What is an alcoholic? Looking after drunks
Can you name the fifteen famous drunks in the picture? Answers below **
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Do people forfeit their right to medical care when they are drunk?
Most of you are going to say “no” but most of you have not worked in a hospital A/E department late on a Saturday night. Forget cosy “Casualty” and “Holby City”. In real life it can be like a like battle zone. Saturday night drunks frequently find their way to the local hospital. Alcohol poisoning needs treatment and may be dangerous. Medical staff do their best but, when you see a burly, middle-aged drunk stinking of stale beer and covered in vomit being aggressive (particularly as is so often the case to young, female nurses) you lose your patience.
The assessment of drunks is a medico-legal minefield. He was not really that drunk, it turns out. He had a couple of pints, tripped, hit his head and had a sub-dural haemorrhage. That is why his speech was slurred. He was not really drunk, he was mentally ill and on a shed load of medication, which potentiated the relatively small amount of alcohol he had consumed. A nurse or doctor who sends home a patient with an undiagnosed sub-dural haemorrhage may well end up in court, and perhaps not just a civil court. Manslaughter charges are all the rage.
But a patient with mental illness who is inappropriately sent home? Well, these days no one gives a toss. Trouble is, when the mentally ill relapse, many of them turn to alcohol. And a huge number of people with alcohol problems have undiagnosed mental illness. And even if they have been diagnosed, if they present smelling of alcohol, they will usually be ignored. Unless of course they are famous, in which case everyone is sympathetic. Winston Churchill was visited frequently by his Black Dog - and no wonder with the amount of alcohol he drank. Oliver Reed, Kingsly Amis, Richard Burton, Brenhan Behan , Dylan Thomas - all fashionable drunks, and all admired.
But if you are an unknown drunk, a down-and-out drunk, no one knows, and no one cares.
A few days ago, I highlighted the case of a schizophrenic patient of mine, who had been drinking and self-harming and who was desperate for help. He was unceremoniously and inappropriately sent packing from an A/E department. Full report here.
The frightening thing is that most people who work in mental health think that this lack of care is justified, indeed appropriate. So the people who above all others should be compassionate and tolerant have lost interest. Worse, they are proud of their lack of interest. You don't believe me? After the article on the schizophrenic who unsuccessfully sought help from the NHS, a mental health nurse wrote in and said:
That post you link to as a "psychiatric emergency" is no such thing. It is a drunk bloke turning up in A&E with some superficial cuts on his arm that he did because he was pissed. By your own description, this is something he does regularly when he gets drunk. That is not a psychiatric emergency.It should not be like this. It did not use to be like this but Margaret Thatcher turfed the chronically mentally ill out of the hospitals onto the streets so that they could benefit from “care in the community”. The modern psychiatric services are sure as hell not going to let them back in.
If the A&E had asked for a psych assessment then the psychiatrist would have immediately refused to assess him until he's sobered up (this isn't laziness - there's no way to accurately assess someone's mental state when they're drunk). By the time he's sobered up, he'll almost certainly have left the A&E of his own accord anyway - and with no indication that he's any risk to himself or others, there's no way to keep him there. Assuming he does stay until he's sober, then unless there's been a deterioration in his mental state then there's no way to get him admitted.
And assuming he was admitted, what would that achieve? It might have given him "a bit of a break", as you suggested (although that is not what acute wards are for) but it might just as easily distress and inconvenience him by yanking him out of his home and onto a ward.
So, with a patient who is (as far as we can tell from your description) expressing no suicidal intent and no psychotic symptoms (acts of deliberate self-harm are not necessarily in themselves symptoms of mental illness), the A&E were entirely justified in sending him home.
As for your question from the original post of "What is David’s curmudgeonly GP to do now?" Well, I would suggest maybe dropping a line to either his CMHT or the crisis team asking if someone can pop round and check on him. They can assess him in the cold light of day once he's sobered up and had some sleep. If he's becoming actively psychotic then they can further assess him for either home treatment or an acute admission. If he's not become psychotic and it's no more than something he did when he was drunk...well, maybe an alka-seltzer would be in order.
But of course, I'm just an ignorant nurse who doesn't know what he doesn't know....except that I showed the original response to a psychiatrist and, as I suspected, he pretty much said all of what I've said above.
The guy described would never have been admitted to an acute ward. Not now, not in pre-New Labour days. And that's not because of protocols or targets or nurse quacktitioners or anything like that. It's because an act of superficial, non-suicidal self-harm that someone did when he was drunk is not a psychiatric emergency. (Mental Nurse)
Mental Nurse's reply is characteristic of those who work in mental health care. Never do anything yourself. Pass the buck. In this case, he suggests I tell the CMHT so that they can "pop" in and assess the patient. I can assess the patient myself, thank you. What I want is some one to provide him with regular care. He does not get it from the so called CMHT who we met in "Shocking Psychiatry". He does not get it from the psychiatrist either.
