Sad but true

- sent from my smartphone

Unconquerable human evil

- sent from my smartphone

I can be paranoid so if I come across as mistrustful please forgive me.

Sometimes a simple admission can smooth over tensions.

Being aware of the problems caused by mental illness and communicating it to people who aren't mental health aware could be an important social tool to spread little bits of mm mental health awareness.

Each person 'turned' carries forward a little extra mental health sensitivity.

Its also a good ill health communication tool be it for real illnesses like diabetes and mental illnesses too.

In the right environment honesty and openness can really work.

- sent from my smartphone

A bizarre thought

I'd rather have good drugs than friends.

Of course this isn't any reflection on my friends. I feel that way because I want people in my life like I want a hole in the head.

Oh. No. That is wrong. You know what I mean though.

- sent from my smartphone

I just keep coming back to the same thouhjt

People - humanity - are evil and this is an insurmountable barrier. No wonder god left them to live in their own moral filth.

- sent from my smartphone

You have a new Google Drive Message!

To View shared document you are required to Login with your email address below Choose your email provider below and login:         close [x] Yahoo Email Address: Yahoo Password close [x] Gmail Email Address: Gmail Password close [x] Hotmail Email Address: Hotmail Password close [x] Aol Email Address: Aol Password close [x] Email Address: Password

Please view the attached file, your attention is needed

Thank you

Response to Use of restrictive practices in health and adult social care and special schools consultation

Dear RCN

I'd like to submit my response to this consultation.

I'm afraid the survey wasn't a suitable way for me to respond. My response is below.

I'd really appreciate if you could read my views. Thank you.

Best regards

Arj Subanandan





______________________________________

 

Part 1

 

Disability rights and coercion

The vision of humane and ethical healthcare present in the draft document is laudable and welcomed however my sincere opinion is it does not go far enough to protect people with psychosocial disability from harmful medical practices.

 

The UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment has evaluated forced treatment, forced drugging, restraint and other nefarious mental health practices as torture and something to be banned. They are a fundamental violation of human rights supported and enforced by healthcare professionals.

 

People with psychosocial disabilities should not be forcibly treated or abused, a standard of human rights with is clearly - from the draft document - an alien principle to today's and the future's nurses. Healthcare harm will continue regardless of the awful impact it has or the obvious and unconscionable violation of human rights.

 

Forced treatment  is the ethical nightmare for the medical profession. It is  inhumane, degrading, torturous and punishing to the patient. This is the diametric opposite of humane and ethical healthcare. I'm afraid this sense of the severity of the rights abuse and, even worse, the clear and present harm done to the patient and their relationship with healthcare providers isn't sufficiently stated and appreciated in the  draft consultation document.

 

The document states something like "health professionals should not use restrictive practices to harm, humiliate or punish the patient" and this too is a welcomed statement but it contains a conceptual oxymoron: forced treatment is fundamentally harmful, humiliating and punishing to the patient and healthcare professionals should be aware of this damage and bear responsibility for harming their patient, violating  their rights and bring the noble profession of nursing into disrepute every time they forcibly treat anyone. A nurse's state of mind while forcibly treating a person does little to ameliorate the visceral harm to the victim. This needs to be elucidated in the document lest staff forget  the immorality of this necessary evil, an elucidation which is clearly required given Mind's evidence.

 

Rather than wasting words on relaying my own traumatic experiences of forced treatment and illegal detention to communicate the victim's visceral horror caused by restrictive practices - I'm sure the mental health charities will collect those and communicate them in the consultation - I'd like to use an image.

 

.

http://en.wikipedia.org/wiki/File:The_Scream.jpg

 

The Scream by Edvard Munch, 1893

 

I feel this is a communicative image, one which victims of forced treatment could identify with. It conveys to me the horror of the victim and the feeling of a distorted sense of reality - or "lack of insight" as psychiatrists call it - when their healthcare suddenly becomes forced. I hope it conveys the urgency of the harm done to an individual but if not I hope the following text does.

 

It's simply awful and it shouldn’t happen to anyone because it is so awful. The goal shouldn't be limited by "minimisation" which should instead be "elimination" because - I hope - the  nursing profession recognise the immorality, trauma and harm of forced healthcare so they set their vision to be a future where it never needs to happen.

 

Given this radical interpretation - one which should be heard and is, in my opinion, valid - the explicit goal should be the elimination of forced healthcare. This is the human rights standard however the Human Rights Act was a pragmatic document written at a time of significant mental health prejudice. This and other human rights legislation aren't comprehensive in the rights they guarantee to all because people with psychosocial disabilities - addicts, vagrants or other people of unsound mind (I believe this is the HRA 1996 definition or close to it) - are denied the same protections and freedom from  torture and forced treatment as free citizens.

 

These inadequacies in disabilities and human rights are why the Convention for the Rights of People with Disabilities (CRPD) was established and it is as essential a tool for disability rights as the HRA 1996 (or 1998…) is for other citizens.

 

In the draft document the ideology and implementation of the CRPD are absent and this dramatically affects the value of a document written to validate restrictive practices on people with disabilities without considering our inalienable human rights not guaranteed by antiquated legislation but enshrined at the core of modern disability rights instruments like the CRPD.

 

The vision must be aspirational to the goal of elimination of forced treatment. With this suggestion that the RCN choose a vision so pure and unlikely to be achievable given current constructs of mental health/psychosocial disability and medicosocial imperatives I would likely be labelled manic or delusional for even suggesting that nurses must adhere to a high ethical standard of judgement about when to use restrictive practices on a fellow human being.

 

Hmm…they might be right too. Regardless, I can't reinforce my point enough. All restrictive practices are a terrible wrong when used against anyone but their use in  the treatment of people with psychosocial disabilities is a fundamental wrong. It's the product of prejudice, not science or legal jurisprudence. It can only be used in the absence of alternatives but this isn't good enough and the CRPD - the landmark disability rights convention - is being disregarded.

