Funding 26/01/2012

Everybody blames all the crap on the cuts, or the mess the previous administration left, or the bankers… or some other group, I have avoided that so far, but sometimes you have to jump on a bandwagon.

I think most of us, as I do, applaud the fantastic work done in cardiac relief, cancer care and other major physical illnesses. I also deplore the lack of support for such as Motor Neurone Disease, Multiple Sclerosis and other such tragic conditions. I know that there has to be an economic factor in the fields of research and development, and that there are relatively few sufferers of these conditions, so for the good of the majority they take a back seat to the relatively common cancer and cardiac problems.

I don’t condone it, not by a long way, but I can understand it.

Now, let’s consider Mental Health, more accurately, Mental Illness. Latest estimates are that between 1 in three or four of us will suffer mental illness of some kind in our lives. Some will be relatively minor, have a recovery and remission. Many others will last for a lifetime, be totally devastating for the person and their family and friends.

Mental illnesses can be so frightening, so devastating, so utterly indescribable, and so damn lonely… and whatever, dear reader, you say there is a totally unacceptable stigma attached to mental illness, that is why you back away from it, don’t try to understand it and are frightened of it, you blame the sufferers and often call them freaks, druggies and countless other less pleasant totally undeserved names.

People with Mental Illness are first and foremost people, people who are suffering horribly with uncontrollable symptoms that no paracetamol, plasters, lozenges or antibiotics can even come close to easing.

If you haven’t been involved you can have absolutely no concept of how hideous, destructive, painful and tragic the situation can be. Imagine waking up in turmoil, with no hope, feeling devastated by everything, unable to cope with anything, unable to find the commitment to get out of bed, unable to stop crying… imagine that being your lot every day of your life. Little wonder that so many see the only way out is to end it all, or to self harm because the physical pain may hide the mental pain for a while. Not a pleasant thought is it… but countless people, for many young people with much to offer society and the world, as well as many people of every age, this is their lot in life, not for today, not for a week, but for life.

Don’t think that Mental Illness attacks people with particular lifestyles, particular age groups, particular races, religions, or sizes. Every single one of s is susceptible. If you think otherwise you are deluded.

So why is it then that Mental Health gets so little support, publicity or funding, why is it the Cinderella of the Mental Services. There could be an argument that in-patient, and indeed out-patient mental illness needs colossal commitment in terms of support and care, which in turn costs money. There is an argument to say that, but it is nonsense.

All too often acute units return patients to the community without a proper recovery, with no proper care programmes in place and without proper family care available, and this is to keep the statistics looking good… it is better for the statistics to have a patient in for a couple of months, discharge them then have them back when they relapse, often far worse than at the previous admission, it is a false economy, it is a callous response to totally false government demands for statistics. Mental Health patients are not statistics, they are people, ordinary, very vulnerable people.

If they were treated more effectively they, and their carers, would not return to inpatient status so often, costing the NHS so much more than doing the job right first time rather than trying to achieve pointless statistics.

So, back to the cuts, I can only really talk about my local Mental Health Services, where medical care is the responsibility of the PCT and pastoral care is in the hands of the City and County Councils.

The County Council does not acknowledge there is a difference in the care and support needed for mental illness as opposed to physical, which means the needs of mental patients and carers are not fully addressed.

As a direct result of the recent cuts the County and City Council are removing all the funding from the voluntary sector patient and carer support groups, which will put all of their existences at risk. Without these groups the patients and carers will have no-one to fight their corner. I have already said that the County Council does not understand the needs of Mental Illness, so they will continue to short change sufferers and carers through ignorance, and refusal to listen to the message the groups are giving them…. All to save money.

They will work with one commissioned group to look after all health care issues, but the funding is dramatically slashed, which means that the specialities will have no voice, no effective voice at least, and will suffer more and more.

Of course the risk here is that more and more will crack under the pressures, patients will be admitted to inpatient care more often and their carers will become service users themselves. We have already seen this happening.

Research into illness and disease is expensive, and funding will inevitably be reduced across the board. There should be a public outcry!!! Major physical conditions, cancer, cardiac and even eyesight, are such high profile, indeed so important that they will face minimal cuts, the cuts will happen with the lower profile conditions, such as Mental Illness, as well as MND and MS.

Commercial medical researchers will have to concentrate on the areas which will bring them the most public appeal and commercial success. Any guesses?

Mental illness is blighted by stigma, whatever I say, do or write, it comes back to stigma… because of that the subject cannot be openly discussed, sufferers and carers alike tend to try to hide their feelings and conditions from all but a select few, you only have to follow twitter to find countless people who are already in desperate need of a solution, desperate in their lives, it is so distressing to see their stories unfolding. Not only that but so many also suffer from bullying because their conditions are not understood.