Psychiatrists and their teams (see an honourable exception here - an article on alcoholics from one of the few remaining compassionate psychiatrists in Britain) no longer care about patients who drink. What is worse, as you can see above, they have concocted a specious justification for this lack of care, for this lack of compassion.
Fashionable famous drunks are tolerated with amusement. Wasn't George Best fun when he was drunk on Wogan's chat show.
Good old George, wasn't he lovely? George Best did not get turfed out of hospitals. George Best got top rate treatment including a liver transplant. How many alcoholic tramps get liver transplants do you think?
Tramps can only access medical care by making the odd visit to the local A/E department. If they smell of alcohol they are sent packing. No one cares. Gordon Brown in particular does not care. Tramps do not vote.
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Picture used by kind permission of the artist, Danny Hellman. Take a look at the rest of his illustrations here.
**Famous drunks revealed here
Labels: alcohol, drunks, schizophrenia
44 Comments:
I am so glad you're back, John.
oh yes and almost a state funeral for George Best too
http://www.smh.com.au/ffximage/2005/12/04/funeral51205_narrowweb__300x466,0.jpg
Regards
Jeremy
I agree with your statements regarding the paucity of services for people with alcohol problems. But you then go and spoil it all by damning most psychiatrists and mental health services as uncaring. A broad statement designed to stir the pot no doubt.
When I last looked at our caseload in the crisis team...Shock! Horror!
Not only mental illness but alcohol problems, drug problems, homelessness, debts, etc...
You could contact the CMHT and discuss/ liaise/ chew the fat with them as to how best to help your patient. Assessing him in the cold light of day and sobriety would be in his best interests. You could even involve the local crisis team. Our local GP's do and it generally works well, especially for the patient. To further the point I am making:
We recently admitted a man with a long term history of alcohol abuse following his self harming - he cut his arms and threatened to kill himself. Within two hours of admission he made it clear he wished to leave, he denied having alcohol problems and had only agreed to the admission because he was drunk at that time. He certainly had a variety of problems in his life yet during the year he did not drink these problems either disappeared or became fairly minor in nature. But he had no mental illness and his problem was and is alcohol. Until the person with the alcohol problem accepts that it needs to be addressed and is willing to address it, short of forcible detention and 24 hour surveillance, they will continue to drink.
As for your blanket statement Dr.C...shame on you. You sound just like those naughty media people who scream 'GP's earn £250,000 a year and are never available!'
It is good to have you back, curmudgeonly as ever.
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This post has been removed by the author.
Asylums started to be closed across the First World (and the UK)long before the 80's. I recall being at a conference in the mid 90's in which the majority of the psych doctors were wholly in favour of 'care in the community', and only the experienced nurses warned of the consequences of closing the 'bins' (their term, not mine).
Acute wards are not the place to deal with patients with mental health problems - the staff aren't trained for it, and as friends have experienced recently, the physically sick patients, especially the bed-ridden ones, get very frightened.
But you then go and spoil it all by damning most psychiatrists and mental health services as uncaring. A broad statement designed to stir the pot no doubt.
When I last looked at our caseload in the crisis team...Shock! Horror!
Not only mental illness but alcohol problems, drug problems, homelessness, debts, etc...
You could contact the CMHT and discuss/ liaise/ chew the fat with them as to how best to help your patient. Assessing him in the cold light of day and sobriety would be in his best interests. You could even involve the local crisis team.
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Thanks Delcatto
You don't get it either, do you. You too have been subsumed into the Stalinist bureacray which sets up soviets.. sorry committees...and pathways and protocols and process, and then pretends that the sytem, the bureaucracy, the "process" solves the problems.
"damning most psychiatrists and mental health services as uncaring."
Yep. I do feel like that. The compassion has gone from the system. Few really care.
"When I last looked at our caseload in the crisis team...Shock! Horror!
Not only mental illness but alcohol problems, drug problems, homelessness, debts, etc..."
Ah, for the first time, bit of honesty. If you guys would just admit that it is a resource issue, and that you don't have the time, or the staff.... that would at least be honest.
But most of you have lost insight. You don't realise that the system is uncaring. It is run by a load of unqaulified automata who do "risk" assessments from their protocolised tick sheets. They do not know the difference between "risk assessment" and diagnosis.
And then you say:
"You could contact the CMHT and discuss/ liaise/ chew the fat with them as to how best to help your patient."
This, I am afraid, is indicative of the fuckwit tosspottery that eptiomises the CMH.."team" (ha ha)
I know how best to help the patient. I don't need to sit down with a coffee and a plate of bourbon biscuits with the well meaning medically unqualified members of the CMHT to work out what schizophrenics need.
They need care and compassion.
Sorry you don't have the time.
And as for "A broad statement designed to stir the pot no doubt."
No.
Just what and how I feel.
Mental health "care" no long exists. It has been subsumed by the soviet bureaucracy.
Tell you what, why don't you roll up your sleeves, get out there and help one of those smelly schizophrenics do their washing? No... you are too busy filling in forms.
John
PS sorry, nothing personal, that is all hard, but it is what I believe. And, ultimately, I have to CARE for these people. You don't.
