The need for alternative practices to hospitalisation for psychosis

tMY first hospitalisation as traumatic. I was experiencing mania, psychosis and paranoia. It as a wonderful time except for the hospitalisation. It was traumatic and it destroyed me afterwards though I'm sure the doctors would just prefer to look at the period afterwards with that simple catch-all of "depression". There's new evidence which I haven't read but heard Jacqui Dillon (Chair of the Hearing Voices Network) that hospitalisation is traumatic and may cause post-tramautic stress disorder.

Anyone who's not been in a psychiatric ward under section has no fucking clue. Being a voluntary patient isn't much better. The key difference is not wanting to be there and the removal of liberty. A person becomes trapped in a skanky environment full of other intensely distressed people. Staff have little time for patients and even the work of Marion Janner I expect has done little to change the problem where patients are just left to rot and drugged to the eyeballs rather than given anything that resembles compassionate care.

People live under the threat of close observation (what can be a degrading protocol where a patient is followed around by a staff member who, in cases I've seen, will stop them interacting with other patients in a demeaning way), seclusion (being put in the equivalent of a padded room away from everyone else) or acute tranquilisation (forced medication with the explicit intent of forcing the indiviudal into unconsciousness and is often used to break a person's will because it is a humilating, degrading and traumatic experience for anyone to be forced down by healthcare professionals and have a large thick needle forcibly rammed into their arse). That's the fears for the difficult, challenging or severely mentally ill. An empowered patient would fit under the first two words because a patient who knows their rights, the law, medical treatments, research, what real mental healthcare is is the worst patient - it's probably why Marion Janner found it so hard to get hospital care when she required it.

The psychiatric hospitalisation system is so bad that the President of the Royal College of Psychiatry is on record saying that he'd rather not have his family in an NHS facility. I've got a fair amount of respect of Dinesh Bhujra for that and for his emphasis on recovery.

There was a recent review published in Psychosis (a new peer reviewed journal) of programmes for first episode psychosis that used totally different paradigms from what happens in the UK. The US has had the Soteria project for a long time but other countries have developed their own ways to treat people going through the worst of the experiences of the human condition.

http://psychrights.org/Research/Digest/Effective/PsychoSocialMoreEffective2009Psychosis.pdf
Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the
literature

There was nothing in the UK. As far as I am aware the UK doesn't have a large experimental facility or programme such as John Bola covered in this review.

There is some hope  A Soteria house in Bradford is being campaigned for.

And yet there is nothing for London. London has a psychosis or schizophrenia rate twice as high as Nottingham and likely the highest in the UK (New Horizons consultation document citing the AESOP study). There is a massive population - over  million - including a high number of migrants (who have a higher risk of psychosis) and black men (9x higher risk of a diagnosis of schizophrenia) crammed into a concrete jungle where no one has any time for each other.

Do I have to swear to make the point at how absurd it is that there is no attempt for an alternative first-episode psychosis programme in London? From John Bola's review there are many things that can be taken from other countries, not just the Soteria principles (which seemed to produce the highest suicide rate in the review).

The hell of hospitalisation, the traumas and the coercive nature of healthcare is why people stay away from services. These alternative programmes offer the hope that people won't be dissuaded from accessing healthcare after their first episode. People will be more likely to comply with treatment and this may, perhaps, help reduce the significant mortality risk in the UK (one of the highest if not the highest in Europe and 5 times Norway's Standardisted Mortality Ratio - from the study I was reading before I smashed up my laptop).

Then there's my personal experience of a bout of acute psychosis a couple of years ago. I wasn't hospitalised because I hid as much of the madness as I could. I wasn't medicated and I got no help from psychiatric services. I had a little befriending from a really nice guy where I worked and that small social contact helped a lot. I went to work and I just kept going through the hell that "hell" doesn't even describe. I was damn lucky to have a boss who allowed my choices and allowed me to keep working. My coping strategy was parasuicide and self-harm (and it was only parasuicide because I failed in my attempts). For months the thought that kept me going as that I would kill myself soon anyway.

And I survived. And I recovered. And I recovered in a way that few people recover after psychosis such as that.

I do not advocate anyone being as fucking stupid as I was but I do believe that the alternative programmes, continued inclusion and social support (not pity, just acceptance) are far better than my experiences of hospitalisation and healthcare.

The most I've seen in the way of progress was the introduction of Early Intervention for Psychosis services (again, New Horizons consultation document) but it didn't seem like they were looking to low or no-dose medication strategies and there was no clarity on whether they would attempt to use medication on children with a risk of psychosis.

In the current climate of budget cuts it will be hard to push for alternatives because these alternatives are more expensive than drugging and people and leaving them to rot in a psychiatric ward. But even the attempt to develop the UK's own progressive treatment for first episode psychosis just isn't there. For a few decades the World Health Organisation result showing that people with schizophrenia do better in the developing world has been evidence that the current psychiatric approach to first episode psychosis and the treatment of the course of schizophrenia simply doesn't work for the best outcomes for the individual. The evidence that the UK has one of the highest risks of death for a person with a diagnosis of schizophrenia redoubles the need, in my opinion, for progress.

But I don't have a social sciences degree nor any real training in the field. I just read this stuff and write my thoughts on my own instead of killing myself.