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Re: A good article

Posted: Wed Jul 04, 2018 9:25 am
by Greta
I saw the article too and thought it was very good. Thanks to Mrs Average for making some supportive remarks too.

Re: A good article

Posted: Wed Jul 04, 2018 11:12 am
by jenny lucas
I know I sound unsympathetic, but it's really more from frustration!

To me, problems exist to be solved, and whilst I do understand that simply 'having' MH can make it impossible to appreciate that 'normal mentality' exists at all, or that it may even be 'achievable', nevertheless with so many folk with what I call 'affective' MH (ie, not the 'cognitive' MH such as schizophrenia, which interferes with the brain's ability to perceive reality), they just seem to spend their lives floundering around 'helplessly'.

I do stick by what I said - that in the end, it really boils down to finding out WHAT the 'best practice treatment' actually IS in the whole world (ie, within medicine itself, per se), and understanding just 'how effective' (or not!) that 'best practice' is (eg, CAN there be actually 'cures' or only mitigation and management, etc).

Then, knowing what CAN be achieved (ie, within psychiatric medicine), to try and obtain it. Yes, the NHS might well not fund it, and then that is the point at which complaints should be made - and it's at that point, grimly, that 'healthcare rationing' kicks in. Just what does the NHS spend its budget on? And why? Tough questions, tough choices. (I'm grimly aware of these from Cancerworld - that terminally ill patients are 'written off' because for them it is 'too late' and instead funds are directly towards other health care needs which are not so life-threatening, but far more treatable)

What appals me most about 'affective MH' is that it seems to last a lifetime! I don't mean the MH itself, I mean the 'helplessly floundering around' trying to get hold of treatments, to achieve a 'mitigated and managed' healthcare outcome, even if not a 'cure' (ie, recovery of healthy mentality).

I think of my niece, 'floundering around' being utterly miserable with her life from the age of 15 to 35 - 20 years of 'waste and unhappiness'.

One further cost-benefit equation to be applied, by the way, is not just whether the nation's health budget should or should not be used in expensive treatments (mostly of course, for MH, that means counselling/therapy, where the very expensive time of a psychiatrist has to be funded!) for MH patients, but actually what the cost of NOT treating them is to society as a whole.

Obviously, that's a huge issue affecting ALL of Health Economics - for example, the cost to society of my husband's terminal cancer was not just whatever treatment he got (or didn't get) on the NHS, it was that society (ie, the national economy) lost a highly skilled engineer at the height of his powers, and that was a net loss to the economy.

We see the same here on the forum, that caring actually loses the useful economic contribution of the carer as well as that the of the caree - a double whammy!

In respect of the article, I was thinking of the writer's opening scene, when a whole posse of police and ambulance crew had to be called out to cope with a single person who'd slit their wrists out of despair. That's an expensive call out. Cheaper to prevent the poor woman from being so despairing she'd slit her wrists......

Re: A good article

Posted: Wed Jul 04, 2018 9:11 pm
by Greta
In respect of the article, I was thinking of the writer's opening scene, when a whole posse of police and ambulance crew had to be called out to cope with a single person who'd slit their wrists out of despair. That's an expensive call out. Cheaper to prevent the poor woman from being so despairing she'd slit her wrists....../quote]

Yes, and I doubt anyone would disagree. What about someone whose cancer is overlooked at a treatable stage? What about someone who has an undiagnosed heart problem? You could save a lot of money treating them earlier.

I was just concerned that someone with mental health problems might be put off the forum by reading this kind of thing. I realize, Jenny, that it is a red rag to you. I was amazed at your anger at someone with such problems being employed by a national newspaper!

Re: A good article

Posted: Thu Jul 05, 2018 2:48 am
by Fiona_1508
Jenny I think you ask very good questions: what might really, actually help people with mental health issues and what can we as a society afford.

But that takes me to different conclusions.

Because I think a key problem is that NOBODY IS ASKING THOSE QUESTIONS. The mental health care system is so under-resourced and pressurised and demoralised that the system and services just muddle through, doing what they do and can...

Nobody would argue that the way things work now is good. Mental health wards are holding pens running art groups that nobody wants to go to, too many of the illest people end up on the streets or in prison, community services are able to give so little that in many cases they are frankly useless and a waste of money, people who could be helped aren't and end up in hospital or prison for long periods at huge cost...

That is exaggerated and it definitely understates the work of many, many good people trying hard under difficult circumstances. But its true enough to be concerning.

Ok so how could we do things better given the limited resources there are?

Your niece - would she go to a woodwork workshop that produced useful articles for sale?

I don't know her, she's been ill for a long time. Maybe that is a ridiculous suggestion for her. But it seems to me that is the sort of thing we should be considering. Thought, energy and ideas to do a better job with the resources we have.

Another idea I have - undeveloped - that comes out of my experience of not being listened to about my son with terrible consequences is: couldn't we make better use of families in mental health care? Families do most of the care in many cases. Could that be formally recognized and baked into the system and improved upon?

And maybe also a bit more resources because it doesn't seem very civilised as a society to incarcerate our illest members in awful drug infested prisons.

Rant over!

Re: A good article

Posted: Thu Jul 05, 2018 8:04 am
by jenny lucas
Greta - I wasn't angry that the author was employed as a journo on the Guardian! I was astonished! Like I said, it is to her credit that she can hold down a high-level job, while being so 'unstable'

My 'snipe' really was for her not APPRECIATING that perhaps?? As in, taking it for granted that she had such a job, and in that respect I'd say the same about any nationals journo, with or without MH issues!!!