A good, motivated, genuinely team oriented Community Mental Health Team can invariably do more for alcohol misuse/problem drinking than hospital admission can.
I'd not see that as anything to do with compassion, it's about good medicine and helping patients. It takes me a lot more time, a lot more worry and a lot more travelling to help someone out at home than simply admit them and treat them as an in-patient. Why do I work rigorously with a CMHT, then? I'm lucky and have a very good CMHT that works. I'm part
Our CMHT provides regular care. I visited some patients at their home twice a day this week, they can get nurse and psychiatrist input at home as well/better than through admission.
What can hospital admission achieve that a good CMHT can't for folk with problem drinking? I really don't see community treatment as less compassionate than in-patient treatment. It's the care that's key, not the location, surely?
A&E department, Dr Crippen ?
It says Walk-in-Centre on the discharge summary highlighted in your recent post, anyway, pedantry aside...........
If your point is that alcoholics/drunks get a raw deal sometimes, then, yes, I agree, entirely, although on occassions A&E staff have saved lives after a torrential GI bleed, prolonged seizure, sub/extra-dural, etc, etc, but in general we patch them up so they are fit for the next days binge.
Perhaps if you had intoxicated (and sometimes aggressive) patients rampaging around your surgery most days it might have a negative affect on the, aherm,.....therapeutic relationship, at least during the shit-faced phase, irrespective of whether they had a psychiatric condition, or not ?
Boozers are usually unreceptive to the offer of referral (to alcohol services) once the demon drink is inside them, even though our FY2's dutifully perform screening (Paddington alcohol test).
www.cmaj.ca/cgi/data/164/3/323/DC1/1
But to rubbish the majority of mental health staff, while claiming that individuals have a tendency to "never do anything yourself" or "pass the buck", well, I find that surpasses my own deeply entrenched tendency toward polemic.
Perhaps psychiatrists and their teams "no longer care about patients who drink", and have even gone so far as to develop slippy rationalisations to camouflage their apparent disinterest - but if they don't give a toss (rather like the ENP cited in your anecdote, I suppose) which group of staff in the NHS does.......... GPs ?
Let me clarify something here, since that's me you're quoting as being "uncaring" and "passing the buck".
I *never* (and I thought I made this perfectly clear) suggested that this guy wouldn't benefit from any support or shouldn't receive any. I merely stated that his circumstances did not justify admission to an acute psychiatric ward. That's not the same thing.
He needs ongoing support, yes - including long-term, community-based support to help him address his drinking. What he doesn't necessarily need is a short-term crisis intervention such as an acute admission.
You may think I'm being uncaring by pointing that out, but the bottom line is that no psychiatrist that I know would admit a patient for the reasons you described.
Now, since I don't "care" as much as the Saint Worthy Doctor Holy Fucking Crippen, I'm off to spend some time strapped to a crucifix.
Long term wards of the state should not be funded to drink themselves to death - sure we have a duty of care to the infirm of mind and body but this should be limited monetarily - if this young man will never work or contribute effectively to society as a result of his schizophrenia then we shouldn't be increasing the burden overall by giving him money from which he should be buying food but which he uses to be booze.
I am not advocating letting people starve in the streets - just that the ability to buy booze, fags or other luxuries used to cause harm with excess use is curtailed; a limit-to-food voucher system would work just as well as giving them weekly benefits and would limit (if not stop outright) the amount of alcohol they can get their hands on.
I'm all for self-determination amongst the mentally well on long term benefits, though this measure should be tailored to deal with them also (say after 12 weeks of non-work, plus travel allowance introduction to those actively seeking to return to work). The arguements for fiscal self-determination amongst the mentally ill though dont work and end up at the expense of all - as is demonstrated in this case.
Dr.C,
I thought and thought about what to say to this, and frankly, I can't think of anything that isn't rude.
I am going to try though.
I've been in contact with mental health services for a large part of London this week. They are the most caring and thoughful individuals I've ever met. They are all passionate about their jobs, care about their patients and have an enormous caseload.
It seems to me that instead of bitching and moaning about the systems and protocols and rubbish you have to wade through, get back to the real issue- the patient. I don't think that hospital admission for a drunk with superficial cuts is right either? Does that make me uncaring? I think its something like 1 in 10 people presenting in A/E having self harmed are likely to commit suicide within 4 years, so obviously this is something that needs to be addressed. But I don't think that by sectioning someone, or forcing admission this is really the way forward-- not every time. If they ask for help voluntarily in A/E, then I think that all efforts should be made to provide that person with someone to talk to about it.
If your schizophrenic is self harming and drinking then he needs to go and see someone, be it one of the mental health team, back to the acute ward or just a chat with someone who knows. If that means contacting CMHT, then do it. In my area, at least, they do an excellent job.
I'm sorry Dr.C, but just because you are his GP it does not mean that you "know what is best". With respect, you are not an expert on every condition known to man. Contact mental health for your area and get him sorted out. Surely, if you call and say that you think he is a danger to himself then they have to react with some speed!