In this financial climate is it possible to imagine that there will be any additional funding for an illness that is not understood, not talked about, that people are reluctant to even admit to?

Let me be clear, I have had a mental illness… am always at risk of a relapse. I have had many years caring for mental illness. I am not proud of it, but hells teeth, I AM NOT ASHAMED OF IT, any more than I would be ashamed of having the flu or a heart attack.

I will always try to be open and up front about it, and talk about it as openly we talk about other medical issues. Of course there are other taboo medical conditions, but I am not involved there, that is someone else’s argument.

No, the cuts will affect the whole range of services, but obviously the more popular, main stream and socially acceptable conditions will suffer less. This means that things like mental illness support will fall further behind in the pecking order, become even less known, but conversely lead to more people suffering, which will increase the cost of the service and of course reduce the proportionate funding for each sufferer even further.

Without the cuts, mental health support would continue more or less at is it, which is unacceptably low anyway, but when the cuts impact, the quality of the support will drop even further, probably even prejudicing the chance of actually doing anything at all for sufferers and carers.

Please, I know the government is totally out of touch with the people of this country, but could we try to make them understand that people with mental illness are amongst the most vulnerable and needy people in the country, they deserve to get full and proper support and treatment at all times. By reducing the level of support we condemn a huge number of vulnerable people to a hell on earth which they just do not deserve, and it is wholly unacceptable.

Finally, of course, the Olympics… while we are all (well some, count me out) gung-ho about the Olympics, have you considered how many charities and not-for-profit organisation have been put at risk, have to cut back their efforts or actually been forced out of business because their funding has been drastically cut as a result of the government cuts and the diversion of funding to the Olympics?

Hard day, but improving...

I normally try to be positive, after going through an horrendous year or two, despite everything, I was feeling really great… thats when life sneaks up on you unawares and kicks you down again., To be fair it hasn’t kicked me that hard this time, well all things are relative, but it has had a massive impact on me, such that I was nervous driving in the dark again yesterday, I have had these bad feelings in the past and thought they were gone forever…

I have had really bad days after a really good patch, and I just don’t like it, it has really thrown me and my confidence has gone again… so I need to put it down and get it out so I can move on again.

So what has happened…

I am currently unemployed and am working with the local Adult Mental Health Service and a Consultancy  called April Strategy, I am the care representative and one of the facilitators of the project. The project is called “Improving the Experience” and after a couple of months planning and training, booking venues and so on, we are now deep into a process named “In Your Shoes”. The events run for two hours, and how it works is that carers or patients come along and each is hosted by a service provider, could be anything from team leader, Manager, Nurse or even ancillary worker.

The service provider sits with the patient/carer for an hour and the listens to their story , They will also make notes of all the key points on post-its, the carer/patient has an hour to talk about all the good and bad experiences they have had in the service and attempts to define a perfect service provider.

Then after a break we get together in small groups and the professionals read out their post-its and we can group them, with everybody else’s into categories, and highlight the main them or success and failure, we then agree between us the main headings that the Trust has to improve on.

I have now told my story to 5 different people, it is a very tiring and emotional experience, but is also cathartic, you see the empathy, feel the support from your listener. At the end all of the points are raised and you realise others have the same sort of issues. All in all the feedback from everyone involved has been so positive, so encouraging, the service providers learn many things that shock them, here many things they expected to hear, but the main thing is that they take them on board and are taking positive messages back to colleagues.

I left Wednesdays event, my second of the day, on a real high, it so so good to have the staff listen to your issues, accept them and undertake to help improve.

So why the misery?

On Thursday I was due to attend a carer group to talk about the process, to encourage people I know have issues to come to a special big event where we were preparing to bring in literally dozens of staff to listen… The meeting was cancelled because the care worker didn’t show up. Only one other carer was there, so we had the meeting on our own… no problem there, a coffee and chat with someone I have got to know through the group over the last year.

From there I went to a Management Meeting of Carers’ Action, a Mental Health Carer support group I work with. Now I do have a bit of a clash with my colleagues, in that I use twitter, facebook, blogs, message boards regularly to tell my story, the story of so many thousands of carers who don’t have a voice, whether it is because of illness, lack of resources or lack of confidence.

My colleagues, and we are all no longer in the first flush of youth, are dead set against any form of interactive electronic communication, refuse to add to message boards oon the media because they are dangerous, and to be honest often are more concerned about upsetting the NHS or County Hall than in really supporting the carers. That said, we have achieved an awful lot over the last few years, but it could be so much more.