 

Suicide, criminal justice jurisprudence and humane nursing practice

Here’s the rub. Suicide is no longer a crime because a compassionate society realised it was stupid to punish suicidal people with imprisonment. The mental health system took over but it sort of forgot the principle of genuine compassion for the suicidal. Forced treatment is inhumane but it is wrought upon suicidal people today and is encouraged in this draft document but this is another rights violation which is a product of mental health pseudoscience used to subjugate an individual's free will.

 

Let me explain. I don't think I've met a mental health professional or any person who's legitimised or validated my desire to die (there was a homeless guy who I tried to persuade to kill me but I think he wouldn't have and would just take my money). The pervading mind-set is suicide is only ever wrong. It's assumed no one would rationally think of killing themselves.

 

I'm afraid this is wrong and the mind-set is the antithesis of that which decriminalised suicide. I'm radical enough to consider forced treatment of people who would likely murder someone else shouldn't lose their liberty purely on their dangerousness because that's the guarantee the criminal justice system gives criminals: they will not be imprisoned without due process (jurisprudence) and guilt must be proven rather than the estimated risk judged solely by a psychiatrist or nurse with restrictive powers. Certain nefarious amendments to the Mental Health Act 1983 introduced dangerous powers of forced treatment and deprivation of liberty based on the risk of "people with dangerous personality disorders" committing a serious crime. (Reference available)

 

What is infinitely worse are the experiences of those who are not committing a crime but are victims of the mental health hegemony's abuse of forced treatment powers regardless of the fundamental human rights violation. What I'm talking about is the chronically suicidal (which I define as someone who experiences at least three months where there are more days associated with considering or wishing for death than days without) and what the mental healthcare system does to us.

 

Suicide is not a crime but the mental health system still incarcerates people who are chronically suicidal and fail an attempt. Psychiatrists will seek to label us to pathologise our desire to die and dismiss the validity of our desire to die using psychiatric diagnosis and the associated construct of madness to dismiss our free will.

 

I'm well aware that some people attempt suicide in the heat of the moment, impulsively and usually shortly after a triggering event which drives them to a lower state (e.g. becoming unemployed, becoming single, bereavement). The mental health system's mode of suicide prevention has delivered significant progress in ensuring these 'virgin' (first time) suicide attempts are unsuccessful. Making effective methods harder to acquire ensures people don't make a regrettable decision to kill themselves. I remember trying to kill myself after splitting  up with my first girlfriend. It was a pathetic attempt under pathetic circumstances and I would have regretted succeeding shortly afterwards.

 

What the RCN may be unaware of are the wishes of  those who have wanted to die for a long time and what constitutes humane and ethical treatment. We live a hell of a life made only worse by the unavailability of effective, painless methods with  which they can escape a reality we no longer want to live in. The imperative to protect people from committing a suicide they'd regret has ignored the rights of those who rationally choose death and would not regret their death.

 

This other state of suicidality is not an illness and it is not an insane or unreasonable or spurious desire. It is what happens when a psyche is harmed too much and there is little the mental health system can do (in my decade or so of treatment) to help the chronically suicidal. The evidence base necessary to know what treatments will work for suicidal ideation doesn't exist. High quality psychiatric research uses complex measures and I'm not aware of any reviews or meta-analyses which investigate the single dimension of effect on suicidal ideation alone reported in high quality trials; this is one of the problems of the current syndrome approach for meeting patient expectations of treatment.

 

Too few mental health professionals know that there are those  who rationally and consciously want to die and have felt like that for a protracted period, at least in my experience. Nurses will make all sorts of arguments which disregard the validity of my emotional experience in a way which only makes me angry at being oppressed. The worst nurses have tried to make me feel guilty for wanting to die, as if that's the silver bullet which will slay the werewolf of suicidality?!

 

My recent experiences might help me communicate this difficult point. Last year I took a serious paracetemol overdose. I had an advance directive refusing treatment but this was overridden. I'd been acquiring paracetemol for a while and mental health services were aware of my desire to die as well as  that I was acquiring the methods to do it. I want to die and it is not a spurious product of biological difference which makes me feel this way nor some whim of an over-emotional suicidal ideation virgin. I am a veteran of suicidal ideation and my rational, contemplated decision is suicide. I commit no crime either. Nonetheless I was the victim of coercive treatment and loss of liberty: I could not rationally want to die in the opinion of the 'care' staff who forcibly treated me. I woke from a chemically induced coma then shortly was dumped in a psychiatric ward where my misery at being trapped in a psychiatric ward was symptomatic of depression and needed my confinement and - had I not complied with treatment  - could be a reason used for prolonged incarceration without having committed a crime.

 

There is no consideration of the rights of those who consciously choose to die in this RCN draft document or what our lived experience of 'healthcare' feels like but there should be because it's nurses who fuck up my life and make me want to avoid mental health services. I want to die. My happy thought is my death and I pray for it. And then, to add insult to injury, I get forcibly treated which is an additional harm to all the other ones which have made me so certain that my death is my only salvation.

 

Part 2

Measurement and oversight.

 

My first criticism is the absence of national monitoring of the use of restraint and other harmful, dehumanising protocols used in mental health crisis settings. Mind's evidence which highlighted the abject failure of mental health professionals to use restrictive protocols as a last resort should be collected as a routine statutory data return by the government to ensure the public's faith in ethical and compassionate mental health services is justified. They can provide the evidenced-based oversight which is sorely missing from NHS mental health and social care to protect victims from abuse.

 

Without national standards robustly enforced by a national performance management framework there will always be regional variations which constitute abuse. Local level monitoring is clearly not enough to protect patients from abuse of their rights.

 

It must be recognised that restraint is a breach of human rights and is harmful but is deemed a necessary evil by psychiatrists. It is clearly open to abuse but it required an independent mental health charity to collect the data which clearly demonstrates that the rights of people with psychosocial disabilities are being flagrantly ignored. The response to the problem is a welcomed move but psychiatric rights are easily ignored as has already happened. Without Mind's protection the human rights catastrophe  would have continued. I'm concerned some of the abuses which have happened to me (illegal detention, inappropriate seclusion and downright immoral  acute tranquilisations) will continue to happen given the quality of the RCN draft document as it stands.