I know next-to-nothing about these matters, but there are several things you could teach me, Doc. I sometimes read Theodore Dalrymple -he tells me that giving up heroin is far easier than we are told by the press. Do you think he's right? Could that also be true of booze? Is alcoholism usefully viewed as an illness or is some other view likely to be more fruitful? Mental illness: there must be some possibility of economic rationalism here. Is there any case to be made that too much is spent on it, in the sense that the same money spent on some other illnesses would do more good? Is the current approach badly wrong; could the same amount of money spent on the mentally ill be spent in a different way that does them more good than the present way? What is the rational case for spending more on mental illness, and what do you think should have less spent on it to free the funds? Do questions of rationality matter in the least? Do politicians always respond solely to shroud-waving and interest-group politics, so that attempts to weigh the economic and social advantages of different courses of action is fruitless?
I'm middle aged and recovering from my first bout (and last!) of severe depression. During my illness i self harmed and attempted suicide on 2 occaisions (neither of which i have ever done in my life before)
When I attempted sucided i bought and took alcohol and pills at the same time with the express intention of ending my life. my experience of psychiatric care in A&E however taught me an invaluable lesson, Alcohol acts as a get "out of jail free card" just say you "did because you were drunk" and your on your way home with a little lecture on binge drinking and / or having an addictive personality, no more questions asked.
(given the fact i don't drink and hadn't done so for 10 years before ending up at A&E or since recovering, made it seem a bit ironic!)
Did i have any idea before attending A&E that having a drink would be such an effective way of getting out without any psychiatric care - nope, but the experience was like being led down a path - the stereotypes and presumptions were so strong that even my befuddled brain could follow them - in fact it couldn't have been clearer, the instructions may as well have been written on the wall behind the the people interviewing me.
The first time i "escaped" (and thats how i saw it) using this method i was shocked and free to try again, which i duly did, the fact that it worked so seemlessly a second time was just staggering.
Do i blame the mental health staff, not really, its obvious to me in hindsight that they were burnt out due to overwork and that the whole service was just starved of funds. How do i feel now, frankly scared to death, that a relapse will lead to a repeat of this kind of treatment(?) and that next time i might be successful.
So perhaps its time GP's and and mental health professionals stopped attacking each other, agreed that the service is inadequate due to lack of funding and started to campaign together for adequate resources- fighting amongst yourselves right now, just leaves vulnerable people in the same situation, on their own.
Zaruthustra - you have my sympathy, A&E staff know that admission is unlikely to be useful after a minor incident of self harm.
This is backed up by research, for example Waterhouse & Platt (1990) found no difference in outcome after comparing patients admitted to hospital to those discharged home following "parasuicide"
http://bjp.rcpsych.org/cgi/content/abstract/156/2/236?ijkey=00a1d123b769b69319d0c2e6dd90cfe14bf58d7a&keytype2=tf_ipsecsha
Cases of self harm rise inexorably with 170,000 cases annually (according to NICE) of these something like 80,000 result in hospital admission, usually because of drug overdose (especially paracetamol, tricyclics, & benzo's) - personally I find the NICE guidelines very helpful but no doubt these will be shot down as part of the great Stalinist conspiricy ?
http://www.nice.org.uk/nicemedia/pdf/CG016NICEguideline.pdf
Study after study demonstrate that there is no reliable way to determine which of the 5,000 or so, from 170,000 who self harm, will actually kill themselves, although the annual suicide rate has remained fairly static - a previous episode of self harm is known to be the "most useful" predictor of suicide, but to my mind this stat is only ever deployed as a hammer to hit staff over the head with after missing something (see example from anonymous above).
Until the NHS has capacity to hospitalise the burgeoning population of self harmers then mental health staff have to take difficult and inherently risky decisions every single day - of course most admissions would have more to do with arse covering than any therapeutic gain.
I'm not sure how we could achieve this given that hospital beds are becoming as rare as a GP on duty at the weekend.
We are all drowning a sea of uncertainty and I can understand why you are so pissed off by the thrust of this post - anyway, move over..... the A&E charge nurse has decided to join you on your cross.
"I know how best to help the patient. I don't need to sit down with a coffee and a plate of bourbon biscuits with the well meaning medically unqualified members of the CMHT to work out what schizophrenics need."
Bourbon biscuits? Must be a private practice.
If you know best, why do you need a CMHT at all? Why aren't you doing it?
Maybe this is why the resources are stretched - cos you're not doing your job dammit.
ok I tried to make it a short post, but I failed, I came back.
But in trying to keep it short:
Having a "mental illness" does not make every behaviour, thought or belief "insane", or based in that illness.
Mental illness does not completely take over the brain except in the worst of cases.
The patient is a person first.
If a person turns up at A&E with superficial cuts; yet does not come with a history or presence of M.I. or alcoholism; what action is given then? Usually the doc and the nurse consider them a waste of time - & don't no-one argue with me, I've watched it happen for years. Those borderlines or anti-socials that drop in A&E on a bad day.