Thursdays meeting was not good, we have what many groups have, a number who speak good sense or stay quiet and a number who talk absolute bollocks and talk long and loud, and inevitably they carry the day when it comes to a vote. I left after two hours totally confused, we had made no decisions, although two of us kept trying to get back to the plot and ask for decisions, and I don’t think any of us took any projects or tasks away to do. It really was frustrating, and it got me down…

So Friday dawned, hoped for a good day, seeing my daughter, weekly shop, take my mum to the hospital for physiotherapy then visit my wife in hospital.

Earlyish in the morning, I got an email from the AMHS to say we had to cancel the special “In Your Shoes” carers event because we had only two people registered an interest in coming, we had long conversations and decided to reschedule it to run alongside another group to make it worthwhile.

I was thinking we are doing all of this to help these people and they don’t want to help us… I know it is hard to do it, it is difficult to talk about a bad experience in the Mental Health Service for an hour, but I know the staff are well trained to cope, and were so supportive and empathetic with everyone, that everyone who attended to talk went home happier and more confident when they left

I got the message out to all of my contacts, only one of whom had responded to my earlier emails inviting people to the event, about the rescheduling. Later in the day I got a message forwarded from the NHS co-ordinator, a bitter attack from the leader of a carers group, basically criticising me and saying we were being discriminatory and excluding the ones who wanted to go on that particular day.

Now, I woulod have thought that this Carer Support leader, who knows me, knows my story, knows about the depression and lack of self esteem would know better than to go effectively over my head and not involve me. That upset me immensely, another blow I didn’t need, on top of knowing the very people we are fighting for don’t want to cooperate.

These things, however, were not going to get me down, they were relatively small issues which I would cope with reasonably well at present.

It was the last thing that got me…

When I got to the hospital my wife was looking very sad, now she can no longer read, sew or do any of the things she loves, she cant get up and look after her washing herself, cant dress herself, needs help to eat, and worst of all can’t communicate now. We talk to her, have no idea if it is going in and registering, there is no clue.

We went and sat in a quiet room and I started to talk about the grandchildren, as usual, now I love my children and grandchildren to distraction, so does she, but she doesn’t seem to remember them without a lot of prompting, she was looking at a photo album we had done for her and I realise there were tears running down her cheeks.

She couldn’t say why, couldn’t say if she was upset… it is hard to witness that. Gradually the tears became a torrent, and she was sobbing. I got one of the nurses, they are all angels, and she came and gave her a tablet (lorazapam I think) to calm her. She continued to sob, no amount of hugging or comforting made it any better, didn’t stop the tears… gradually she fell asleep, but was still sobbing in her sleep, after 20 minutes, it was getting near to meal time, so I thought I should wake her and go, so she could eat… gently woke her and she continued to sob… the nurses helped, I couldn’t take anymore… look I will never walk out on her, never desert her but it is more than I can manage to stay with her any longer than I did when she is that bad.

I came home, put the shopping away and realised I was crying, all the little frustrations crowded in and I blamed them for my upset… but it wasn’t that, it is obvious why I was so upset.

When you have shared a life with a person for nearly 40 years, had children together, gone through a miscarriage and life in general you are close, and there is nothing worse than seeing someone you love in this condition. It is truly heartbreaking, you want to give up, you feel guilty for having a life while she is so ill and missing any quality of life, missing seeing her cherished grandchildren growing, and they missing a grandma… life can be so cruel, I always come away feeling upset, but when you are with her for 90 minutes, and she is sobbing the whole time it totally shatters you… it really has been too much for me again.

Last night, I used facebook and talked to a dear friend for an hour or so, started to come back to myself, and today have been subdued but starting to get things back into control.

I will be back at the hospital on Monday, strong again, and able to support her as she deserves, but I can only do that because I can write it out of myself like this, I have special friends who will talk to me, who understand, and a lot of support and encouragement via the social network channels.

So for everyone out there who has supported me in any way, everyone who have said kind and supportive things, everyone who has shown they understand, thank you so much, without you I could have gone under again… I am coming back, and I will carry on fighting the authorities to get a proper level of service for mental health sufferers and their carers, I will continue to fight the system to try to remove the stigma that makes life so hard for all of us….

Finally, I am here for anyone who needs someone, check out @mralbionman on twitter, make contact, and I will help as much as is in my power to do so.

Bless everyone out there who is lost and suffering, may the pain ease, and you find some comfort.

Whats in a Name?

How often have you heard someone do something trivial, say chip a finger nail, and say they are depressed about it? How does it make you feel?

For most people, it will have no impact, for anyone who has suffered clinical depression, or cared for someone who has, that comment can make you angry. Normally when I hear the comment made, I feel angry, walk away, try to ignore it… more recently I have actually reacted to the person making the comment, told them precisely what I thought, and how offensive the remark is.