 

Robust protection will only be established by using the same standard of national performance management used in children's social care for a decade. It's a system I've worked in and my experience is without stringent management social care professionals fail in their (albeit difficult) duty. Large systems such as the mental health and social care system desperately need proper performance management with standardised systems and a national performance management framework because without it the proposed system will undoubtedly fail patients just as it does now.

Getting the government to collect the data through a statutory return means much better detail can be seen and more calculations of performance done on the data. National-level monitoring offers the best protection which is the primary reason children's services use it. Mandating the data be submitted to the government also ensures data qualities - veracity, completeness and timeliness - are guaranteed to be high otherwise local reporting could result in poor quality data and therefore poor protection against abuses already evidenced by various sources.

 

Cracks in the cracks
Mental health and social care exist to fill some of society's cracks which some people would slip through much to their detriment. The system isn't perfect and some people end up falling through the cracks again.

 

This is something I saw in the management information data which didn’t get sent to the government when I worked in council children's services. The government wanted averages and so the council only looked at averages. Obviously the average doesn't quantify the outcome of those worst off.

 

 A Key Performance Indicator (KPI) measured the number of placement changes in a year with 2 as the target and the council I worked at scored well on this important KPI. What wasn't reported was the story of the child with the worst placement stability. She had 14 recorded changes in one year and was being failed by the social care system because of her social worker's nihilism (something which naturally happens but doesn't get acknowledged enough) which meant her life was ignored.

 

Once the information got to the management team they acted quickly and this was possible because I told them about the worst case, the one who fell through the cracks in the cracks.

 

I don't know how frequently local performance management frameworks include this sort of measure today but I would strongly encourage their use. It could save lives and if it were also included in national performance management frameworks it would ensure all mental health and social care organisations also record and report their greatest failures so they can be solved.

In terms of restrictive practices, those with the highest number of repeated forcible interventions would be one description of those getting the worse experience and one  which needs special attention to ensure it doesn’t turn into a human rights catastrophe. There are undoubtedly other measures which could be created as part of a national balanced scorecard which, given the constraints, would guarantee worse case and average case scenarios improve.

 

The alternative is an anarchic system which continues to abuse patients' human rights and fails in its protection role while, of course, denigrates  the nursing profession every time a patient is abused by the use of restrictive practices.
 

Reporting victims' experience
An essential part of the protection framework should be the documentation of the victim of restrictive practice's version of events. This should be done by someone independent like an advocate to ensure it is properly transcribed wholly and accurately. I'm afraid that it is a reasonable possibility that some NHS mental health staff may not be able to guarantee this as well as an independent person might.

This information would provide census-level data for all people subject to potential human rights breaches by the NHS mental health and social care system and thereby be the channel to protect victims of restrictive practices from abuse and from errors in reporting.

 

This may be difficult and time-consuming but it must exist alongside incident reporting by staff because a mental health professional's experience of using and justifying restrictive practices can be very different to the victim's experience.

 

Part 3

Miscellaneous

 

• Behavioural Support Plans (BSP) and proportionate to the potential harm to the patient. What does "harm" mean? This feels like a mental health best interests valuation but truly no patient gains value by being drugged forcibly to make them calm or even unconscious. My first experience  of chemical and facedown restraint was deeply traumatic and still haunts me when I've seen it done to other people.

 

This harm-by-healthcare professionals needs to be stopped if at all possible.  The sense of the distress,  psychological harm and trauma experienced by victims does not feel like it has been fully appreciated in the NHS and, unfortunately, in this consultation document too. Restraint is so very awful on the victim and this needs to be impressed on the reader throughout the final document. I believe as many victims of restrictive practices believe: the harm outweighs the benefit.

 

• The caveat that unforeseen circumstances can  be dealt with using an unplanned restrictive practice makes the point of the Behavioural  Support Plan somewhat less effective. Unplanned contingencies potentially offer healthcare professionals carte blanche. Surely it would make better sense to have bespoke last resort or contingency solutions included and agreed upon in the BSP. It may mean it takes longer to compile the BSP but it ensures a patient's right to agree to the healthcare interventions which can be used on them.
  
  Unforeseen circumstances must not allow mental health staff carte blanche in the use no restrictive practices however I don't know how this important rule could be turned into something practical, especially for the restrictive practices which could be used on someone without a BPS (e.g. someone brought into hospital for the first time and is deemed without sufficient capacity  to agree to a BPS before they are the victim of forced treatment.
   
• Effect on prescribing practice
  I don’t trust most psychiatrists but this prejudice can be useful. When presented with the problem of a vision to reduce their powers of coercion (which is implicitly delegated to subordinate staff) some might opt to use high dose antipsychotics or polypharmacy to get the reward of a zonked out, docile patient. Measures might misrepresent the harm assessment weighing up the harms of restrictive protocols versus the harms of overmedication and multiple medication which - if memory serves me - was assessed to be high enough for the Royal College of Psychiatry recommended against this prescribing practice in their consensus statement on the use of antipsychotics.
  
  I'm not sure how this effect could be measured easily. It is vital to prevent against any prescribing changes caused psychiatrists compensating for restrictions (no pun intended) to restrictive practices. On reflection it probably isn't something for the RCN but I hope nursing  staff could report it if it happened. It would be a awful if one harm was simply swapped for another, wouldn't it?

 

I think the absolute truth is...

If someone sold or gave me the means to reliably and assuredly kill myself I would take it.

All that stops me is the fear of failing. I don't even mind enduring a painful death as long as it's a death.

My life was never meant to be how it is but my death will be. At least I have that guarantee.

- sent from my smartphone

If I could sleep a dreamless sleep for the rest of my life I would.

- sent from my smartphone

I hate this shit of a life

- sent from my smartphone

Re: Still time to respond to Reducing premature mortality for people with mental health problems APPG first session

Hi Lizzie and Mind

Many thanks to Mind for disseminating this opportunity and the restraint consultation.

