September 2008

September 2008M ental I llness Concerns All

.... a web site for family carers of serious mental illnesses, who give voice and help to those who can't, or don't, voice for themselves

"think clearly, and do not ( just ) hope" Camus ......

August 2008

... The site is edited by a retired consultant psychiatrist who has looked after a family member at home, affected by schizophrenia, for the last fifteen years

For beginners - This Home page links to other pages by a click on the underlined linking like this ...e.g. ... click on CPA for the Care Programme Approach ..
. [
If it is not in the Needs ssessment stage of the Care Programme Approach you will not get it !!!! ]
... and then to return, you click on the back button - at top left usually on the internet page of your computer when connected to the Internet, and this page, or, at the bottom of every page there is generally a link to click that goes back to the starting Home Page

Items marked red are new or retain importance !!!
NEW
The project, which scooped the 'NHS Live' award, is a collaboration between the Department of Psychiatry at the University of Oxford and Oxfordshire & Buckinghamshire Mental Health NHS Foundation Trust. The group worked together to come up with a text messaging system for people with bipolar disorder that enables them to monitor their own condition and keep GPs up-to-date with how they're feeling. 'I am delighted that our project has been selected from so many for the NHS Live award,' said Professor John Geddes of Oxford University. 'We believe our text messaging system is a great way of improving support for those with bipolar disorder and it allows them to take much more control of the way they live with their condition. We’ve created something that can really make a difference to the way care is provided’
HealthCare Commission examines in-patient admission services and systems
Headlines about 'escapes'... and one tragedy
How the Government ... 'New Ways of Working' [ NWW ] ... ... wll affect carers
Anybody know what the creepy appendix D is supposed to be about - it can't be real ? it reads like '1984' and a love in for Big brother. If it's a made up - then that's it; the whole thing is a phony !!!
The list of those on the Committee does not include one working front-line psychiatrist in an ordinary mental health Trust service. The spokesperson is a specialist in rehabilitation, some one arriving long after the diagnostic formulation has been made. A User giving his benefaction does not describe what kind of a 'user' he is. The carer giving their benefaction does not describe the kind of mental illness they are caring for.The other psychiatrists stopped w and became spokespersons.
Oh dear
orking
What NWW does is to put, at a remove, the Authority in psychiatric services. The most intelligent, the most qualified, and the most experienced in practice, psychiatric opinion; the consultamt psychiatrist is to be removed from the lead position for first opinion, and the patient is to be attended to, by a first assesment that is carried out by a less qualified, less experienced opinion.
It will rest with them, the gatekeepers - the first contact in the mental Health Trust community team, as to whether they know their limitations, and pass the patient onto a more qualified view. After seeing the patient they will report to a multidisciplinary team , and on what they have discovered at first assessment will be presented there.
The lead clinical opinion - deciding the working diagnosis - will have to come to that decision at secondhand, depending upon the description, to be able to declare their view on what is best for the patient.
The system will only work if that first interview reveals enough information , and the first interviewer, knows what is relevant.
The most likely next step will be to get back to the contact patient to be, to find out more information, and to open a door for further observation. The whole process is an ideal. In ordinary practice the team is inconsistent, and changing in experience, and pesonnel, all the time. Contrast this dictat, for that is what it will be with this, the previous working arrangement.
" Until the late nineteen eighties each Consultant had attached to the team a Community psychiatric nurse and a Social worker . These three professionals worked closely together ; for example, in the out-patient clinic they occupied adjacent rooms, and would be in constant contact with each other about both new and established patients "
... CLICK on ...UNMET NEEDS... what to do !!! ... this is a vital, crucial, urgently important topic ... for carers ... particularly for family carers ...
If it is not in the Needs ssessment stage of the Care Programme Approach you will not get it !!!!
The journey for patient and carer into Secondary Specialist mental health care, deliverd by your local Mental Health Trust Community Mental Health Team.
A code for for professionals who are assessing the situation of carers in respect of family sufferers

Family and Community Carers absolutely must start to know what was - and still will be for some on the enhanced category - the
Care Programme Approach - ( usually spoken of as the CPA ) this process is the basis system for community care, and can therefore be brought up, referred to , when seeking proper service for the family sufferer.
Now - after a year taking 'evidence' there is new guidance that the NHS Trusts will follow.
There is now a New CPA
The following link is the less patronising guidance to the NHS Trusts about the change second line is best But better still click on the link "refocussing the care programme approach" in the right-hand column
Even more important that you, the family carer, are recognised and intervene at the Needs Assessment stage of the NEW CPA ... that is at the first stage after first contact.
If it is not in the Needs ssessment stage of the Care Programme Approach you will not get it !!!!
and about your entitlement to a
Carer Assessment

