Prone restraint in mental health hospital

My partner and I recently finished Season 4 of Orange is the New Black (highly recommend), and one episode particularly resonated with me. In fact, it made me cry, and I’m not a crier.

The episode centred around an inmate named Poussey, who, in the midst of an ‘incident’ within the prison, was forcibly held to the ground by a prison guard for an extended period of time, whilst the prison guard was being tackled by another inmate.

My partner had no idea what the result of this act would be. I knew, through my work within Public Law and mental health, and I knew that the use of such restraint can bring about death.

Prone restraint is where a person is held to the ground in a face-down position and is physically prevented from moving from that position. Too much force and the result can be fatal. The concern is that prone restraint can result in dangerous compression of the chest and airways, thus placing the person being restrained at a huge risk.

The majority of NHS Trust policies on the use of such restraint suggest that it ought to be used only as a last result, following unsuccessful attempts at de-escalation. Unfortunately, I am aware of incidents where prone restraint appears to be used as a first port of call, often on those with severe learning disability, and often in mental health hospital.

I appreciate that professionals within such a setting must keep themselves, the service user and other patients’ safe, but it is frightening that use of prone restraint remains commonplace, and remains the norm, despite policy suggesting that it should be used only in the most extreme circumstances.

There is a reason that prone restraint ought to be used as a final option – in 1998, a 38 year old gentleman named David Bennett was held in the prone restraint position by 5 staff members for a 25 minute period, resulting in his death. An independent inquiry (bbc article 18/06/13) found that Mr Bennett died as a direct result of prolonged face-down restraint and the amount of forced used by staff.

Did this end the use of prone restraint? No. According to Mind (2013), there have been 13 reported incidents of restraint related deaths in the UK since this. This figure is only for those detained under the MHA 1983 and included only those deaths which were actually reported. The figure is therefore likely to be higher, particularly taking into account the years following the study.

Shockingly, as someone living and working in the North East of England, Northumberland Tyne and Wear NHS Foundation Trust responded to a freedom of information request from Mind and stated that, in 2011-2012, prone restraint was used 923 times.

This is not uncommon, however, with Stewart et al (2009) finding that manual restraint is used 5 times per month on an average mental health ward. According to Mind, one Trust which responded to an FOI request stated there had been 38 incidents of prone restraint, whilst another said there had been over 3000 incidents.

Mind’s recommendation from the 2013 research was, of course, that the government ought to end the use of face down physical restraint.

Has this happened? Of course it hasn’t. The figures speak for themselves. Prone restraint continues to be used, on a large scale, and for as long as this is the case, there will be more and more restraint related deaths.

Not only ought the risk of death be enough for professionals to use every possible de-escalation technique available, but the use of such restraint can cause physical injury and psychological harm. Mind (2013) provided a quote from someone who had experienced such restraint; “it made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better”.

The free reign to use prone restraint is frightening. The fact that it is used to varying amounts across the country is worse, because it suggests either that instances of prone restraint often aren’t reported, or that staff aren’t provided with the same training across the board. I fear that both are correct.

Those detained under the MHA 1983 are in hospital, usually, for assessment and/or treatment. The mental health hospital ought to be viewed as a place of safety, where care is provided to those in crisis. The possibility of attending hospital and dying there due to an excessive use of force by those who were supposed to be caring for you, is a frightening concept, but it is one that is all too real.

Patients need to feel safe in the hospital environment. The use of prone restraint must be ended.

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#semicolonproject

On 10th July 2015 I had a semi-colon permanently inked on my skin. It was something that I had wanted to get for a while, given what it means to me, but I had no idea where to put it.

I already have two tattoos so the pain wasn’t so much of an issue, but I wanted the tattoo to be somewhere where I could see it. This ruled out the ankle or behind the ear.

My semi-colon project tattoo is my first, and likely last, visible tattoo. I chose to get the tattoo on the inside of my wrist, wrapping round the right hand side (on the bone because I’m THAT brave). The placement means that from lots of angles you cannot see the tattoo.