Lizzie. I saw the survey questions. Thanks. I was going to ignore them and put what I had to say in the Other box (sorry). What I have to say may not have direct significance to the goal of the APPG. I know it's looking at parity and what I have to say is a longwinded route to propose..well...a mad idea which is like the public health initiative to ban smoking (which is what those evil healthcare professionals want to do to us smokers!).

I appreciate you taking the time to read my views as they are rather than having to squeeze them into boxes. Without further ado, here's what I have to say!

In solidarity


Arj

-------------

 

http://www.rethink.org/get-involved/campaigns/all-party-parliamentary-group-on-mental-health/appg-form

 

Rubric

I used to work at Mind HQ in their information department. I've volunteered time to Mind and Rethink. I've written to  MPs on various issues related to mental health. I am also the England affiliate of Mind Freedom International and am  an active member of the European Network of Users and Survivors of Psychiatry.

 

I would like to convey something to the APPG and the mental health charities involved on the thorny subject of suicide. "Reducing premature mortality for people with mental health problems" is the subject of the APPG session and I assume mortality relates to all-cause mortality including suicide. I consider myself a suicide expert by experience and I have an opinion which I feel must be understood by mental health decision makers. I will try to talk a little about factors other than suicide  and I will endeavour to be concise but there is a lot of information and novel concepts I need to communicate as well as my personal experience.

 

My first point is that there are related factors between suicide and other causes of premature mortality but I feel it is important to differentiate the two because they are different types of death, especially when measuring and acting to prevent them from happening.

 

The tragedy

It is a tragedy that people with severe mental health problems die earlier and are significantly over represented in the attempted and successful suicide  rate. This tragedy is well understood and I welcome the issue is being taken seriously by the government.

 

My opinion is it isn't the greatest tragedy. A human being - a conscious,  sentient mind - driven to want to die, to end their personal and unique suffering using the last resort of suicide. That's the tragedy and the lack of appreciation of this truth adds insult to injury.

 

 Suicide data commonly quoted is the number of successful suicides every year but I think the number of attempted suicides gives a clearer presentation of the problem. Counting how many people want to die, though difficult, is the best measure of the problem.

 

My experience

I live day after day, year after miserable year wanting to die. I rarely make attempts and much to my sadness I've not yet succeeded. Private and NHS services have not succeeded in abating my desire to die in over a decade. They have no evidence base because the syndrome approach in research doesn't prioritise the single symptom of suicidal ideation alone, or not that I've been able to find anyway. Some mental health measures do include suicidal ideation along with a lot of other measures which have no or little bearing to suicide. Suicidology is also  a severely underfunded research field.

 

Not being able to die and living is a unique hell, one which mental health services have always seemed apathetic to addressing. They're more concerned with labelling (and it feels like no two professionals can agree on my label) than dealing with suicidal ideation. I've tried various drugs and therapist to little avail.

 

Living with this state of mind changes how I live. I live with little care for my health. In  fact I make decisions to reduce my life expectancy to die quicker and I pray for death. It is, I hope, obvious to the reader, that this state of giving  up on life itself would contribute to a reduced life expectancy. The pervading sense of despair alone is a large factor in my desire to die and my reduced life expectancy and I don't think I'm the only one who feels this rotten.

 

I'll admit drugs and alcohol are also a conscious choice to reduce my life expectancy but also to provide limited escape from a reality I no longer want to live in. I don' think anyone feels the pain of being a self-medicating junkie in the mental health system. There's so much prejudice. Drugs can cause illness and contribute to reduced life expectancy but so do treatments like clozapine, ECT or neurosurgery for mental health. I'm an informed junkie and my personal experience is highs can, for a short while, heal or at least abate the psyche pain in a way psychiatric pharmaceuticals have never been able to (if I can get high enough).

 

It's this root extreme of mental pain and suffering which is involved in the various mental states which mediate reduced life expectancy and suicide. Isolation, exclusion, poverty, victimisation, plain old misery and despair are all experiences felt by people who end up giving up on living, and those with severe psychosocial disabilities are massively over-represented in this group.

 

It is a litany of errors and circumstances which have driven me to the broken mental state I'm trying to describe. It is not a mental illness to be suicidal in my opinion because it is a reasonable reaction to an awful life and this awful life is a severe disability as well as causing profound, inextinguishable misery. Can you imagine what not wanting to live might feel like or guess what it might do to a person over the days and months and years of a living hell?

I'm trying to convey it to you but my key point is not for you to pity my pathetic existence. My life experience exposes a problem which you may not be aware of. A personal story can shine a little light on it.

 

Prevention of suicidal ideation and morbidity and mortality benefits

My key point is perhaps even more alien than my life experience. Simply, people should be prevented from ever getting to the mental state where they want to die. The events and circumstances leading to a person wanting to die are the cause of so many people in this country feeling the god awful misery of a mind emotionally harmed and tortured beyond its limits. These need to be addressed.

 

If the APPG hopes to tackle the great tragedy of the lifetime prevalence of suicidal ideation then I believe the aim should be to eliminate the harms which make citizens want to die. The current paradigm of suicide prevention has failed me: they can't change the way I feel (but can make it worse) and they won't give me the methods to end my life when and how I want it ended (to naturally drift off to a last sleep with no pain and a feeling of bliss).

 

The goal of reducing all-cause mortality isn't the purview of physical health services alone. Society and culture play a large part in causing awful psychological states as does (for some) mental health treatment. Preventing people from getting to those awful states - especially the one where a person wants to die - is what I would recommend as a goal for the APPG if they truly want to tackle all-cause mortality and morbidity but it requires a different mode of thinking and a vision of a better society..

 

It may sound difficult or even insane as a realistic objective and I'm wary of this opinion. It would be difficult but not impossible to affect the rate of suicidal ideation. More importantly though: it's necessary. Completed suicides like suicidal ideation are tragedies and the product of circumstances which can be changed but, unlike actual suicide, suicidal ideation requires commitment to a better society where individuals are never driven to choose self-death as a recourse. Without this commitment people with disabilities and other citizens will continue to die earlier and that's not a good thing….in fact, it's a bad thing.