The differential distinctions that are being made here seem to originate in the understanding of what mental health is about. Just as a cut finger would be triaged back behind a respiratory distress; a superficial self harming episode gets put back behind an acutely psychotic person. it isn't insignificant, but it doesn't warrant an all out assault on the person. If we want people who DSH to have proper care as a priority then we need a DSH service.
The trouble for me with mental health services is how it seems to catch anything that doesn't fit med/surg but is a person in distress.
Most the issues they come with are social problems; or inadequate educational ability; cognitive disability - these all 'belong' outside of 'health' altogether. But they still get sent to mental health - that's where all the 'miscellaneous' get sent.
oh, and TomRat247...
"if this young man will never work or contribute effectively to society as a result of his schizophrenia then we shouldn't be increasing the burden overall by giving him money"
On that principle, someone should kill your internet access and take your computer off you too.
Your contributions are ineffective and having to read it was burdensome.
If I can offer my two pennies as a layman (I am in no position to judge the professional's turf war above), Mental Health Nurse's comments quoted in the post struck me mainly as an implicit admission the System simply does not have the capability of dealing with this situation.
Arguments over who does and doesn't care are irrelevant.
"It's not what the acute wards are for" - no, but they're the only thing there. Declaring them out-of-bounds is not what I would call helpful.
"liase with the CMHT [or whatever] team" - yes, and where are they on a friday night? Assessments are lovely and all, but they're not exactly responsive, are they? If your best friend came to you and said they were really upset and needed some help, you wouldn't tell them you'd assess them on monday morning, would you?
This whole thing looks like a game of passing the hot potato to me. It is quite possible everyone is doing their jobs as they are supposed to, and to the best of their abilities given the constraints on them. But does any one want to claim that this is what is supposed to happen?
ur right on this one
single males with no dependants who fall on hard times are let down by british society in all sorts of ways, whether it be by drink or bad luck, many of us are closer to sleeping on that park bench than we realise, which especially for folk who have paid megabucks into the system for many years is really not good enough
benefits system is tailored to those who can manipulate the system, and so is the nhs
by the way ive seen young girl failed suicides sent home without a "psych assessment" so nothin surprises me
Charles you have hit the nail on the head, Mental health nurse or Zarathustra’s,( as he has identified himself), post is a tacit admission that the system does not have the capacity to deal with the demands being placed on it.
But Z is right, any patient presenting in A&E with the history described would not be admitted and the case would hardly raise a blip on psychiatry’s radar. This is not because we don’t care or as Dr C would have you believe because we are all protocol wielding, bourbon biscuit, eating brainless numpties who haven’t been to medical school. It is because there are not enough beds for every drunk that wants one.
It is also debatable whether that would be a good thing in all cases anyway.
I would love to see more beds, including wards given over entirely to providing inpatient alcohol detox to those who want and need it. In my area we have one acute psychiatric ward with 22 beds for a total population of around 150 000 and at the last count there were two dedicated alcohol nurses for the entire population, it’s not enough.
It would be nice if Dr C would acknowledge that the majority of the staff in mental health services, like him, are trying to do the best they can with what they have got and most of us are as competent in our respective roles as he is in his. But the sainted Dr C appears incapable of recognizing this.
Okay, I'm back. My, it was refreshing on that crucifix.
Hi Charles. I was going to give you a reply, but I think E has pretty much said what I was going to say, on the subject of resources anyway.
Resources aside, I also happen to think there are good clinical reasons not to admit to hospital in a case like this. For one thing, a truly accurate assessment of his mental state would need to be done the next morning when he's sobered up.
Given that there's no indication that he's a risk to himself or others, he might as well spend the night in his own bed rather than on a ward - after all, admissions to an acute ward can be a relief to some, but can be highly traumatic to others. Why risk that trauma and distress unnecessarily?
Can I just throw a final thought into the mix? Nowhere in the description is there any suggestion that the patient mentioned actually *wanted* to be admitted. In fact, I'd be willing to bet that what he wanted was to be steri-stripped up and then go home and try to forget about it. I base that suggestion on my younger years when I spent a few nights in the company of a six-pack of Stella and a razor blade.
I do get 'it' Dr.C but I'll ignore your further comments re. uncaring MH staff.
Yes there is too much bureaucracy in the NHS (and other public services) and sadly we do have to complete paperwork. But I and many other colleagues do work with these "smelly schizophrenics" as you call them. I suspect that is half of your problem, in that the world has turned a few revolutions since the 1970's and mental health care has moved on but you haven't. However, I am sure you can make political points about the lack of funding/ poor services/ inadequacies in the NHS without broadstroke criticisms of other colleagues.
Although there are processes, protocols and pathways, it is the human beings who staff the various teams who work with the human beings who have mental illnesses. The three p's can be worked around and those "smelly schizophrenics" receive care and support.
But making noise and blaming others rather than talking to the patients CPN...Give them a ring, they might share their biscuits with you and this week it could be Jammy Dodgers.
Gordon Brown does not care period.
