More words on words

The word on the street is that the term ‘absconding’ will soon be as obsolete as ‘insane asylum’ and ‘typewriter’. As well as being offensive and stigmatising, it’s also inaccurate. It implies that the (dangerous) patient is legally required to be on the ward. Does that mean that it doesn’t matter about patients who aren’t legally detained?

I’ve been trying to come up with alternative terms and the best I’d managed was something about ‘off the ward without agreement’. But while chatting to the wonderful Malcolm Rae yesterday, he used a word that completely captures (oops) the concept. Missing. That’s the point. The patient is meant to be on the ward or somewhere else that the staff know about, but they’re not. It conveys the conern about the patient’s absence, is easy to say and doesn’t make us sound like criminals or naughty school-kids.

A helpful range of terms are being used to replace ’seclusion room’. (In due course, rooms with this function will be as obsolete in non-secure units as the term ‘absconding’. But in the meantime….) Chill-out room, de-escalation room etc. I read about a facility for fire-fighters, or judges or vets. I can’t remember. But the name was good! Rest room. Does this constructively suggest what the purpose of the room is about and provide helpful implications for its use, support, design and contents?

Sussex Older People’s service are constantly innovating and looking for ways to further improve their services. I loved the alternative name for their ladies’ lounge – pampering room. Even if the room isn’t continuously used for pampering sessions, the fact that it sometimes is and the term carries over to other times helps reinforce its identity as a very nurturing space.

To be continued

The Star Wards blog is now part of the main Star Wards site. For Marion’s latest musings, the latest news, from Star Wards and many other Star Wards resources go to:

www.starwards.org.uk

Shocking patients

Reading something about ECT made me realise we’ve never intentionally used those letters in that combination. We’ve got a million opinions and ideas about medication whether voluntarily and informedly taken or forcibly administered, I’ve sounded off about the use of ‘mechanical restraint rooms’ in Continental Europe and stun guns (on mentally ill children!!) in America. But not a word about ECT.

There are three reasons for this. The main one is that ECT totally freaks me out. The second is also a personal one. There was, terrifyingly, an ECT room on the ward where I was at The Priory. But on the ward at St Ann’s (which inspired the setting up of star Words) the only things plugged into electrical sockets were toasters, TVs and hair dyers, Not people.

And thirdly, it just hasn’t come up. Why is this? Why aren’t magazines, journals, conferences, agendas regularly including stuff about the most intrusive, bizarre and controversial treatment? I have once been offered to be shown an ECT suite when visiting a hospital. Otherwise ECT has never been raised or seen.

Completely hypothetically, what sort of things could Star Wards do in relation to ECT?? In partnership with patients who have experience:

1. Think about the standards for ECTAS, the Royal College of Psychiatrists’ accreditation scheme for ECT services, to see if we think they are as robust and require services to be as ‘patient friendly’ as possible, if that’s not an oxy-moronic concept in relation to ECT. Liaise with RCPsych colleagues if we feel the standards and accreditation process could be improved. (We’re closely involved with the College through their sister scheme for acute wards, AIMS.)

2. Look at the following and think whether there are additional implications for patients experiencing ECT. Star Wards’ 75 ideas; information about members’ services, activities etc; AIMS’ standards

3. Spend time hanging around an ECT suite talking to patients, staff and carers:

4. Solicit ideas through articles, blogging, networking, conferences etc.

The sorts of things we’re likely to want to promote are examples of excellence in the physical environment (including waiting area), information provided, scope for patient control over the actual procedure and informed consent.

That’s what we could do. Whether I can get my past my own stuff, even far enough to liaise with a colleague about them taking this on, is another matter.

So you think you’ve got problems

At least you don’t have to contend with bears breaking into the hospital, like they have to in Romania!

http://www.ananova.com/news/story/sm_2517311.html

Stunning patients

Stunning news from America. Police are using stun guns on psychiatric patients!! Here’s what the Taser website says about its top of the range device:
The TASER X26 uses a replaceable cartridge containing compressed nitrogen to deploy two small probes that are attached to the TASER X26 by insulated conductive wires with a maximum length of 35 feet (10.6 meters). The TASER X26 transmits electrical pulses along the wires and into the body affecting the sensory and motor functions of the peripheral nervous system. The energy can penetrate up to two cumulative inches of clothing, or one inch per probe.