Are you still with me? Then you probably have experience of depression, and I am with you, ready to help as much as I can. For the most part that is by fighting my battles with the local Adult Mental Health Service so totally screwed up my wife’s treatment and pushed me into depression feeling suicidal, and further my work with voluntary groups supporting mental health carers.

Hopefully some of my experience, which appears throughout my blog, will resonate with someone, show them they are not alone, show them there is help to be had and people are fighting for the cause. Maybe someone will be inspired to pick up the challenge and get involved themselves. It is at times frustrating, but also exhilarating.

Any improvements we can achieve will of course benefit, in some little way, every mental illness sufferer and carer.

I have often heard people referring to people who seem ‘different’, who have a mental illness of any kind, use the phrase “there’s something wrong with him!” Yes, there is, the person has a mental illness… you would use a term like that for someone obviously racked with cancer would you? No, because it is an insulting and offensive comment, and you don’t treat cancer victims like that.

Let me be clear, I have seen too many people close to me lose the battle with cancer to ever consider trying to belittle it, it is an awful, destructive illness, which all too often proves fatal. I only use it here to try to give an example. There is no offence meant to anyone involved with cancer, and certainly no intention to minimise its destructive power.

My point remains, people treat sufferers of mental health differently. Unless you have been personally involved you may well not understand the nature of depression, may not understand the destructive power it has, not only to the sufferer, but to their carer, and the whole family.

That is why it doesn’t seem incongruous to describe yourself as ‘depressed’ when you really mean ‘disappointed’ or ‘a bit down at the moment’.

What does depression look like, well, it can be different from person to person. In my direct experience depression stops you getting out of bed in the morning, stops you caring about yourself because your self-esteem and self-confidence has gone, you don’t bother to wash, don’t bother to dress, can do nothing for yourself. The cleaning becomes irrelevant, the house gets dirty, you can’t eat or drink, often you think you don’t deserve to because you value yourself so little.

Your relationships suffer because all the domestic work, as well as wage-earning and caring falls on your partner who then has to work virtually around the clock to keep things going. This leads to relationships stretching and potentially breaking, you lose contact with family and friends because the patient cannot go out or socialise, and the carer has no energy or time to do so.

Other people suffering depression display different symptoms. Sometimes the pain of isolation, of despair, of lack of motivation of pointlessness can push you the other way… you make extra effort with appearance, you prepare a perfect smile for the public and say “I’m fine” even though you are hurting so much inside, feeling so desperately alone, isolated, pointless, un-valued, un-wanted.

This situation is what can lead to self-harm or self-motivation. Self-harm is not about attention seeking, it is about the mental pain getting so unbearable that you have to inflict physical pain because you can cope with that, you can get plasters, stitches, painkillers and the rest… you have a pain you can cope with.

So, next time you chip a nail, don’t tell me you are depressed, or I will react…

The trouble is, I understand this, all sufferers understand this but most others don’t, so they see no problem with claiming to be depressed… they then here people who are genuinely suffering from clinical depression putting on a brave face and think their problem is as trivial as a broken nail.

No-one chooses mental illness, and because so many people equate depression with a minor mishap, people do not appreciate how you are suffering, think you are being a drama queen. They even make comments like “pull yourself together” which is one of the most ignorant, heartless and offensive things you can say to someone suffering depression.

So, I am looking now at the celebrity culture, at the shallow majority out there who use inappropriate words to draw attention to their selves. There are other examples, how often do people with a bit of a cold claim to have the flu?

Please, let us try to use language more appropriate to the situation, depression is a serious, debilitating, destructive nightmare of an illness… it is not a weakness, not a chipped nail…

As long as people use the names attributed to mental illnesses to trivial day to day issues, the public at large will never be able to associate them with the destructive illnesses they are, will always believe that the illnesses are minor, and consequently will never be able to understand the how serious they are, never understand the indescribably horrors that sufferers go through, and never understand the massive pressures and stresses that build up on the carers.

If this persists, mental illness will always be a Cinderella illness, never get the support or understanding it needs and things will never improve for the sufferers or their carers.

How and Why I work to support Mental Health

I have several times been asked how I got involved in campaigning for the support of mental health sufferers and their carers, I was even once told my efforts were inspirational. No false modesty here, but there are others in a far worse place than me who do far more. I like to think though that I do my bit.

I first got involved in campaigning because my wife, for who I have been a carer since 2003, has spent the last 2-1/2 years in hospital, still without diagnosis except the confirmation that she cannot now recover and will now have to go to residential care.

Throughout her time in the clutches of the Adult Mental Health Service, 30 months, I have met some wonderful professionals, nurses, OT’s, Doctors… but I have met far too many who are simply not good enough.

For the first 18 months the treatment she, and I as a carer, received was little short of disgraceful. I have raised complaints about it, talked to the Trust received nothing but dishonesty and apathy.