I waited 5 months from diagnosis of Prostate cancer to operation. When the DoH was reported as claiming all cancer patients were receiving treatment within 31 days of diagnosis I wrote to the Secretary of State. The response, from a civil servant, advised me to write to the PCTs. I wrote to the PM complaining about his Secretary of State. The letter was passed to the DoH. The response, from a civil servant, gave detailed instructions for complaining to the PCTs
yea and the type of op you can have for Prostate cancer is very restricted on the nhs, much better treatments are routine privately
dont think there is such a wide variation in treatments between nhs and private for breast cancer, but then those patients are a bit more vocal politically
yep nu labour and the nhs complaints process are both a sham
wanna know which city nhs is trying to hush up a TB outbreak? fucking cunts
A further thought about the "it's all about resources" argument.
To a degree it is, though by no means entirely. Just to illustrate the point, over on Random Reality Reynolds has had to fight to get a patient admitted to an acute ward.
Reynolds' patient was a risk to himself, a risk to others, and psychotic.
From the description given, there's nothing to indicate that Dr Crippen's patient was *any* of those three things.
Assume we have an acute ward with one bed lying vacant for the night. Say we give it to Dr Crippen's patient.
Then, imagine that five minutes later Reynolds turns up with his patient. What do you do now? You've got a suicidal, violent, psychotic patient with nowhere to go. Good call?
So yes, resources do come into it when deciding that the suicidal violent guy should be admitted and the guy who made some superficial cuts on his arm should see the CMHT in the morning. We do what we can with the resources we have. Until a magic wand becomes a standard piece of clinical equipment, then that's always going to be the case.
And you, Dr Crippen? Are you somehow immune from this? Do you have some magical ability to be everywhere at once? Never had to make a patient wait a few days for an appointment? Never had to close the books to new patients because your practice is oversubscribed?
I just want to pick up on someone's suggestion that people with schizophrenia should get vouchers not benefits.
I have severe mental illness. Getting cash gives me the flexibility to get the help I need to live in the community. For example, I use some of my DLA to top up my housing benefit so that I can live in a (more expensive) flat that's nearer to relatives who care for me.
Disabled people, including psychiatrically disabled people have fought for more than half a century for the right to have the resources we need to live on equal terms in the community. I don't see why our ability to determine for ourselves how to spend the money we get to best advantage should be compromised just because some people on benefits make foolish judgements on how to spend their money.
"Asylums" closed in the 70's and 80's. They were often places that had a famr and craft workshops where people with learnoing disabilities and fragile mental health thrived in the routine and rhythm of life there. Unfortunately that routine that gives ALL of us stability and grounding in our lives was labelled institutionalism by social workers in Afghan coats and headbands and beads...peace man...
Now these Asylums are slowly coming back -htis time with a more caring name
Care Farms
look at www.ncfi.org.uk and see the wrok that is being done. And I believe they can take GP referrals?
Claire
By Charles, at Thursday, January 17, 2008 6:14:00 PM
"by the way ive seen young girl failed suicides sent home without a "psych assessment" so nothin surprises me"
There's not really one party to blame here. There isn't enough people to do the amount of "Psych assessments" that need doing. The hospital afaik keeps the patient in a bed until they turn up - this can take up to a week. That's a bed that could be used somewhere else, so more clogging for the hospital.
It certainly doesn't mean no-one cares. I've had a mixed experience of the NHS, both positive and negative. I certainly couldn't say that no-one cared.
"I'm not going to comment on why Dr Crippin thinks his patient should be admitted and I don't".
- Student nurse on ward Zarthustra.
The reason is why is clear.
On this very disturbed ward,
(Where said nurse published a sado- masochistic psycho fantasy about screwing Dr Crippin),
Said student nurse presumes, (worryingly so),..
that Dr Crippin, a fully qualified and experienced Doctor,
(who unlike student, had seen this patient),..
could not tell the difference (unlike student who dangerously sterio-types )..
between a drunk with a few scratches,( many of whom he will have seen over the years, not all of whom he would seek to admit)..
and a mentally ill man in a dreadful state that needed a bed!
Moving on...
This must have been suggested before but as this kind of problem is increasing, and in order to take the burden off A@E staff, maybe there should be a special area set aside for people that come in drunk. Also, 'on call' Shiny Happy Consultants with a specialist and experienced team linked to homeless shelters and other relevant services etc.
Of all the 1000's of people that get drunk every evening, it must only be a small proportion that end up in A@E. They may not all need A@E but they do need some sort of help, (as do the staff), not least, as they do not know where else to go.
Dorothy, a few points in reply:
- I'm not a student nurse, I'm qualfied
- The "sado masochistic psycho fantasy" you refer to was an obvious spoof
- True, I'm not a doctor, but I did show Dr Crippen's to a doctor trained in psychiatry. His response, as I suspected, was that the in case like this he wouldn't even assess him until he's sobered up, and certainly wouldn't admit him, for the reasons I've already described.
Zarathrusta,
OH, then it must have been one of your alter egos that stated, more than once, that you are a "third year student".