It might also be difficult, from certain angles, to know that the tattoo is a semi-colon, because if I extend my arm out the semi-colon is on its side. The reason for this is that it looks like a perfect semi-colon when I look directly at it. It is there as a symbol of power for me that I can get through anything that life throws at me. Now, at the stage where I am in life, I feel as though I can look back on darker times and be proud of how far that I have come.

Lots of people do not, however, make it, and that is the point of the semi-colon project. For those who are not aware of the message behind the semi colon image, a semi colon is used when a writer could have ended his sentence but chose not to. In essence, the sentence represents life and the writer the person with mental health issues. It is about raising awareness mainly of depression and suicide, but I view it as raising awareness of mental health in general.

The hope is that people will see these semi-colon tattoos popping up and will enquire as to what they mean, which in turn will raise awareness. Whilst doing this, it is also a great comfort to me when I look at my tattoo to know that things are never as bad as they seem.

Your story isn’t over #semicolonproject

semicolon project

Me, myself and Anxiety

“The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts)”               Scott Stossell, ‘My Age of Anxiety’

The major problem when it comes to Mental Health issues is not the person, not the illness, but the fact that such issues are surrounded by a cloud of silence and stigma.

Mixed anxiety and depression is the most common mental health disorder in Britain, with 9.7% of the population experiencing it.

During my second year of University, the pressure of exams was looming and I found myself in a place I had never previously been – one filled with anxiety, feelings of failure and a constant fear that I would never be good enough to embark upon the career that I had worked so hard for.

At the time that my journey with anxiety began, I was putting in 14 hour stints at the library – that seemed like normality for the majority of students at my University. I thought that I was fine, I had always prided myself on my emotional strength. That was, until it came to the date of my Contract Law exam and I had a panic attack in the library whilst I was attempting to read through my revision notes. It had taken me around two hours to read one page and it was clear that something was wrong. I didn’t want to have a panic attack, but I couldn’t stop it and, honestly, I had no idea what was going on. I didn’t know what a panic attack was, but I was left shaking and crying uncontrollably on the quiet floor of the library, 2 hours before what was, in my mind, the most important exam of my life. Of course, it wasn’t- that was the anxiety talking.

I had been revising for around two months – I should have been ready for exams. I was ready, but my brain would not let me pass this wall of panic in front of me.

Funnily enough, I actually had no idea that there was a problem with my mental health until the day that I had that first panic attack. Following that, things started to click in to place and I realised that, for the two months prior to that panic attack, revision had taken over my life and I was rarely eating and barely sleeping. My room was a mess (which was very unlike me) and, in all honesty, I was too.

I sought help from my GP, and utilised the help of IAPT. I was given medication to help to control my anxiety (Citalopram worked really well for me and I, thankfully, haven’t had to chop and change pills to find what suits me). I attended Cognitive Behavioural Therapy which taught me to change the way that I thought. Apparently, doing this means that I am in a minority – a YouGov survey of 2300 adults in Britain carried out for Mental Health Awareness Week 2014 found that one fifth of people who have experienced anxiety do nothing to cope with it. Indeed, fewer than one in ten people have sought help from their GP to deal with anxiety.

At first, admitting that I had a problem made me feel that I was weak. Once I had come to terms with my anxiety disorder and felt that I could tell those closest to me about it, I found that most people’s instant reaction would be to ask ‘Well, what are you anxious about?’ There was absolutely no malicious intent behind that question, it was just a question that simply could not be answered. As Critchley (2009) has stated, “If fear is fearful of something particular and determinate, then anxiety is anxious about nothing in particular and is indeterminate”. It can be difficult to come to terms with the fact that you have anxiety whilst at the same time having absolutely no idea why.

Now that my anxiety disorder is behind me and I have learnt to cope with any feelings of anxiety that I may experience, I feel slightly angry when I look back at that time of my life – that I didn’t know that I had a problem until it was too late. If only more people spoke out about mental health issues, and the help available were promoted further, people may not have to wait for their mental health issues to manifest themselves externally before they are able to receive help.