I had been a carer for nearly seven years before I realised I was a carer, and as I learned, I came to understand that many of the problems we had faced should not have been. Had I known then what I know now I could have made things better for everyone.

The problem is, the AMHS treats patients and doesn’t support the carers, who are crucial to the recovery process. The carers are not made aware of how the system works, are never told about their rights and are left in ignorance so that the Trust, it seems, do not have to fulfil their obligations as they are not challenged.

During 2010 I was so frustrated by things, so wound up and tense that I thought I would crack up. I did lots of research and finally found myself supported by Rethink (Mental Health). My carer support worker proved to be an genuine angel, and has given me so much in getting my life back into some form of control. She also gave me contact with a legal advocate (LAMP) who supported me with my complaints, and directed me to an open day with the Care Quality Commission who were researching into the experience people were having in the AMHS.

I went along and also met John, who is chair of Carers Action, local carer support group.

I also started to attend meetings with the LAMP to discuss mental health support issues. At one of these I again met John and was invited to join the Carers’ Action Management Committee . Through my connection with the LAMP  I also attended some meetings with another local group, Genesis, who were running some education programmes with the Acute Psychiatry wards.

Through these groups I was meeting individuals from various other local support groups, as well as the service providers from the County Council and NHS. It was clear that Mental Health issues were getting scant support from the professionals, and I knew I had to do what I could to improve things.

I simply started to attend meetings with the various groups until I decided which ones were most appropriate for me, and am now an established member of the management committee  of Carers Action, and attend Leicestershire LINk mental health group meetings.

Through both of these groups I get invited to consultations and briefings by both the County Council and NHS which serves to increase my knowledge and list of contacts, and I believe, therefore my potential influence.

Whilst getting involved in these various groups and developing my contacts and knowledge I was also pushing ahead with my complaints against the NHS service. This was a very frustrating process as the investigation was poor, was not allowed to investigate staff performance, and abandoned half way through. I had meetings with the Chief Executive, which diverted me to an administrator, who, based on my story, recommended some 14 procedural improvements.

I continued to push for realistic answers to my complaints, and eventually met the Director responsible for Adult Mental Health, he outlined a forthcoming project to be carried out by an external consultancy, April Strategy. I subsequently met with April Strategy who invited me to participate fully in the project.

The project, headed “Improving the Experience” features “In Your Shoes” where mental health service users and carers speak one to one with service providers to outline their experience within the service, whether good or bad.

The professional listener takes notes throughout then everyone joins into work groups to discuss the issues raised. There are some 25 listening events scheduled, and so far they are proving to be very successful. These events also give me an insight into the workings of the Trust as well as other peoples experiences.

I have discovered the merits of twitter and blogging to compliment facebook to spread my message and experience further , and also to hopefully show others that there are people fighting their cause and that there may be some hope at the end of the line.

It is too late now to help me or my wife, the damage is done and you cannot turn the clock back, I can however, do my damnedest to help to influence improvement in every aspect of mental health care. It has become a driving force in my life and I will keep fighting the cause as long as there is need, and I can keep going.

It would be wonderful, to ask every carer and their service user to take up the cause and make their voices heard, but clearly that is not possible, would not be fair to them.

What I propose to do is to continue this fight, to continue to offer support to anyone who needs it, and to help anyone who wants help to get involved.

The inspiration for this has been Rethink Mental Health, and I simply want to put something back to show my undying gratitude for them.

Also I owe it to my wife to continue the fight, to prevent others suffering the abuse and negligence she has suffered at the hands of the trust, and to do all I can to help sort it out

Why am I still angry

Am I angry about something to do with the Adult Mental Health Service. You bet your life I am.

Since raising my complaints in Feb, March, July and September 2010, I have followed the letters up, had several meetings, with all sorts of people , including the Chief Executive Officer. I have been lied to, fobbed off, ignored, but I have not had any answers or explanations.

Part of my complaint referred to the many shortcomings of the so inappropriately named Crisis Resolution Team. I had a meeting 18 months ago at which I was promised some answers and explanations.

I met the team manager last February, and made my points, he promised a letter in two weeks with some answers, when it had not arrived in the summer I wrote again. Apparently he had not written because our meeting was informal, he assumed I did not want a response. We met again in November, I was promised a letter early December after a team meeting. Guess what? Still nothing in mid January.

After a meeting with the Drioector responsible for the AMHS I was invited to become involved in a project called “Improving the Experience” where carers and service users will talk one-to-one with service providers to explain their issues, and for the service providers to start to understand to issues. From this a process to educate and improve will be brought in and we will see improvement.

I have also met and had a long and informative, both ways, conversation with the current acting Chief Executive, and a meeting to look at the proposed outline of a new acute pathway model.