As I say, such jobs are rarer than hen's teeth, and you have to be an INCREDIBLY privileged person to get within sniffing distance of one - it is part of the 'elite establishment' to work in the media at that level, and should NEVER be taken for granted, as, I felt, it was by this author.

It was to point out that for all her woes about her MH, she was, without question, an INCREDIBLY PRIVILEGED PERSON, simply BECAUSE she had that job.

I do think, in her defence, she was spot on when she pointed out that it was 'glamourous' to have MH when one is 'young and beautiful and talented'..(or even, best of all, a celebrity and/or acknowledged genius!), but quite a different matter to have it when you're just a sad, middle-aged, low-paid shopworker..... all credit to her for that biting observation and bitter truth.

Re: A good article

Posted: Thu Jul 05, 2018 8:13 am
by jenny lucas
Fiona, I completely agree. The NHS just 'reverses into' MH-care, and stays in reverse (firefighting, if that) for the rest of the time.

It's a hard call to make though. On the one hand one can say that 'early intervention' is THE best way to tackle MH - ie, the moment a teenager displays any sign of it, one should immediately 'tackle' it, and see if it can be sorted out and dealt with and the young person 'cured' and got back on track for a mentally health life again.

On the other is the risk of medicalising what is actually only 'teenage unhappiness' (and teenagers have SO much to be unhappy about - from worrying about exams to worrying they haven't got a girlfriend/boyfriend etc etc)(exacerbated hugely by social media of course these days).

I think what frightens me most is that it is SO easy for 'youthful MH' to 'take root' and be increasingly hard to tackle as the years go by. That's what upsets me most about my niece - it's just gone on and on and on and on and on....

As I've said elsewhere, and would repeat again, and I fear I'm not alone in thinking this, the longer someone has MH - both in terms of them labelling themselves, and being labelled - the HARDER it is to be 'free' of it. They BECOME 'someone with MH'....it becomes a 'lifetime problem' for them. It becomes the person they are.

My niece now identifies herself as 'someone with MH' - it's HER. She can't imagine NOT having it, can't imagine having a 'normal mentality' because she has no idea what 'normal mentality is' - she's never experienced it!

Yet she longs for an instant 'cure'.

To me, the full bitter paradox of MH is that the very qualities required to tackle it oneself - courage, resolution, determination, optimism, etc etc etc - are the very qualities that the MH itself 'attacks'. Those qualities I listed are the ones required for anyone to 'cope well' with any kind of physical illness, but with PH, the mind itself is 'unwounded'.....to try and find those qualities somewhere within the 'wounded mind' of the MH patient is infinitely harder.

Re: A good article

Posted: Thu Jul 05, 2018 8:15 am
by jenny lucas
PS - should have added that any idea of 'self-cure' (courage, determination, etc etc) is not going to work if the actual 'cause' of the MH is simply an inherent defect in brain chemistry (though that in itself raises the VERY interesting question of whether we can change our own brain chemistry 'at will'????) (the old intractable 'does brain make mind or mind make brain' question!)

Re: A good article

Posted: Thu Jul 05, 2018 8:25 am
by jenny lucas
Fiona - very interesting you should raise the issue of woodworking! In fact, my niece started an arts degree (dropped out, couldn't cope, to frightened of the other students, gross social anxiety etc etc), and is a very good artist (as in, that is clearly her 'talent'!).

I stress over and over again to her and her parents that that is what she should be doing as her 'primary function' because it is where her creativity lies. But she uses it very little - occasionally, when she is an 'up' frame of mind, she'll settle down with her mum (she lives next door), and they will do 'arty-crafty' things together (her mum is an artist too)(as in, that's her degree and talent) and it is, indeed, very therapeutic for her.

What seems to make 'art therapy' (ie, doing anything with the hands at all), or even 'work therapy' (eg, housework, gardening) so difficult for those with affective MH (mood MH) is the 'torpor' that grips them, the horrendous, paralysing inertia that makes them lie on their beds doing nothing or rubbish.

They need so much more 'activitation' energy than others to 'get going'.

I've often wondered whether the best way to stimulate the exertion necessary to 'get going' would be to 'starve' them. Quite literally. If we consider the Maslowian hierarchy of need, that humans attend to the most urgent need first (ie breathing), and then the next one (water), and the next (food) etc, and so on up the 'need food chain' (to, presumably, either 'art' or 'spirituality'??)(anything 'above those' I wonder?), whether one of the most effective ways to 'cut through' the ghastly inertia of depression would simply be to stop feeding patients? At what point, then, would the inertia be overcome? Just how hungry would they need to be before they actually got off the bed and went to seek food (and work for it first??)

It's not cruel - it's just reminding them that life is not free to anyone, including themselves. It's a way of reminding them, actually, how 'normal' they are in that respect.

Re: A good article

Posted: Thu Jul 05, 2018 6:32 pm
by Fiona_1508
They need so much more 'activitation' energy than others to 'get going'.
Exactly. So what - practically and affordably - can we do? That's a rhetorical question. But that is what we need to be asking ourselves.

Starve people? Umm no I dont think so. I sympathise with your frustration. But that's too harsh. But a bit more of carrot and stick and fewer sympathetic questions would be an approach to consider.

As for early intervention, my son experienced poor care from an overworked Early Intervention Service and an arrogant care co-ordinator who was trying to avoid over-medicalising his illness. As a result he is probably iller than he needed to be. And has already cost the NHS - I dont know - but about a year in hospital - £100,000? - that could maybe have been saved if he had been treated effectively early on.

So I certainly think some sorts of early intervention need to be better funded.