Tuesday, 26 August 2014

the bankruptcy of a system where the prevailing culture is coercive

There are no winners in a game where casualties are the outcome.  There is nothing to be proud of.

Stratheden signposts
The problem with psychiatric system thinking and the biomedical model of mental illness is that any resistance is met with patriarchal decision-making and the infantilisation of the conscripts.  On both sides of the fence.  The staff also lose their agency but not their liability.  

"If you fly with the crows, you get shot with the crows": If you wish to be associated with a particular high risk and/or high profile situation and benefit from the rewards of that association, you have to accept the consequences if things go wrong - you cannot dissociate yourself. (Cambridge International Dictionary)

Forcing psychiatric drugs into a person is very risky, regardless of the label they are given beforehand (or after) so as to justify the coercion.  Mental health acts are laws that reinforce the coercion although they are meant to also safeguard the person being detained.  But in my experience the safeguards aren't safe and the Act gives more power to the enforcers.

Stratheden - view from Lomond car park
The risks of working in mental health leadership or as a psychiatrist is that anosognosia (lack of insight) takes root and capacity wanes.  A godlike persona appears, surrounded by their sycophants, and they believe their own press.  Regardless of relationship or scientific proof.  Because they say it then it is so.  Delusions of grandeur.  Madder than a box of ferrets.  (I can name a number of folk like this in Scotland's mental health world)

But it's not funny when people are being disabled by a coercive system and mothers are having to pick up the pieces.  I am really fed up with numpties at the helm.  Mostly men but some women too who have left their marbles back in the playground.  

There are more issues when there are less resources, as with Stratheden Hospital and the other Fife psychiatric settings.  You just need to compare the cost of a patient bed per week.  In Fife it is around £2000-£2500/patient/week whereas in Carseview it is £3000 and in the new Rohallion low/medium secure unit at Murray Royal, Perth, I hear it is £4000/week.  A general acute inpatient hospital bed is around £4500/week.

It won't just be about the money but also about the management of resources.  I met with the Fife heads of Clinical Psychology and OT back in 2011.  The former said she had no authority in Stratheden, the latter said she wasn't about "micro management".  They may have now changed their tunes.  But I do know that there was no psychology available or OT groupwork going on in either Lomond or IPCU wards in 2012.

I also met with clinical management back in 2011 after first raising concerns about Lomond Ward in 2010, and the meeting was a right waste of time.  They were defensive and patronising.  I was bullied.  At that time the leaders at Stratheden were not accountable to their "customers".  I expect things to have improved but have no evidence to prove it.

Stratheden- older wards

In 2012 we tried to access CBT for my son at Stratheden and we could only get Mindfulness, regardless of our trying to negotiate it with the clinical psychologist.  He would not listen.  It was his way or no way and I had to work through CBT techniques with my son.  Like keeping a dog and barking yourself.

I think the patriarchal nature of psychiatry has impacted negatively on Stratheden Hospital in particular, because of its lack of resource and coercive culture.  If they take the facilities out of the wards then the nursing staff will be left to their own devices.  That's what was happening back in 2010.  I raised the alarm to no avail.  Shooting the messenger was our experience come 2012.

We need psychology and occupational therapies in the wards, also voluntary organisations with a presence.  The more people going in and out of the psychiatric wards will lessen the likelihood of abusive practices (keeping it in the family) and patients becoming casualties.  I recommended this back in 2010.  But no-one listened to me.  

I hope someone is listening now.

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