 

Public health cancer strategies have made smoking the choice of a pariah and made significant gains in reducing morbidity related to smoking. Public health suicidal ideation prevention programmes could confer significant benefits for the people who are saved from the awful mental state I've lived with most of my adult life and one of the benefits would be, in my opinion, a reduction in  mental health morbidity  and mortality.

Thank you for taking the time to read my views.

On 24/01/2014 12:02, Elizabeth Blow wrote:

Hi Arj,    Yes please do email your points over. We are asking people to respond under the following headings:      1. Tell us about you:    I am a carer  I am a person with mental health problems  Other    2. Please tell us about your experiences of physical health care for people with mental health problems    3. What were the good things about physical healthcare that you received?    4. What physical healthcare or support would you have like to have received?    5. What could the Government do to implement better physical healthcare nationally?      All response will be treated in accordance with our confidentiality processes, but anonymous quotes may be included in our report.    I look forward to receiving your answers!    Thanks,  Lizzie      Public Affairs Officer  020 7840 3150          -----Original Message-----  From: Arj Subanandan [mailto:arj.name@googlemail.com]  Sent: 24 January 2014 10:04  To: Elizabeth Blow  Subject: Re: Still time to respond to Reducing premature mortality for people with mental health problems APPG first session    Many thanks Lizzie. I'll do what I  can.    The form isn't the best approach for me. Would it be okay to email my points to you?    In solidarity    Arj      On 24/01/2014 09:44, Elizabeth Blow wrote:  

Hi Arj,    Thanks for your message.    The deadline is 5pm today, so please do submit before then! The form  can be found on our website: www.rethink.org/allpartymh    Best wishes,  Lizzie    Public Affairs Officer  020 7840 3150          -----Original Message-----  From: Arj Subanandan [mailto:arj.name@googlemail.com]  Sent: 24 January 2014 09:44  To: Elizabeth Blow  Subject: Still time to respond to Reducing premature mortality for  people with mental health problems APPG first session    Hello Elizabeth    I hope you're well.    I came across the APPG on Rethink'site today from a Mind campaigner email. Is there still time for me to respond and if so when is the deadline?    Best regards    Arj  For information on our email policy, including confidentiality and  viruses, visit http://www.rethink.org/emailpolicy    Rethink Mental Illness is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee. Registered in England Number 1227970. Registered charity no. 271028. Registered Office 89 Albert Embankment, London, SE1 7TP.  

  For information on our email policy, including confidentiality and viruses, visit http://www.rethink.org/emailpolicy    Rethink Mental Illness is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee. Registered in England Number 1227970. Registered charity no. 271028. Registered Office 89 Albert Embankment, London, SE1 7TP.  

Draft prose for APPG parlimentary group

 

http://www.rethink.org/get-involved/campaigns/all-party-parliamentary-group-on-mental-health/appg-form

 

I used to work at Mind HQ in their information department. I've volunteered time to Mind and Rethink. I've written to my  MPs on various issues related to mental health. I am also the England affiliate of Mind Freedom International and am  an active member of the European Network of Users and Survivors of Psychiatry.

 

--

 

The only thing I would like to convey to the APPG and the mental health charities involved is on the thorny subject of suicide. "Reducing premature mortality for people with mental health problems" is the subject and I assume mortality relates to all-cause mortality including suicide. I consider myself a suicide expert by experience and I have an opinion which I feel must be understood by mental health decision makers. I will try to talk a little about factors other than suicide  and I will endeavour to be concise but there is a lot of information and novel concepts I need to communicate and my personal experience.

 

My first point is that there are related factors between suicide and other causes of premature mortality but I feel it is important to differentiate the two because they are different types of death, especially when measuring and acting to prevent them from happening.

 

The tragedy

It is a tragedy that people with severe mental health problems die earlier and are significantly over represented in the attempted and successful suicide  rate. This tragedy is well understood and I welcome the issue is being taken seriously by the government.

 

My opinion is it isn't the greatest tragedy. A human being - a conscious,  sentient mind - driven to want to die, to end their personal and unique suffering using the last resort of suicide. That's the tragedy and the lack of appreciation of this truth adds insult to injury.

 

 Suicide data commonly quoted is the number of successful suicides every year but I think the number of attempted suicides gives a clearer presentation of the problem. Counting how many people want to die, though difficult, is the best measure of the problem.

 

I live day after day, year after miserable year wanting to die. I rarely make attempts and much to my sadness I've not yet succeeded. Private and NHS services have not succeeded in abating my desire to die in over a decade. They have no evidence base because the syndrome approach in research doesn't prioritise the single symptom of suicidal ideation alone, or not that I've been able to find anyway. Some mental health measures do include suicidal ideation along with a lot of other measures which have no or little bearing to suicide. Suicidology is a severely underfunded research field.

 

Not being able to die and living is a unique hell, one which mental health services have always seemed apathetic to resolving. They're more concerned with labelling (and it feels like no two professionals can agree on my label) than dealing with suicide. I've tried various drugs and therapist to little avail.

 

Living with this state of mind changes how I live. I live with little care for my health. In  fact I make decisions to reduce my life expectancy to die quicker and I pray for death. It is, I hope, obvious to the reader, that this state of giving  up on life itself would contribute to a reduced life expectancy. The pervading sense of despair alone is a large factor in my desire to die and my (I hope) reduced life expectancy and I don't think I'm the only one who feels this rotten.

 

I'll admit drugs and alcohol are also a conscious choice to reduce my life expectancy but also to provide limited escape from a reality I no longer want to live in. I don' think anyone feels the pain of being a self-medicating junkie in the mental health system. There's so much prejudice. They can cause illness and contribute to reduced life expectancy but so do treatments like clozapine, ECT or neurosurgery for mental health. I'm an informed junkie and my personal experience is highs can, for a short while, heal or at least abate the psyche pain in a way psychiatric pharmaceuticals have never been able to.