surprise ... surprise -the first line link on the new CPA page ( see above ) gives this within it ... needs ssessments that find some needs unmet ...will, occasionally !!! lead to service improvement ... occasionally ??? !!!!
it is both patronising and misleading. It talks about Partnership in Care - they believe in it - without adding that you will Care all the time and we will visit occasionally. ...and - oh - some people used the CPA to claim access to services !!!! ???? so we will abolish it except for those the Team decides are serious and complicated - [ and not too greedy ]
? Who decides about who continues on new CPA - the local Mental Health Trust service deliverers - the Mental Health teams - the DOH new CPA guidance says p 12 para 5 .. " Services should continue to use current local eligibility criteria to make initial decisions on an individual's need for secondary mental health services ". local thresholds are what decides .... if they have nothing further to offer serious illness aftercare is let down - no commissioning - because their resource access is limited, then - off you go.
And don't think the Local Authority Social Services can help with aftercare - they have their own cut off point
click on FACS = Fair ? access to social care - below that - they decide that - you are off their books, as well.
An audit of homicides in London over the last five years finds 26 cases should have had a mandatory external Inquiry and did not.
Avoidable Deaths - the new 5 year review
of suicides and homicides.
Links to Inquests and the right of 'victims' to know what went on . Mental Health Trusts and the Coroner - one Inquiry comments.
*
reporting serious untoward incidents anonymously ; the National Patient Safety Agency likes to know.

confidentiality ??

SCHIZOPHRENIA .....
go to this link

Affective [ Mood ] illnesses
- manic-depression [ Bipolar ]
Hypomania,
puerperal depression,
endogenous depression
Medications:-
SSRI
Tricyclic drugs
ECT
A site which gives general information without preferencies or priorities
A nice personal Blog and self help site
When - and why - things go wrong !!!!
Your observations and experience are ignored or worse declined. British Journal of Psychiatry(1990),157-671 - 674
The Assessment of Psychiatric Disability in the Community A Comparison of Clinical, Staff, and Family Interviews
C. R. BREWIN, F. VELTRO, J. K. WING, B. MAcCARTHY and T. S. BRUGHA

.... "Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them.
In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. "
These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff "
see one extreme example ... page143 para 6 from the Blom Cooper; Robinson Inquiry
the current List of Inquiries after Homicide
...... by alphabet; subjects of care ....... updated regularly .....
Updated list by Health Authorities since 2002 ...
Why Inquiries are good for you ?
' To unmask falsehood, and bring the truth to light' ... : Shakespeare; The Rape of Lucrece

New
Consultation on direct payments regulations, Department of Health, 19th August 2008
The Health and Social Care Act 2008 extends the availability of direct payments to those people who lack the capacity to consent to their receipt.
In addition, the government is also reviewing the current exclusions to receiving direct payments for those people who are subject to various provisions of mental health legislation in light of the modernisation of mental health law brought about by the Mental Health Act 2007.
the current direct payment position ? ... see the official web page
Caring for Anxiety
Sedatives - beware

What they can do if people who have been ill
apprehend a future breakdown
and want to put in
their wishes about that
in case they are
too ill at that time
patients make an advanced declaration - what they want to happen if they are ill again and can't say it.
Here is one example
of a personal advanced declaration

Alcoholism

about being
obsessional

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FREEDOM OF INFORMATION GUIDELINES
About Counselling and CBT

Rethink - policy was useless - but now better - new CE -good advice service ... Telephone: 020 8974 6814 (open 10am to 3pm, Monday to Friday) .... very good.a very good source of support information from people who are directly affected by schizophrenia !! It's North American but these people know schizophrenia in the home at the police station appropriate adult ... prosecution procedures ... Pace - the police guidelines ... domestic violence

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Healthcare Commission examines community care links to Q's and results
Healthcare Commission reviews acute in-patient service: Onward and Upward not the Duke of York again !
The New Mental Health Act 2007 - effective October next year - some parts earlier - principally gives authority over community care after a Section admission. Mental Health Capacity Act becomes Law... link to Capacity Act training material link to the D o H funded 'evenhanded' analysis of Community Treatment Orders - no evidence for, nor against .
a Response ! from North Carolina - wrong !
look at Compulsory community Care ..... as experienced in New York over the past five years ... now confirmed as American Law, Kendra's Law - they call it " Assisted Outpatient Treatment "
american comment on the Kendra's Law experience - for and against ...
Risk assessment ..... violence in schizophrenia
A Conspiracy of Silence ......
Louis Appleby does not speak out against 'cuts' This is an unworthy and a misleading paper.......
Sainsbury Centre Inquiry and Reports about mental health services ...
I can't see the morality in this. Why can't those who overspent be discovered, and be made to make up for it themselves?
King's Fund .. some do, some do not
e.g. "At the extremes, on mental health, Islington PCT is spending four times the amount spent in Bracknell Forest PCT after accounting for needs and other factors.
Leaving aside the most extreme contrasts, there are still large variations with a two-fold difference in mental health spending per head across 90 per cent of PCTs "

a blood
test for anxiety

try out is a local catchment area website for carers (Cornwall )

