because I got to see her work first hand.

And best of all – she had a student of her own in tow.

The nursing family works best when we look after our young.

NHS free at point of delivery?

This is appalling. As a community psychiatric nurse I know people who can’t afford enough food because of this despicable government’s policies, let alone afford to pay to see their family doctor.
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The NHS is part of a social contract between the state and the people, paid for by National Insurance and free at the point of delivery. Many of us have warned for years that the vicious ConDems are dismantling it and this proposal to charge ill people for GP appointments is clear evidence of that. Successive cuts in healthcare and siphoning of funds to private investors created the climate where this debate, this vote is possible at all.

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I know the argument is that we can’t afford the NHS but please remember how poor this nation was when the NHS began in 1948. We had just come out of world war 2. Rationing was still in place to ensure people had (barely) enough to eat. This country was broke but we still provided access to healthcare for those who needed it.

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We did it then because we believed in fairness and social justice. Now…… 30 years of neoliberalism and the current coalition of cynical, nest-feathering profiteers in government have turned those values on their head. We’re becoming like America where people with means can lose everything paying for services and those without means just die unaided.

How much more can this country take?

Mental Health and Social Care

Don’t forget about my other book – also available from The Care Guy website.

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This easy to follow book has been written with social care support workers in mind. It’s jargon free and packed with reflection points, tips and exercises to guide you through the social care process from basic principles to support planning and relapse profiling. What’s more – it only costs a tenner. You can download a sampler here.

The author, Stuart Sorensen has many years experience of working in mental health and social care. Drawing on past experience of ‘real world’ care services he boils down the complicated theory of mental health care into the fundamental principles of best practice. The result is an easy to follow book that explains what mental disorder is, what recovery really means and what social care staff can do to help

Behaviours that challenge

It’s taken me a while to finish this but my new book ‘Behaviours that challenge’ is now on sale on The Care Guy website. Only a tenner plus P&P.

Go on, you know you want to

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Often the advice given to social care workers about behaviours that challenge makes their problems worse instead of better. This easy to follow workbook is full of no nonsense tips, techniques and ideas for dealing with the behaviours YOU face at work (and at home).

Contents

Introductory questionnaire
What is Challenging Behaviour?
Legal principles
Theories of behaviour and interaction
Different types of Challenging Behaviours
Its only behavioural
Philosophy and challenging behaviour (rights, paternalism and intervention – people are just people)
Assertiveness – as opposed to aggression, passivity and passive-aggression
Assessing behaviour – ABC, the Pleasure Principle, lessons from research
Basic behavioural management – classical and operant conditioning, reinforcement, gradual progression
Boundaries and the escalation or recession of inappropriate behaviours
The importance of the whole team approach
The problem with punishment
Expectations
Questionnaire
Answers to safeguarding quiz

Improving the mental health worker’s guide

Pic 1I’m remaking the video versions of ‘The guide’ in a more interesting, ‘documentary’ style. Hopefully that will make them a bit more user-friendly. It’s also turning out to be a lot of fun and seems to me to be a useful long-term project/hobby.

I’ve only managed to make the first 5 minutes of the initial ‘overview of mental disorder’ (I expect each one to last between 10 and 15 minutes) but I’m putting it out for comments. I’d really appreciate constructive criticism. I really want to make these as good as I can.

Please have a look at the unfinished movie file and let me know what you think.

Cheers,

Stuart

Woohoo! Welcome back, Inspector Brown

Inspector Michael Brown is back!

Within the last hour @MentalHealthCop resumed on Twitter and announced that the Mental Health Cop blog is available for public scrutiny again.

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This is truly fantastic news.

If mental health and/or rights interest you go and have a look. Follow @MentalHealthCop on Twitter too. You won’t be disappointed.

Come back soon Mental Health Cop

I still can’t quite understand this.

Yesterday, along with many others in the online mental health community I learned that the Mental Health Cop (AKA Inspector Michael Brown) had disappeared from the internet. Michael’s multi award winning blog (www.mentalhealthcop.wordpress.com) has been a truly incredible resource for anyone interested in or professionally concerned with the interface between mental health care, law and police intervention.