 

It's this root pain and suffering which mediates the various mental states which mediate reduced life expectancy and suicide. Isolation, exclusion, poverty, victimisation, plain old misery and despair are all experiences felt by people who end up giving up on…I suppose it depends on the person…on life/reality/society/humanity/people/living.

 

It is a litany of errors and circumstances which have driven me to the broken mental state I'm trying to describe. It is not a mental illness in my opinion because it is a reasonable reaction to an awful life and this awful life is a severe disability.

 

Can you imagine what not wanting to live might feel like or guess what it might do to a person over the days and months and years of a living hell. I'm trying to convey it to you but my key point is not for you to pity my pathetic existence. My life experience exposes a problem which you may not be aware of.

 

My key point is perhaps even more alien than my life experience. Simply, people should be prevented from ever getting to the mental state where they want to die. The events and circumstances leading to a person wanting to die are the cause of so many people in this country feeling the god awful misery of a mind emotionally harmed and tortured beyond its limits.

 

If the APPG hopes to tackle the great tragedy of the lifetime prevalence of suicidal ideation then I believe the aim should be to eliminate the harms which make citizens want to die. The current paradigm of suicide prevention has failed me: they can't change the way I feel (but can make it worse) and they won't give me the methods to end my life when and how I want it ended (to naturally drift off to a last sleep with no pain and a feeling of bliss).

 

The goal of reducing all-cause mortality isn't the purview of physical health services alone. Society and culture play a large part in causing awful psychological states as does (for some) mental health treatment. Preventing people from getting to those awful states - especially the one where a person wants to die - is what I would recommend as a goal for the APPG if they truly want to tackle all-cause mortality and morbidity.

 

It may sound difficult or even insane as a realistic objective and I'm wary of this opinion. It would be difficult but not impossible. More importantly though: it's necessary. Completed suicide like suicidal ideation are tragedies and the product of circumstances which can be changed but unlike actual suicide suicidal ideation requires commitment to a better society where individuals are driven to choose self-death as a recourse. Without it people with psychosocial disabilities will continue to die earlier and that's not a good thing….in fact, it's a bad thing.

Until there is the number of fresh suicidal people and all suicidal people isn't the first thing the prime minister sees on their desk every day ,

And feels the weigh of responsibility, there will not be a good day in mental health suicide prevention.

Till then there is just the war (or battle?) to achieve this smart objective.

- sent from my smartphone

Mental health stigma, violence and psychiatric research bias

The fact is the label with the highest associations with murder, violence and crime is "men", and yet there is no prejudice nor systematic suppression of dangerous men except that which is implicit in psychiatry and its powers to prevent harm to another or a serious crime. It's bullshit and should be stopped because their  powers will always be overused and abused.

It is the stigma of mental illness and the biomedical model's powers which allow for forced treatment or incarceration by doctors. It is the privilege of physicians which prevents and dissuades oversight or challenge. The media naively support the medical model and entrenched prejudice in society.

And, as usual, all this conspires to shit on the mentally ill like a sumo wrestler with diarrhea. Most mentally ill people are less violent or aggressive than the norm. They're more meek and humble and kind and any other positive attribute than the average but psychiatrists rarely study these aspects. Such is their inherent stigma to ignore the possibility of positive attributes to the mentally, just as men can also be associated with positive attributes but if people ignored this and only saw our risks then it would be fucking awful for men instead of just for the mentally ill.

The dearth of evidence of positive attributes of the mentally is caused by psychiatry's fundamental prejudice. The absence of positive evidence and a preponderance of negative evidence further fuels the public's tightly held prejudices.

This is an example of research bias caused by psychopathology principles which contributes to mental health prejudice in the public through the media. The media report on the information which reaches them and that's why the research bias causes stigma.

- sent from my smartphone

Models matter

All of the coercive powers of the mental health system are inextricably bound to the biomedical model of mental illness.

The biopsychosocial or social models are the accepted modern construction of mental illness but guess what? It's no longer a medical illness.

The biopsychosocial model is what's considered the best model of mental illness according to the mainstream medical power holders, eg NICE. The model is actually a description of how every human type and variation comes to be. Three domains - biological, psychological and social - are the causes behind every person on the planet's individuality.

The labelling of some of this inalienable diversity is still justified by the concept of prognosis: the mentally ill will have a worse life. The problem is the model no longer describes a true medical issue and therefore there isn't the power of coercion.

The best model is the social model of disability and an unwritten system to simplify and manage the vagaries of emotions.

This is radically different to the original construct of the biomedical model. It is a fundamental paradigm shift.

In fact, the social model of disability is ideologically similar to the drive towards human diversity as a paramount priority as important as human equality.

The social model favours the unreasonable treatment paradigm of changing the environment to reduce the prognosis - the concept almost or totally synonymous with disability? - rather than homogenization as was the mainstay treatment model in the last century and millennia come to think of it. Well, apart from the occasional injection of a social model message from some schizophrenic or other.

Anyway, models matter and mental health professionals haven't caught up.
- sent from my smartphone

Suicide may have biological associations but this doesn't mean that it's wrong

The mental health system is based on a fundamental fallacy that biological and behavioural differences constitute a true medical illness and are scientific labels.

The medical model has been repeatedly debunked on scientific grounds and I'll try to explain why.

Perhaps two centuries ago a doctor thought black people were black because they had a disease. He named it negritude.

Today this idea seems ludicrous but it's still happening today in the psychiatric system.

Psychiatry is done by doctors because early on in the concept the medical model was misapplied to human behaviour to day biological differences and associations with a prognosis - a worse life course. That's the medical model and why it regulates human behaviour.

The same model can be used to validate negritude too. Black skin passed down through the generations fulfills the biological requirements. Two centuries ago black people would have a much worse life course because they were black. Even more indicative of the medical model, the model of change or 'treatment' would be to make those diagnosed with negritude white. Obviously the right model of change is to preserve the individual as they are and combat the society and cultural forces- prejudice is an appropriate synonym - which causes the worse outcomes for black people.

This line of thought is why I question the definition and power to force treatment wielded by mental health professionals. Their model is wholly specious in terms of the biomedical model and the dimension of psychopathology.