These meetings, and the Improving the Experience programme fill me with optimism for the future, it really looks as though they are seriously looking to understand the problems and to make changes. I can’t get too excited yet, not until we see the results of the processes, and of course the previous CEO is due back which could change things again.

So, this looks encouraging so why am I still angry. I’ll tell you that now.

During the 18 months leading up to the first complaint, and indeed through the year and a bit between the first complaint and my wifes transfer to a ward where the staff actually know what they are doing, and take a pride in doing it, there have been countless issues to complain about.. some 43 pages of A4 of complaints to raise.

Some of the things that I have seen staff do, not only the ward staff, but also consultants, Community Psychiatric Nurses, Community Health Centre Staff, Social Workers and the Chief Executive himself, have been mind boggling bad. These are not issues about money, they are all about attitude and basic competence.

Several of the incidents have been so serious that, were I in charge, the people involved would have been dismissed instantly. Some of the transgressions have been severely negligent bordering at times on being close to criminal..

What has been done about these individuals? Absolutely nothing. Nothing at all.  They have been allowed to behave disgracefully, with the blessing of the Trust. It looks to me as though the Trust condones this sort of incompetence and uncaring callous behaviour.

Why are they allowed to do that? It is because of two things. Their own internal procedures allow them to investigate complaints thoroughly, but only to the extent that they investigate that there are procedures in place to deal with the situation. There is no procedure in place to investigate whether the procedures were followed well or badly, no procedure to investigate individual performance.

Even worse than this, the watchdog, the Care Quality Commission (CQC) inspects the service on a regular basis, but after a meeting with them to discuss their whitewash of the shambles that is the Brandon Centre and Bradgate Unit, they say that they can only investigate whether there is a procedure and whether it has been followed. No way to investigate the quality of the performance.

Let’s think of this. You go into the hospital to have a leg removed, they remove the wrong one, but all of the procedures have been followed, albeit very very badly. Their conclusion is that nothing has gone wrong, there is nothing amiss.

Although the new initiatives are aimed at improving the standards, and making individuals accountable for their errors, can we be confident that this will happen. I am not confident.

But the thing that makes me very angry is this… staff have been allowed to act in an irresponsible, negligent, dishonest, uncaring, uncompassionate and incompetent way and have not even been told.

Simply because there are procedures in place, their disgusting performance is accepted by the Trust

Justice for Jane Clough

Justice for Jane

It has often been said that the law is an ass, and in so many ways it is, but overall I think it is fair to say that the law, and its application, in the United Kingdom is as good as anywhere in the world.

However, mistakes do happen, that is what this is about. A judge made a decision that was to cost a young woman her life, leave a young baby an orphan and destroy the lives of the decent, loving parents.

Let us go back to the beginning of this story. Jane Clough was a young woman, a nurse in the A&E department of Blackpool Victoria hospital, in a relationship, and expecting a baby. On the face of it, you would say that the future looked rosy for Jane and her family. She was a good nurse, and would prove to be a good mother to her as yet unborn baby.

Sadly, as can happen the relationship became unstable, Jane was beaten bullied and raped by her partner, a body builder with a steroid fixation, even whilst pregnant, and more so after the birth of the baby. Understandably Jane chose to end the relationship, and reported the assaults to the police.

It is an incredibly courageous step to do that, so many women become accustomed to it and put up with it, it is so important that people can display this sort of courage and speak out about domestic violence, it gives society a chance to understand what goes on behind some otherwise respectable doors and gives the authorities the chance to deal appropriately with the perpetrators.

This has the effect not only of taking the offender out of society, of protecting the victim, but also keeps the theme in the public consciousness, which can help preventing it becoming an even more taboo subject. Only when these things are out in the open can something be done about it, only by talking about can we, the public, start to understand the pressures, and see the tell-tale signs. For this reason it is important that the subject is not swept under the carpet.

The partner was arrested and charged and was due to stand trial for his violence and rape, the Police and CPS opposed bail strongly because they perceived that Jane could be at serious risk if he was out in the community. The judge took different view, and granted bail.

Now, in the event, Jane and her family, the Police and the CPS objected to bail being allowed because they felt Jane would be at risk. There is no appeal against this decision for the victim. The victim, and indeed the family and the Police, simply have to accept the decision, however wrong, and try to cope with the fear.

There was no intensive police protection for Jane, who lived in fear of her ex-partner, so much so that her life was put on hold, she moved back to her parents with her baby, and was afraid to leave the house, always fearful that he was watching, waiting, determined that whatever it took she would not testify in court against him.

This state of affairs continued for untold weeks, gradually Jane started to regain some confidence, and finally went back to work at the hospital after her maternity leave, although still living with the baby, at her parent’s house.