Nice. We’re thinking of diversifying into a new range of protective clothing for our American co-loonies, consisting of three ‘cumulative inches of clothing’. Also helpful for those cash-strapped hospitals which are having to cut down on ward heating.

There’s a Jewish version of April Fool’s jokes at the festival of Purim. That was months ago, so the following is not a parody. Unfortunately. The Associated Press report that:

- Juveniles were shocked by stun guns once in 2003, twice in 2004 and once each in 2006 and 2007. All but one of the incidents occurred at Brattleboro Retreat, a private psychiatric hospital where police have been called to help with out-of-control patients.

– On several occasions, officers have drawn Tasers but not shot them because suspects suddenly complied with orders when faced with the weapons.

Of six Taser incidents involving juveniles dating to 2003, five were at Brattleboro Retreat and four resulted in patients being shocked with the device, according to the records.

Mental health advocates and others are disturbed by those numbers.

“Our feeling is that there should be other ways of handling situations that require de-escalation,” said Ed Paquin, executive director of Vermont Protection and Advocacy, Inc., a private not-for-profit agency that protects civil rights and human rights of people with disabilities.

“It’s rare or almost never that the Vermont State Hospital calls in an outside entity, and they handle folks that are of greater intensity or difficulty than the Retreat does,” he said.

Ken Libertoff, executive director of the Vermont Association for Mental Health, said his organization wants a moratorium on Taser use on minors.

“It should not be acceptable to use a Taser on a child in treatment,” he said. “It’s time for a public conversation about how to de-escalate situations so that we don’t have need for calling in the police.”

The names of the people who were shocked with Tasers weren’t released. According to a summary sheet provided by the Brattleboro Police Department, the behavior that precipitated the Taser deployments included assaulting police, threatening to commit suicide, self-mutilation and destroying property.

“We never plan on calling the police,” said Peter Albert, director of external affairs for the hospital, a private facility specializing in psychiatric and substance abuse treatment.

“The police are never part of any treatment plan intervention. We call the police when it’s deemed to have moved from a clinical crisis to a simple matter of safety,” he said.

Where to start with that? Using electrical shocks on mentally ill children in a psychiatric hospital?! Using them on people who are suicidal??!! Truly outrageous. And who’d have thought it from the country that created The Simpsons, hot fudge sundaes and lesbian softball leagues? (Oh. Well, they did also create the invasion of Iraq. Not an outstanding humanitarian triumph.)

To read the full gory details:
http://www.boston.com/news/local/vermont/articles/2007/09/08/police_records_show_how_and_when_cops_used_tasers/?page=1

There doesn’t seem to be a way to email the American Embassy in the UK, but you can ring them on 0207 499 9000. They’ll probably be pleased to hear someone furious about something that doesn’t include the words ‘civilian deaths’ or ‘unjustified imperialism’.

Alternatively, go straight to the top and try emailing Dubbya. The White House website says:
Please send your comments to comments@whitehouse.gov. Due to the large volume of e-mail received, the White House cannot respond to every message.

But Bright does so do let us have your comments! And we have an unblemished record of not invading and occupying other people’s countries.

Hallam Street Hospital, gazebos, hugging and more

Had a wonderful visit to Hallam Street Hospital in West Bromwich, thanks to the fab ward manager of Friar House, Lisa McGowan. Although I was dazzled by the ultra-impressive activities patients can do in the computer room and recording studio (!!), the strongest impression came from staff attitudes. Us patients are a reasonable bunch, and when asked what we want from our time in hospital, top of the list is to be able to talk with empathetic staff. Look no further than Friar House! Lisa’s palpable commitment to and warmth with patients provides the best possible role-modelling. One aspect that particularly interested me is that Lisa encourages staff to have (appropriate!) physical contact with patients. Amidst what a modern matron I hugely respect refers to as ‘risk mania’, it is very common for staff to avoid touching patients. This is compounded on (the happily reducing number of) wards which have a quaintly old-fashioned culture of ‘observing’ rather than ‘engaging with’ patients.

But go to Friar House and if you’re upset, a member of staff will put their arms around you, if that’s what you want and need. So huiman. So comforting. So boundary-blurring – which makes it riskier for staff but even more reassuring for patients.