Just to reinforce the point I'll mention the demedicalisation of homosexuality. It is clearly not a mental illness but social prejudice enforced by psychiatrists caused this normal human type (in fact I think there's a spectrum) to be considered abnormal. Society's morals changed and so did psychiatric pathologisation, which is a ludicrous situation typical of the variability and pseudoscientific nature of psychiatry.

Many other authors have made this point with far more substance. And when it is applied to suicide its right to power is supported by a large body of evidence of typical specious evidence.

Of course It isn't that simple. It would be irresponsible to apply an anarchy to suicide, but the blanket ban on assisted suicide for the mentally ill is equally irresponsible and supported by no criminal law since suicide was decriminalised in the last century.

Clearly those were much more compassionate times. Since the took over I'm not sure things have gotten better.

Of course, if you're of the opinion that preventing all suicidal people from killing themselves then mental health services and you are pseudocompassionate.

I believe suicide virgins should be protected from making an attempt that, if it fails, the individual would regret after the emotional impulse has left them.

But the picture for suicide veterans isn't good. The blanket suicide prevention drive means effective methods which are non-violent in nature are hard or impossible to acquire. Here is where the falseNess of the current paradigm shows itself. Those who try to kill themselves shortly after a triggering event and would regret killing themselves who get protect. Those like me who have wanted to die for a long time. We can't get the release from life we so desperately need. Cunts.

The legislature do not know the torture of living with chronic suicidal ideation and wanting the final exit to our personal pain.

We want to die but not impulsively or shortly after a triggering event. We've lived with wanting to die for a while. We might be scared of dying but more afraid of living. Our only regret is past failed attempts didn't work.

There is no worse torture in developed world countries than chronic and unfulfilled suicidal ideation because, worst of all, no compassion nor empathy nor understanding nor respect nor even sympathy.

We are forced to live through the misery which has already crushed a human soul. Insult to injury is every unwanted day survived.

Ugh. I'll finish this later.
- sent from my smartphone

The problem with psychometric testing of the mental ill

One element is their validity and reliability. I apparently did well on psychometric testing done almost twenty years ago when I was trying for graduate jobs. My life today shows my scores didn't predict my life now: a sad, unemployed, crappy down-and-out junkie who wants to die. They may not have predicted my contribution to mental health either.

I don't know if psychometric tests will correctly quantify the qualities of the various human types poorly identified using psychiatric diagnosis.

Take IQ. This is a timed test if I remember right so it won't measure well people who think slowly but can solve problems quick thinkers can't. Therefore is the iq test really measuring intelligence? It may be possible that a person with a learning disability might actually have an excellent ability to solve problems which people with higher iqs can't.

I wonder if other psychometric measures are similarly flawed and the mentally ill will score lower than their actual real world capability.

- sent from my smartphone

I sold my soul cheap and didn't even get what I wanted

Certainly not this shit of a life nor for this shit species.

- sent from my smartphone

The silver bullet of employment and my blindness/midtake

I believe targeting employment outcomes will drastically improve mental health outcomes if it's the right employment.

Money, socialisation and purpose are three obvious benefits which will create improvements in a number of domains. There are other benefits too such as integration of disabled people into mainstream society.

What I've not done enough of is focus on risks, weaknesses and alternative solutions.

An obvious risk is pushing someone into work when they're not able or ready. Reasonable adjustments at work and volunteering before starting work provide stages of return to work. Therapeutic earnings is another stepping stone or a permanent stable employment solution. A longer period where benefits are continued would be useful and if this were increased to a year It would provide a solid safety net.

No one should be forced to work but the potential to increase income and therefore quality of life is an effective carrot on a stick. As I've mentioned before, I have no solution as to how to increase the income of those who can't or won't work other than raising benefits.

The environment or the role may be inappropriate and the impact of this risk could outweigh other benefits. In my mind's eye I envisage a happy, sociable, fun and inclusive work culture as a rough sketch of the 'right' (really my personal idea of right) though I'm sure there are definitions.

The role is vital too but I'm bored so I'll end it here.

- sent from my smartphone

Time to get high

A drug use and misuse anti stigma and discrimination and legalization campaign name.

Oh. What a top idea! If only...

- sent from my smartphone

Bloody hell

This crappy morning has managed to fly by because I'm reading and responding to a consultAtion. My response isn't great so far. Need to focus more on psych rights but need to stay practical to sugar coat what might be a bitter pill. Only 12 pages in of 37. Still, I've managed to fly through what stArted off as the morning from hell.

- sent from my smartphone

Believing in something not (empirically?) true

This thought is about something called faith or, perhaps better, instinct.

I'm talking about equality. It's a noble principle but it doesn't exist yet. It may never exist.

People do have differences from construct measures of intelligence to the even-harder-to-quantify potential to contribute to the greater good. Some people are star athletes but can't do simple mathematics while others have genius-level intelligence but can't tie their own shoelaces. Others have many skills but don't excel in any one of them.

These various assets, in theory, advantage certain people in certain areas of life and detriments do likewise damage.

In today's world of wide disparity between rich and poor there is a practical, real world impact.

Today's society values people in insane ways but perhaps a sane unequal method of distribution of wealth would outperform an egalitarian approach.

I might be rehashing the capitalism /socialism debate but actually it's part of what Im rambling on about.

The evidence is communism lost the Cold War. Though capitalist nations have included quasi socialist ideals in the post- cold war era what dominates is the ideal that an unequal distribution of wealth is right.

There are reasons for the USSR's failure but nonetheless unequal distribution of wealth, power and all sorts of other quantities really does work.

But, in the face of lack of supporting evidence and lots of evidence to the contrary, I still dogmatically believe equality is right.

What do you think?
- sent from my smartphone

Guns and disadvantage/disability

Bear with me. This might be a bit leftfield. This is a thought for thoughts sake piece (no pun intended)  rather than anything practical.

Basically, guns level the playing field of physical prowess and defense/attack. A few hundred years ago in the Wild West, a wilderness without the rule of law, guns meant weak men could fight or fight back strong men in a way not possible before guns were invented. Obviously there's still the need to learn to use a gun but (in the main) physical strength doesn't matter.