Of course the parents fully understood the reason for Jane’s fears, knew her fears were justified, so their lives were also put on hold while they tried to maintain a quality of life, in fear of the violent ex-partner.

Sadly, one night when crossing the hospital car park to start her shift in A&E Jane was alone, isolated, when she was confronted by her ex-partner. He stabbed her repeatedly, viciously, and she died there, on the car park.

Jane was an innocent victim of a disturbed mind, of a violent and abusive man who the Judge had decreed was safe to be left in the community. Clearly the judge was wrong.

I am not qualified to say if the Judge’s decision was enforced by the law, whether his powers to refuse bail were limited, or whether he made a tragic, fatal, misjudgement.

Whichever is true, it is of no consolation to the Clough family. Jane is dead, and would be alive today if this man had been help in custody rather than being granted bail

It is obviously too late now to help Jane, but it is essential that the gaps are plugged, that this cannot happen again, that no more loving families can be so destroyed by such a bad decision.

Since losing their daughter, John and Penny Clough have displayed tremendous dignity and courage in trying to come to terms with their situation, and by launching a very positive and courageous campaign to get the laws changed to prevent any such tragedy striking again.

There request is simple, to allow the victim to object to the decision and have it reviewed. Had this been available at the time, Jane would be with us still today.

There is a petition available requesting MP’s to support an amendment to the bail bills to allow an appeal by the victim. This is such an important bill that every one of us should be taking a stance, signing the petition and lobbying our MP’s vote for the amendment.

To sign the petition, go to:

http://www.petitiononline.co.uk/petition/justice-for-jane-clough/3123

This could happen in any of our families, 1 in 4 people at some time suffer mental illness and that can lead to irrational and violent behaviour. Please, let’s not wait for another Jane Clough to happen, let’s do something positive about this right now.

We can only admire John and Penny Clough in their courage to fight this campaign, the dignity and nobility that they have shown, I think the least we can do is offer our compassion and support.

It is too late of course now to save Jane, but if any repeat incidents can be prevented by the amendment, perhaps Jane will not have died in vain. We, as a society, owe it to the brave Clough family to support their cause.

Please sign the petition, help to bring some justice to victims of such loathsome behaviour, prevent further unnecessary, tragic deaths.

Holistic Treatment in the Adult Mental Health Service

I want the Mental Health Service, in all their guises, to start treating their patients in a more holistic way. So, perhaps I’ll start off by saying what I mean by holistic.

Simply, it is by not only treating the patient, but also by treating the carer/family and involving them in the team treating the sufferer.

In my experience, holistic treatment of patients is unheard of in the hospitals, though here I do have to make an exception in the case off the Willows Unit, which is a treatment and recovery centre, a specialist facility, who are an absolutely wonderful unit, who fully understand and apply the principal of holistic care.

It has to be said that the Willows unit, being a specialist, has a higher staff to patient ration, so that it is easier for them, but if the other units would embrace the philosophy, they would find their workloads and stress levels reduced, as well as providing better care for everyone involved.

We can split the service into three primary stages, being pre-admission, in-patient and community care post discharge.

We will start by looking at the pre-admission stage. Generally the first step is to visit the GP who , depending on the situation, may offer one of a number of solutions, ranging from “keep away from the stressors” via medication, cognitive behavioural therapy and referral to a psychiatrist. Often the first visit will be in the relatively early stages, and the doctor will treat the patient as for a physical illness.

However, once the problem has reached the stage where the patient needs a professional to keep an eye on them, involving either the County Crisis team or support from Social Services, it is important to fully involve the carer and the extended family if appropriate.

The professionals must remember that they have been trained to deal with mental illnesses, that they only see the patients for a short period. The carer, be it husband, wife, parent, child, has not been trained, has the situation to deal with around the clock, 24 hours per day, seven days a week, there is no break and they do this caring with no support, no real advice and no training. This is an all but impossible situation. The carer doesn’t know how to cope, how to deal with the patient, and can get no respite.

If the professionals could understand this, at the first appointment they should get to know the patient and the carer, to learn what skills and knowledge they have, and to understand the needs of both patient and carer, and provide the support and training to help the carer as well as the patient.

The implication of the professionals not engaging with the carer is that the carer becomes stressed, has a reduced tolerance to the symptoms of the patient and cannot help them properly. This leads to the patient not being properly cared for and to the carer becoming exhausted, frustrated and struggling to cope with the situation. Holistic treatment will give pointers into how to deal with the patient, and give the professionals a much better idea of the circumstances of the illness and care as well as the medical details. This can only benefit everyone concerned

Proper support for the carer at this stage will do many positive things. It will give the carer some real input into the treatment, educate them and allow them to support their patient much more effectively.