" Public bodies are given their duties under statute. Their first duty is to discharge the statute, defending themselves for any perceived shortcomings in performance is wholly subsidiary to that end. Health Trusts accordingly should first strive to give care to the best of their ability, and where problems arise their duty is to investigate, acknowledge and improve in order to fulfil their statutory duty to attend to other patients. Defensive conduct that minimises or evades the full examination of such incidents in whatever forum through a desire to protect the Trust is likely to be in open conflict with that primary duty of continuing care.
This is the distinguishing factor between the public and private sector, which justifies the continuation of public trust. It is the foundation of public accountability."

send an e-mail about any psychiatric topic to this - click on david@jidgey.e7even.com

*

E-mail reaction is welcome
click on
mica@jidgey.e7even.com
or, ring david, at 01208 81 6035

M ental I llness C oncerns A ll

Family and Community Carers absolutely must start to know what was - and still will be for some on the enhanced category - the Care Programme Approach - ( usually spoken of as the CPA ) this process is the basis system for community care, and can therefore be brought up, referred to , when seeking proper service for the family sufferer. Now - after a year taking 'evidence' there is new guidance that the NHS Trusts will follow. There is now a New CPA The following link is the less patronising guidance to the NHS Trusts about the change second line is best But better still click on the link "refocussing the care programme approach" in the right-hand column Even more important that you, the family carer, are recognised and intervene at the Needs Assessment stage of the NEW CPA ... that is at the first stage after first contact. If it is not in the Needs ssessment stage of the Care Programme Approach you will not get it !!!! and about your entitlement to a Carer Assessment surprise ... surprise -the first line link on the new CPA page ( see above ) gives this within it ... needs ssessments that find some needs unmet ...will, occasionally !!! lead to service improvement ... occasionally ??? !!!! it is both patronising and misleading. It talks about Partnership in Care - they believe in it - without adding that you will Care all the time and we will visit occasionally. ...and - oh - some people used the CPA to claim access to services !!!! ???? so we will abolish it except for those the Team decides are serious and complicated - [ and not too greedy ] ? Who decides about who continues on new CPA - the local Mental Health Trust service deliverers - the Mental Health teams - the DOH new CPA guidance says p 12 para 5 .. " *Services should continue to use current local eligibility criteria to make initial decisions on an individual's need for secondary mental health services* ". local thresholds are what decides .... if they have nothing further to offer serious illness aftercare is let down - no commissioning - because their resource access is limited, then - off you go. And don't think the Local Authority Social Services can help with aftercare - they have their own cut off point click on FACS = Fair ? access to social care - below that - they decide that - you are off their books, as well. An audit of homicides in London over the last five years finds 26 cases should have had a mandatory external Inquiry and did not. Avoidable Deaths - the new 5 year review of suicides and homicides. Links to Inquests and the right of 'victims' to know what went on . Mental Health Trusts and the Coroner - one Inquiry comments. * reporting serious untoward incidents anonymously ; the National Patient Safety Agency likes to know. confidentiality ??	SCHIZOPHRENIA ..... go to this link Affective [ Mood ] illnesses - manic-depression [ Bipolar ] Hypomania, puerperal depression, endogenous depression Medications:- SSRI Tricyclic drugs ECT A site which gives general information without preferencies or priorities A nice personal Blog and self help site When - and why - things go wrong !!!! Your observations and experience are ignored or worse declined. British Journal of Psychiatry(1990),157-671 - 674 The Assessment of Psychiatric Disability in the Community A Comparison of Clinical, Staff, and Family Interviews C. R. BREWIN, F. VELTRO, J. K. WING, B. MAcCARTHY and T. S. BRUGHA .... "Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them. In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. " These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff " see one extreme example ... page143 para 6 from the Blom Cooper; Robinson Inquiry the current List of Inquiries after Homicide ...... by alphabet; subjects of care ....... updated regularly ..... Updated list by Health Authorities since 2002 ... Why Inquiries are good for you ? ' To unmask falsehood, and bring the truth to light' ... : Shakespeare; The Rape of Lucrece

New Consultation on direct payments regulations, Department of Health, 19th August 2008 The Health and Social Care Act 2008 extends the availability of direct payments to those people who lack the capacity to consent to their receipt. In addition, the government is also reviewing the current exclusions to receiving direct payments for those people who are subject to various provisions of mental health legislation in light of the modernisation of mental health law brought about by the Mental Health Act 2007. the current direct payment position ? ... see the official web page	Caring for Anxiety Sedatives - beware
What they can do if people who have been ill apprehend a future breakdown and want to put in their wishes about that in case they are too ill at that time patients make an advanced declaration - what they want to happen if they are ill again and can't say it. Here is one example of a personal advanced declaration	Alcoholism about being obsessional
------ FREEDOM OF INFORMATION GUIDELINES	About Counselling and CBT
Rethink - policy was useless - but now better - new CE -good advice service ... Telephone: 020 8974 6814 (open 10am to 3pm, Monday to Friday) .... very good.a very good source of support information from people who are directly affected by schizophrenia !! It's North American but these people know schizophrenia in the home	at the police station appropriate adult ... prosecution procedures ... Pace - the police guidelines ... domestic violence
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