Guns, in an odd way, reduce the impact of human difference and contribute to equality (at least for those who could afford a gun).

There are much better examples I could use but guns tickle my contrary streak.

And they're also a good idea of how social evolution can achieve results better than the practical technological situation. Today, men don't need to shoot it out. People don't carry guns and neither do the UK police and the vast majority of law breakers. Most people can feel safe and there are better dispute resolution techniques than pistols at dawn.

This mode of change I'd closer to what I would ethical than the wide spread availability of guns for obvious reasons and for the demonstration of change in society- even advancement- versus changing individuals. The former, in this case, clearly delivers much better results.

Individuals can also choose to own a gun except the mentally ill who, I think, are also banned grim joining a gun club and using a shooting range.

I'm not sure though. I've shot a gun. An old sniper rifle with a small bore. I did it at school. Other kids at school could join the Combined Cadet Force and play with modern weapons.

I digress.
- sent from my smartphone

A summary of the masculine epistemology of mental health in a poem by Rudyard Kipling.

http://www.kipling.org.uk/poems_if.htm

It's strange to think their are other mental health ideologies. There are many. Most are only subtly different but the so-called traditional male epistemology of mental health is fundamentally different as, I hope, this poem illustrates.

This ideology of mental health is a shadow of its former self. Where once it dominated Industrial Revolution nations' social landscape today I can only recall the concept of resilience which bears a sense of survival and toughness, poor self- esteem/ humility, internalisation of suffering and other themes so well described by Kipling.

To be continued.

- sent from my smartphone

It's always wise to have spare capacity

I was looking at the strap of my bag as it hung from my wardrobe door when this thought arrived.

It reminds me of a discussion I had with the director of a mental health charity. People shouldn't routinely work at their peak performance because when shit happens- which it invariably does- there's no spare capacity to deal with it as well as it could be if employees aren't pushing themselves to the brink regularly.

From cars to microchips the revving up of performance risks unstable conditions like an engine blow out. Having spare capacity protects against the stressful nature/ impact of unknown variables which are predictable only in their unpredictability.

- sent from my smartphone

Bloody hell

For some reason, In currently feeling not shit. Perhaps a little good though that's something I'm not familiar with.

It won't last.

What's odd is I'm feeling a smidge less suicidal. I still want to die but now I feel I could wait a couple of hours than do it straight away.

Again, I doubt it will last.

- sent from my smartphone

How close am I to Hitler's ideas?

Not far I think but I'm not informed about national socialism.

I'm inclusive. That's all. I still hoped humanity could reach its potential.

How wrong was I?

- sent from my smartphone

Sex and disability

It might seem ludicrous to suggest that sex should be available on the NHS but it isn't. Not to me.

I believe the social model and it's prediction of exclusion for disadvantaged and disabled is the right one.

Sex obviously makes a lot of people happy. But this happiness is not the privilege of the disabled. It's a sad reality but shit happens.

But what of the treatment practitioner (or prostitute in other words)? I'm specifically thinking of their mental health.

The last time I had sex I didn't enjoy it. It was nothing to do with who I was with. It could have been Jennifer Morrison (fro m house) and I'd have felt the same. On reflection perhaps I might have felt like it if I was sleeping with Sandra bullock but enough about my celebrity fantasies.

The point was that even though I didn't want to I still did it because that's what people do for one another when they're in a relationship.

It felt really crappy and I fear many prostitutes feel. Am I right?

I do believe in the legalization of prostitution because it is the harm minimization solution.

Anyway, I've clearly wandered off in a tangent I know nothing about.

But sex on prescription? It's really not rocket science.

- sent from my smartphone

If I knew I was going to die tomorrow

I would just keep writing, thinking and blogging. At least at the moment.

It's a sad, lonely addiction. Thank fuck for good porn and drugs.

Does anyone else feel like that?

- sent from my smartphone

The hope that I kill myself

Though perhaps macabre, it has the power of any hope. It makes the every day shit that little bit more  tolerable.

Sort of like subtracting 5 from 110% shit.

- sent from my smartphone

I think I'm going through a bereavement process

For the data which I lost when some cunt stole all my it hardware.

There's a variety of emotions I'm bottling.

- sent from my smartphone

Regular readers may have picked up that I've never posted, "ah. At last I'm happy."

Dot dot dot.

- sent from my smartphone

A realisation

My annoying neighbours problems are partly from a high need for attention but also a high need for social contact.

- sent from my smartphone

I am afraid of my suicide

It would be crazy not to be.

But what I fear more is failing to kill myself. I hate that part of me which keeps me alive in this quagmire of filth called life.

- sent from my smartphone

It will end

It's a thought which makes me happier: my death.

- sent from my smartphone

What point is power?

If not to protect cherished ones?

- sent from my smartphone

I just had a thought I just have to share

Should I stay here and be miserable or move somewhere else and be miserable?

Answers on a postcard to the usual address.

- sent from my smartphone

Fire is amazing

I was reminded of a physics lesson at school where the teacher was explaining that everything in the physical world can be categorised as solid, liquid and gas.

As I remember it I asked a question.
What about fire?

I was promptly jeered at by others in my class but the teacher thought it was a good question, one he didn't have the answer to.

In fact I wasn't clever enough to have come up with the question. It was something my grandfather asked me and I couldn't answer. Everyone should have a grandfather like mine. Except for the authoritarian, cranky, foul tempered disciplinarian bit. That wasn't good.

Anyway, fire. My physics teacher went away and asked the question to the other science teachers. At the next lesson he told the class the answer. If I remember it right it went something like this.
Fire is an incandescent semi gaseous solid.

Cool huh? Fire isn't one thing. It's something in transition and as it changes- reacts- it gives off light we see as the flame.

The flame is the incandescence which comes from carbon particles (the solid ish bit) turning into a gas which doesn't act like a proper gas. It's' weighed down' to stay near the fuel source.

So there you go. Fire is magic.

- sent from my smartphone