When you need more than a hug, and only a ciggy will do, you’re likely to be exiled to the garden, and will definitely be from next July. You won’t particularly appreciate the severe, ugly ‘protection’ of the bus-shelter excuse for a smoking refuge, looking something like this:
http://www.wivenhoe.gov.uk/WTC/2005/BusShelter2.JPG
How much nicer to have a piece of furniture which is not only a pleasant environment for smokers to enjoy our addiction, but one that also enhances the look and feel of the garden for everyone. Friar House has an elegant structure something like:

http://www.summergardenbuildings.co.uk/showprod.php?ref=GARDEN-GAZEBOS-802126&ptx=GAZEBOS-PERGOLAS

The perfect place to have a fag and a comforting hug.

Finding common ground

Another posting stimulated by the JC (Jewish Chronicle). Last week’s issue had no fewer than 5 pieces about experiences bringing together Jewish Israelis and Palestinians. These are:
* Surfing for Peace “aimed at bringing Middle East surfers closer together”
http://news.bbc.co.uk/1/hi/in_pictures/6957108.stm
* hanging out together on holiday in nearby Turkey
* Side by Side, an amazing project by the equally astonishing Parents’ Circle Families Forum. The Forum is made up of bereaved families from both communities, and the project equipped 7 Israeli and 7 Palestinian teenagers with cameras to observe and photograph how the ‘other side’ live
www.the parentscircle.com
www.photovoice.org

It’s been proven over and over again that the best (and sometimes the only) way for warring communities to be reconciled is for there to be direct contact, ideally shaped around mutual interests. This is one reason why the current Israel boycott meshugass (craziness) is so damaging.
http://links-not-boycott.blogspot.com/

A novel idea

New York City’s spooky looking and pre-post-modernly-ironically named Bellevue Hospital has diversified into book publishing. Not worthy tomes about exotic mental illnesses, but novels and other books ‘about the human condition’.

http://www.msnbc.msn.com/id/20361951/

Star Wards is planning a book project – Book Sanctuary, which we hope to run in partnership with the Arts Council. Perhaps we should think beyond books to read or look at and encourage hospitals to consider ones they create and publish? The energy and creativity of Star Wards’ members continually dazzles me so I wouldn’t be surprised if small hospital publishing houses start springin up all over the place.

Translation for non-English speaking patients

Lisa McGowan at Hallam Street Hospital, Sandwell, is the sort of ward manager that every patient would like. Very warm, personable, committed, focused on what patients need, and also great with staff. I arrived in the middle of a fairly ‘average’ struggle to get the next shift covered, Lisa doing some nifty negotiations with her colleagues. What was particularly impressive was that she maintained her good-humour and didn’t resort to strong arm tactics. But above all, when she explained to me that the extra staffing was needed because two patients were in a very bad state, she explained this in terms of how unfortunate it was for the two men to be in such a bad way. Nothing about the inconvenience, risk to staff etc. A truly caring professional!

Patients at Hallam Street have access to a computer suite, which includes a keyboard machine. The multi-talented instructor, Graham, demonstrated just how amazing a keyboard rigged-up to a computer can be. He played and recorded a tune in piano mode, and then a harmony in flute, one on guitar and finally the string accompaniment. A couple of clicks and there was a full orchestral version of the tune.

To reach the title of this blog…. Graham then showed me something which could be revolutionary for wards who have patients who don’t speak English, and who have reasonable literacy in their mother tongue. You can get software which translates text into different languages! Obviously not The Answer to being able to communicate with all patients, but definitely something worth considering, especially when an interpreter isn’t available, or for particularly important documents like CPA stuff or medication leaflets.
Here’s one software product. Small print/disclaimer: I’ve no idea how good it is, but it will give you an idea about what I’m on about.

http://www.babylon.com/display.php?id=14&tree=3&level=2

Business community involvement

A nice piece from Qatar, but could have been from Kettering, about a mass volunteering exercise. Involving local businesses is a good idea because:
1. employees are also neighbours, service users, carers….
2. having volunteered time, businesses are likely to be much more interested in and commited to the hospital and might go on to donate money

http://www.thepeninsulaqatar.com/Display_news.asp?section=Local_News&subsection=Qatar+News&month=July2007&file=Local_News200707313216.xml

Next Page »