A 'spoof' indeed, obvoius and revealing to all, which explains why it, and much more besides, has suddenly been removed.
"I showed it to my shrink and he said......",
He protesteth much and swiftly, hides behind coat tails, avoidance behaviour and passing the buck all in one go. And he's "Qualified"?
We still have the lovingly referred to "drunk tank" in our A&E. Its basically a room with some beds/matresses where people can "sleep it off" if they are too drunk to go home but not really a candidate for an acute medical bed. Some stay the night- others don't. The problem is lack of money/resources. Imagine you are the senior nurse on for the medical unit. There is one acute bed left and the A&E consultants are badgering as they have several patients who are about to "breach" the 4 hour wait. You also have registrars/consultants within the ward system that want to transfer surgical patients who have respiratory problems that now require an HDU bed. Bed needs to be allocated according to clinical need. End of story. Unless your intoxicated patient is bleeding, has respiratory problems or a worrying head injury, to name just a few complications- he is not going to qualify. I have friends who are mental health nurses and their stories of day to day ward life are truly distressing. What is the answer? Sad to say the social problems around drinking are abundent. At what point do you say that people have to take a bit of responsibility for their own health? In the years I have worked for the NHS I have watched patients self distruct by booze, drugs, over eating etc etc despite intervention. Your heart sinks when admissions phone up with a known patient, DOB and hospital number. Sometimes you cannot fix people. Watching a 35 year old homeless woman die from a GI bleed in A&E just a few days after being discharged is a picture that still sticks firmy in my mind even 10 years after it happened. Drunks with money tend to live a bit longer but ultimately the outcome is the same.
"OH, then it must have been one of your alter egos that stated, more than once, that you are a "third year student".
"
Er - most third year students tend to turn into staff nurses at some point, Dorothy. It's called "qualifying as a nurse", and it's what happens when you have completed the three year course. Do you see?
I went to university in a disused mental health hospital.
Then i lived next to a block of apartments which was a converted mental health hospital.
No i am a Physiotherpist who works in a department that is part of a general hospital on a site which was previously solely for mental health.
Apart from my worrying propensity for mental health hospitals doesn't this show the decline (certainly in numbers or site of mental health institutions
GB
Dorothy
OH, then it must have been one of your alter egos that stated, more than once, that you are a "third year student".
As moobs points out, it's not an alter ego, you're reading an old post.
A 'spoof' indeed, obvoius and revealing to all, which explains why it, and much more besides, has suddenly been removed.
It's not been removed, merely archived. You can find it here
He protesteth much and swiftly, hides behind coat tails, avoidance behaviour and passing the buck all in one go. And he's "Qualified"?
I'm not passing any bucks at all. It is my clinical opinion that the case history provided by Dr Crippen provides no information that suggests a compelling rationale for inpatient admission, and would therefore be better served referring to the CMHT in the morning. Unless of course Dr Crippen can provide any further information suggesting the patient is a risk to himself or others, or exhibiting relapse signatures.
That's my own opinion and I'm happy to defend it as being mine. It just so happens that the psychiatrist I work with agreed with me.
I've heard reference to this phenomena before, and I'll admit, I can't tell if it's 'face value' or intended - but .. Wow... Crippen puts up a post with his opinion,... and everyone picks a side and *BaM* - Take that Batman ....
So... to summise:
1. NHS resources are shit
2. There's a difference of understanding and awareness of those who work IN mental health and those who only refer TO mental health as to what costitutes a mental health emergency +/or the treatment (or not) pathways.
3. The patients SHOULD get some help: the type differs depending on where you fall in #2.
4. Some CPN's occasionally have Jammy Dodgers.
5. Dorothy assumes too much and should attempt more fact finding and self restraint to avoid seeming a bit doughy.
7. What happened to 6?
8. Dr Crippen is nowhere to be seen in this debate he started.
6. Ahh there it is.
9. medical and nursing seem to be fighting over an issue that clearly belongs to a social worker. See below.
Social workers should start staffing units 24/7. They should provide care and shelter for those cases that do not resent as either needs a full nursing bed yet requires some support.
I believe this happens kind of in aged care 9or used to) with the old Part III accommodation (run by social services); or where assessment between residential or nursing home care was required - Social worker did this.
Let's just build a big separate institute for those that don't fit the box and instead of fighting amongst the nursing-medical peers, let social services run it, we can refer the non-medical non-psychotics social/behavioural/personality issues to the miscellaneous box over the way, and then blame social workers for the system flaws, like we did in the good old days. That should leave the Acute unit alone for a while yet still give Dr Crippen somewhere to get his needing patient seen to. (c)
Z: My phone also has a thermometer on it. Like I can't tell when it's hot or cold - so I have to take my phone out to check??
It's no use for checking the core temperature of the roast chicken either... the waterproof diving case doesn't keep the greasy fat out.
Z
I am afraid you can't have the crucifix right now...you have to join the queue, and wait patiently until it is your turn!
NEXT!!!!