People simply do not talk enough about mental health issues and, even whilst writing this, I feel a sense of worry that people may look down upon me because of my experience with anxiety. That is wrong.

In the UK, one in four people will experience some kind of mental health illness in the course of a year. That’s a lot of people, and it’s likely that the majority of those people are too frightened to speak about their experiences, for fear of discrimination and being ridiculed.

We need to raise awareness of mental health issues and let people know that it is ok to speak out about their experiences. Speaking of your experiences with a mental health issue, whilst a bit daunting at first, is actually incredibly refreshing and, you never know, you could be the difference between someone suffering in silence or attending their GP and getting the help that they need.

During Cognitive Behavioural Therapy, I learnt more about what a panic attack was, and what the early signs of an attack were for me personally. Some techniques which helped me included focusing on something other than the attack. It used to be that I would be so worried and anxious that I would have a panic attack that I brought one on myself. My therapist told me to focus on colours, perhaps the colours of different leaves on a tree. I personally preferred to rub tea tree oil or some other scent on my wrists and simply focus on smelling that. It sounds so simple but it really did work.

Another simple thing that can make a huge difference is to talk about any issues you may be having with those around you. I was able to talk to my friends and my partner who were incredibly helpful and, as some of my friends also had mental health issues of their own, I was able to use some of their advice (the smelling scent distraction actually came from my best friend whose mum is an aromatherapist).

I also really like ‘The Quiet Place’ at http://thequietplaceproject.com/thequietplace which had the effect of basically bringing me back to normality. For me, my anxiety was mainly linked to exam stress and the general hardship of life. The Quiet Place is great as it allowed me to take a step back and really put my fears into perspective, the majority of which were totally irrational.

Mental Health is no longer something that should only be spoken about behind closed doors and I hope that we, as a society, are now moving in the right direction towards a better understanding of mental health issues and a more accepting approach towards those who suffer. In talking about mental health issues, we raise awareness and it is that awareness of such issues that will help those suffering to get the help that they need.

I have struggled with anxiety and have overcome it, hopefully by speaking out we can help others to do the same.

Depression and Parkinson’s Disease

Today’s headline reads ‘Depression may be factor in Parkinson’s risk’. This comes from a Swedish study where more than 500,000 people were tracked for over two decades.

The finding was that people with depression may be almost three times more likely to develop Parkinson’s disease.

Parkinson’s Disease is something very close to my heart – my grandfather was diagnosed with Parkinson’s Disease rather late, as doctors thought that his troubles may be caused by a past heart operation, leading them down the wrong path. Diagnosis took a while and the disease took hold of my Grandad pretty quickly. I was 16 years old when he passed away, and in the end he was bedbound, unable to swallow, blink or talk. It was awful to see, particularly given that only 5 years prior to that he was dragging me round in a sledge at the age of 76 when I was quite clearly too heavy.

Often, people associate Parkinson’s Disease with shaking, but my Grandad never really had that and, though people say that you cannot die from Parkinson’s Disease, that is what went down on my Grandad’s death certificate.

Because of my experience with Parkinson’s, I really want to make whatever difference that I can. Parkinson’s UK is not government funded and therefore relies entirely on donations from the public. Two weeks ago, myself and my partner walked 6 miles for Parkinson’s UK and raised just under £350 in the process. It really isn’t a huge amount but the charity was very grateful.

parkinsons

The problem with Parkinson’s is that there isn’t enough money available to fund research into the disease. In truth, people don’t seem to view Parkinson’s as one of the ‘big’ diseases (for want of a better phrase) and therefore know very little about it.

Parkinson’s is a neurodegenerative disease, affecting around 127,000 people in the UK (or one in every 500). It is the second most common neurodegenerative disease after Alzheimer’s and it is a condition which causes loss of nerve cells in the brain. The disease is categorised by shaking, slowness of movement and stiffness.