I really don’t know what has happened except that Michael’s employer (West Midlands Police) appears to have had an issue with something he wrote on line. The upshot is that his blog has gone and his twitter account (@mentalhealthcop) is also inaccessible at present. Up to the minute news will be available via the #mentalhealthcop hashtag on Twitter as literally thousands of subscribers to Michael’s blog follow events.

I sincerely hope that this matter is resolved quickly and that Michael is able to resume his fantastic work very soon. More than that though I’d just like to add my voice to the many who wish Michael well personally. He is very definitely one of the good guys.

Come back soon Mental Health Cop. We miss you.

Safeguarding 8: Psychological/Emotional abuse

“for there is nothing either good or
bad, but thinking makes it so”

William Shakespeare, Hamlet, Act 2, Scene 2

With this simple line Shakespeare’s Hamlet summed up the basic notion behind psychological and emotional abuse. Eleanor Roosevelt said it rather differently three and a half centuries later when she pointed out that an insult only hurts if we agree with it. What both of these different expressions of the same principle have in common is this:

If I want to change the way you feel I must first change the way you think, either about yourself or about your situation.

thumbnailCA3H80ASAnything that causes distress or confusion or that misleads the other person causes psychological and or emotional harm. If the behaviour that causes that harm cannot be justified then it is also abusive.

The distinction between ‘harm’ and ‘abuse’ is as important here as anywhere. After all you can’t please all of the people all of the time and people do sometimes become upset for their own reasons even though no-one has done anything wrong. If a person becomes upset because you’re carrying out your legitimate duties then that’s not your fault.

For example the relative who chooses to become angry or distressed because the carer refuses to do what they demand is not being abused. They have no right to demand that they obey them – your duty is to the service-user, not the carer and so you are not being abusive by doing what you think is right, whatever the carer’s opinion might be.

However sometimes our dismissal of others opinions, wants and needs really is abusive. The service-user who becomes distressed when the carer insults or ridicules them is a victim of emotional and psychological abuse. We may not be able to please all of the people all of the time but that doesn’t excuse meanness.

Deliberately misleading, isolating or demeaning another person is likely to be psychological abuse as are intimidation, over use of criticism and hostility. If these things are done from a position of authority they may well also meet the European criteria for torture precisely because of the distressing impact they have on the victim. Repeatedly focussing upon distressing situations for no good reason such as constantly surprising dementia sufferers with the news of their parents’ death for example is a form of psychological/emotional abuse too.

Earlier we made the point that abuse is a violation of an individual’s rights. Rights are not only about the things we shouldn’t have to put up with – they’re also about our entitlements. For example service-users have the right to experience a stimulating environment (so long as they can cope with it). Endless hours of daytime television is not really appropriate psychological stimulation which is one reason why so many people in residential care or long term hospital placements become clinically depressed. What would happen to your mood if all you had to occupy your mind were chat shows relating to a world you no longer felt part of? Physical and environmental circumstances have psychological and emotional impact, for better or for worse.

Over-stimulation due to noise, overly bright lights or even simply too much frenetic activity can cause psychological harm. Critical, demeaning staff or dehumanising routines create difficulties too, particularly in relation to self-esteem. Consider the psychological impact of having someone else make your basic decisions such as what you wear or eat, what time you get up, when you bathe and even when you go to the toilet. Imagine someone else feeding you.

Of course it is undeniable that many people in our care need a great deal of support and assistance with all these things and more. However – when they are able to exercise choice about when and with whom for example they are much more likely to maintain a sense of independence and control than when they are simply factored into a routine that is decided ‘in the office’.

To the busy care worker these things are functional – they’re just routine and can become no more than ‘tasks’ to be performed in the minds of the staff. To the incapacitated patient or resident they may be the last aspect of independence supporting their self-esteem. Even routine can be a form of psychological abuse. We’ll explore this concept a little more when we cover Institutional abuse shortly.

As with so many aspects of abuse it’s always worth wondering how you would feel if you were in that situation. If you’d become distressed, depressed, angry or humiliated then there’s a good chance that the same will be true for your service-users.

The fact that they may not complain is no guarantee that they are satisfied. It is usually the most depressed and/or dehumanised people who complain the least because they have simply given up. That’s one reason why health and social care inspectors monitor complaints about a service. The service that has no complaints is often the service chosen for an inspection visit simply because it is impossible to please all of the people all of the time and so if nobody is complaining the inspectors often want to know why not.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

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