As for alcoholics turning up at A&E. Well, they may have underlying MH problems or being an alcoholic, I have been informed, is classified as a MH problem....so having MH specialists on call there wouldn't go amiss would it?
and by that I don't mean some fwit of a psychiatrist. My experience of them is that they are utterly useless.
No...let us have something a bit more humane. Like people with empathy, savvy and good communication skills (so that referring on doesn't become a press number 5 if you wanna offload this one scenario).
Yep...I said good communication skills...something the NHS is piss poor at.
and with my father having just done a flit again, I am right up for a debate on the effectiveness of CMHTeams in regards to identifying crisis situations (when the person (me) is telling one it is going on) and how..make that...IF they respond.
Bring it the fekk on!!!!
"Delacatto, you don't get it either do you",
Funny how no one except Dr C appears to get it.
"Good old George, wasn't he lovely? George Best did not get turfed out of hospitals. George Best got top rate treatment including a liver transplant"
Fat lot of good it did him. Like most other alcoholics, he carried on drinking, just like your guy will, with or without the input of the psyches.
I don't criticise nihilism where it's justified.
Good to see you back John,
There was a time when hospitals for the mentally ill were known as Asylums. Asylum is a place of safety, as in that much abused word asylum-seeker.
As someone who has steered dangerously close to the cliff of insanity in the past, I would appreciate a place of safety, but I am not sure that modern psychiatric services are orientated that way.
Until the recent crime wave the numbers of long term inpatients in mental hospitals and the number in prisons added up to a fairly steady figure. I am NOT suggesting that Psyche patients are criminally inclined, I am suggesting that for some desperate people police cells and prisons appear to be the only places that they will be looked after.
The alcoholism is a widespread "disease" that should be given attention.Alcoholism can be controlled and cured if only friends and family as well as oneself will do something about it, before it gets worst.
希望大家都會非常非常幸福~
「朵朵小語‧優美的眷戀在這個世界上，最重要的一件事，就是好好愛自己。好好愛自己，你的眼睛才能看見天空的美麗，耳朵才能聽見山水的清音。好好愛自己，你才能體會所有美好的東西，所有的文字與音符才能像清泉一樣注入你的心靈。好好愛自己，你才有愛人的能力，也才有讓別人愛上你的魅力。而愛自己的第一步，就是切斷讓自己覺得黏膩的過去，以無沾無滯的輕快心情，大步走向前去。愛自己的第二步，則是隨時保持孩子般的好奇，願意接受未知的指引；也隨時可以拋卻不再需要的行囊，一路雲淡風輕。親愛的，你是天地之間獨一無二的旅人，在陽光與月光的交替之中瀟灑獨行.......................................................................................................................................................................................................................................................................................................
Alcoholism is a two fold malady of an allergy to alcohol and a mental obsession to drink. Regardless of waking up terrified in A&E and not knowing how the hell I got there and feeling hopeless and suicidal at times, I continued to drink as I could not stop- despite desperately wanting to.
I am a very attractive, well spoken and take great pride in my appearance but if I take a drink... we all have a problem as I will not stop drinking and can be drunk for a week where I could wake up in A&E looking like a bag lady and also capable of ruining my life in one spree- losing jobs, being kicked out of where I live, alienating family, friends, crashing cars, being arrested... just insanity and chaos. Why would someone do that to their self? Because they are a chronic alcoholic and are powerless over the mental obsession to drink.
I wasn’t aware of treatment centers but tried everything else and AA was on the bottom of my list, however, it is the only thing that has worked for me. I don’t drink- how bloody great is that!!! And it is FREE and the only requirement for membership is a desire to stop drinking.
Obviously alcohol is just the symptom and take that away, and you’re often left with someone who is damaged and unable to cope with life. AA teaches people, how to live again and in a spiritual way (which am aware freaks most people out) but it bloody works- so I personally can’t knock it even if I did initially think it was a bit gay.
People are damaged to varying degrees but logically if someone puts the drink down then they are going to stand a better chance of addressing whatever other problems they have. It is the first step.
What I found very helpful was that a friend called someone from AA and they came round to ’12 step’ me and planted the seed that it does actually work and there was hope as I did feel so hopeless that could not see how sitting in a room, confessing to being an alcoholic with a bunch of boring middle aged men- could possibly help me but the fact is that I got desperate enough to try it.
I would have thought that someone writing under the name of ‘alcohol rehab centre’ would be fully aware that if someone is truly alcoholic then it can never be controlled and complete abstinence is required. And an alcoholic is never cured, the allergy to alcohol never just goes away and and it is a question of maintaining ones emotional well being which keeps the obsession to drink, at bay and this is an on-going process which can’t be cured with a stint in a rehab centre but an on-going commitment for life.
A lot alcoholics can lose their families, they may be the cause of deep routed problems, enabling, or standing in the way of getting professional help-everyone has a different story but generally it really has to come from the individual their self. Support if you have it, is good of course.
I went to CADA before AA and was amazed that was told to ‘cut down’ – I am an alcoholic for goodness sake, if I had any control over alcohol then I wouldn’t have a problem.
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