This study has now linked Parkinson’s and depression, though it is not certain as to whether depression is a “very early symptom” of Parkinson’s, or whether depression is a risk factor which increases the chances of developing the disease.

140,000 Swedish citizens over the age of 50, who had been diagnosed with depression between 1987 and 2012, were studied. Each person was matched with three control participants i.e. someone who had not been diagnosed with depression and who had the same year of birth and sex as the person with depression. It was discovered that 1.1% of those with depressive symptoms developed Parkinson’s. In comparison, the figure for those who did not suffer depression was 0.4%.

Interestingly, no link was found between Parkinson’s, depression and genetic or environmental factors – there was no link between one sibling having depression and the other having Parkinson’s. Crucially, when the researched adjusted for other conditions related to depression such as alcohol and drug abuse, the link between depression and Parkinson’s did not change.

The more serious the depression, the greater the risk of Parkinson’s disease. People who had been hospitalised for depression were 3.5 times more likely to develop Parkinson’s disease than people who had been treated for depression as outpatients.

This new study could really have an impact on our understanding of Parkinson’s Disease and our understanding of depression. My hope is that the articles on this study in newspapers today will raise awareness of both issues, and will encourage earlier, more accurate diagnosis in sufferers. Every single hour, someone in the UK is told that they have Parkinson’s Disease, and we need to work together to find a cause and ensure that people are able to live a long, happy life with Parkinson’s Disease.

Should workplaces screen for depression?

The world is still reeling from the news that 150 people had died on Germanwings flight 9525. Speculations began shortly after the crash that the plane had deliberately been brought down, by the co-pilot Andreas Lubitz.

With this suspicion in mind, focus turned to Andreas’ private life and what dark goings-on could lead him to kill 150 innocent people. One of the first things that reporters were very quick to jump on was the suggestion that he had depression because, of course, having depression automatically means that you’re going to do terrible things.

Nevertheless, it was Andreas’ history of depression that was the focus of investigations.

IMAG0123The Daily Mail went for this delightful headline – “Suicide pilot had a long history of depression – why on earth was he allowed to fly?” whilst The Sun simply stated “Madman in Cockpit”.

I am not going to comment on Andreas or Flight 9525, I simply wish to use it to highlight how quickly people, influenced by the media, can give negative connotations to depression, a mental health illness which the sufferer has no control over. No one chooses to be depressed, and it certainly does not make you a bad person if you have depression.

It seemed that the discovery that the co-pilot had depression was the piece of information that everyone needed to enable them to blame him. Now, in light of this, BBC News has recently asked whether there should be screening for mental illness at work. My answer, and that of BBC News, would be an emphatic ‘no’.

Screening is something that the majority of us are familiar with, it being mostly used in testing for cervical cancer. Screening is fantastic because it allows you to assess for a disorder in an individual who does not know that they are ill and who has no symptoms.

One well-established principle in medical screening is that there is a ‘latent’ stage where the disorder is present but it is not apparent to the individual. Not only is there no recognised latent stage of depression, but the idea of ‘symptom free’ depression is difficult to entertain.

Even if mental illness screening were possible, I would feel great unease if it were done in the workplace. In ‘testing’ for mental illness there is the automatic sub-conscious connotation that mental illness is wrong. It is wrong and therefore your workplace must know about it.

For me, screening for mental illness would add further stigma to those suffering, particularly if screening is introduced off the back of the story of Andreas. It would most likely serve to discourage people from speaking of their mental health issues and this can only be counter-productive.

Say that an employee has such a screening and a mental illness is discovered, what then? Are they fired? Are they closely monitored because they have depression and therefore there is a chance that they may endanger someone?

It simply does not make sense, at a time where awareness for mental health issues ought to be raised and stigma reduced, to screen for mental illness.

We do not need to screen for mental illness. What we do need is to encourage sufferers to get the help that they need and to feel comfortable in doing so.