If the situation does not improve, or deteriorates, the next stop is likely to be admission to one of the acute wards in hospital.

On the ward, the way forward is to ensure that everyone is working towards the same goal, the recovery of the unfortunate patient. The way to do this is to involve the family, that is the primary carer and the close family in the treatment.  If they know what is happening, and if the ward staff consider their health, both physical and emotional, as well they will get more support from them, confidence and rapport can grow and a great deal of work can be taken off the shoulders of the ward staff.

I think this is rather easy to achieve. When a person is admitted, there is a fair chance that their carer will be with them. Do the initial admission documentation, explain to the patient and carer ward protocols, who is who, who will be involved in the treatment. That way everyone knows what is going to happen

Show the patient and carer around the ward, there could be some issues of confidentiality and dignity in the case of a mixed sex ward, but these can be overcome with thought.

The carer has a wealth of knowledge and experience of the patient, both when they are well and when they are ill, they will know the likes and dislikes, it is important to have an easy dialogue with the carers to extract this knowledge, don’t forget the carer is not a specialist in Mental Health Care and may well not know what is relevant, what is important and what is irrelevant, so it is important to have these discussions, and record the answers.

There is a major question I believe around the protected meal time issues. I have been on the ward during the protected meal time and seen a patient Take a dinner, throw it all into the bin untouched only to be told at a ward round next morning that they had eaten a good meal and left nothing on the plate. This is simply not acceptable as for many patients eating is a crucial component of the care and treatment. We cannot, however, blame the nurse in question. When there is a ward of 18 people, it could be that 9 or 10 have eating issues, but there may be only two or three staff to supervise them, in which case they cannot be expected to be able to oversee everyone, but of course that is no help to the patient, and is very upsetting to the carer.

By all means have protected meal times, but at present it looks as though they are protected purely so that carers are not aware of the shortcomings, simply invite the carer to stay with the patient to assist with meals.

Most carers will be glad to do that, and there are so many benefits, including better supervision of patients at meal time and inclusion of the carer.

For a carer, regular visiting of a patient on a psychiatric ward is incredibly draining, and incredibly distressing. If the carer feels they are not included in the process the situation is even worse. If the carer becomes ill as a result, which is not uncommon, their support of the patient deteriorates, putting more pressure on the ward staff.

It would not be difficult for the staff to simply welcome the carer and assess their well-being in a short conversation. The staff can then help to keep the carer as well as possible, which will also in the longer term, help them in their work.

Carers should always be invited to Ward Rounds, they will often not be able to attend because of work commitments of course, but the invitation shows a desire to include them, which is important. The ward round itself should be open, honest and effectively run. The medical staff should be able to draw on the knowledge and views of the carer in support of the patient, and should be willing to be sure that the carer understands the current situation and the future plans for treatment, as far as they are known. It is no help to the carer to be told, as I have been, that we would rather make something up than say I don’t know, and to ask me questions about the patient that they should be telling me.

This simply undermines the carers confidence and respect for the medical team, and of course does not help their emotional or physical health, as it simply causes frustration and stress.

Finally, we need to consider the care after discharge. The discharge plan must be for the benefit of the patient but crucially must also take account of the carers condition and circumstances. If it doesn’t the carer is put under more pressure, more stress, and their health can suffer, and have an adverse effect on the carer, in the worst case, both could end up back in hospital.

It is so important that the carer is fully involved in the treatment of a patient. The carer is a crucial part of the team and if not included, can feel abandoned, suffer severe stress and end up as a patient. Not only that, but when not included the patient will lose confidence in the medical team, lose respect for them and this can lead to tensions and stress that make things more difficult for patient, carer and service provider. This makes everyone’s  job, and life, so much more stressful and difficult, and is very negative.

In the best run wards, as with industry, mistakes will be made as we are all human, none of us is perfect. When things do go wrong, whether in reality or in the perception of the patient/carer it is important  that the staff should listen to the issues, and either reassure and explain why the perception is wrong, or they should accept the criticism, highlight the problem to the staff concerned and do all possible to ensure that it doesn’t happen again. When the staff are defensive, and refuse to listen to and accept the criticism, it further undermines the carers confidence and trust.

I have seen this holistic approach in action in the unit on which my wife currently is. I have seen how effective it is, and how much more relaxed the patients, carers and staff is at all times. It is wholly conducive to everyone working together, a fully supportive network working for the improvement of the patient.

I have also seen the opposite, where carers are viewed as a nuisance, disregarded and generally treated with contempt. I know which approach I prefer, and I am sure that the staff would agree.

It is not much to ask…please treat the patient as well as you can, by fully involving the carer and family in the treatment, and developing a fully effective team to help the patient