stuff I just wrote on acute/crisis care

I hope who I sent to bothers to read my shit.

1 - monitoring of deaths in psychiatric wards
One bit is from the Rethink Fair Treatment Now report. P11 onwards has the info they've uncovered on acute care. One of the most chilling things I've heard is
"Rethink has advised families in cases where a Mental Health Act ‘section’ has been lifted when a person is dying, so that there is no need to report the death to the Coroner for investigation. The solution to this would be extending the requirement to report deaths to apply to those who have recently been detained under the Mental Health Act. It is not fair to leave these deaths uninvestigated."

Anon 2010, Fair Treatment Now Report, Rethink
www.rethink.org/document.rm?id=11234

It is obviously very scary if it is true that NHS staff are fudging the figures; it may simply be a case of the need to remove a section top get treatment outside the confines of a psychiatric ward. Regardless, it means their deaths are not investigating nor noted in the figures.

2 - the lives of long stay patients + BME experiences
It leads me to something else though. Imagine spending that long in a psychiatric ward that you died in there.

This is a quote from the last Count Me in Census.
"67% of [BME] patients had been in hospital for one year or more; 31% for more than five years"

The lives of long stay patients are akin to the lives of prisoners, however the only crime committed by a long stay psychiatric patient is not getting better. The amendments to the Mental Health Act 1983 removed the treatability test so no  existing treatment needs to exist. There is no mandate to provide treatment and therefore this is de facto imprisonment; in practice the only treatment is drugs and these may not be working for these long stay patients. Their quality of life may be appalling too. I've only spent a month at most under section and it was awful. I can't imagine what 5 years would be like.

More information may be gathered from the NHS Information Centre which is responsbile for collecting these statistics. The hospital episode Statistics are also useful - http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937 - but needs someone with some good Excel skills. Of course the most up to date figures would be useful. There's stuff other than gender, for example average length of detention.

3 - provision of beds
Rethink has done a press release on the result from this paper already. Sadly the authors of he paper didn't take into account episode counts which may help to build a better picture. I've emailed one of them but they've not responded.

This is the relevant text however there's a caveat.
"Between 1988 and 2008 the provision of mental illness beds in the NHS decreased by 62%, from 166.1 to 63.2 per 100 000 adults (total numbers decreased from 63 012 to 26 430; fig 1). During the same period the rate of involuntary admissions increased by 64%, from 40.2 to 65.7 per 100 000 adults per annum and exceeded bed provision by the end of the study period"

At the end of the study period is around the time the Community Treatment Order was introduced into the medico-legal framework when the Mental Health Act was revised. This was aimed at reducing the number of 'revolving doors' patients (the term given to those who would leave hospital but be readmitted within a year.

Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study
British Medical Journal
http://press.psprings.co.uk/bmj/july/beds.pdf

4 - progress in acute care for first episode psychosis
Once again I'd like to reiterate the need for progress in acute care. by progress I mean an alternative treatment paradigm, one which focuses on low or no dose medication. The John Bola review takes data from international sites where this is being experimented with. The UK is absent because there is no experimental or progressive treatment paradigm. The Bola reivew and the systematic review of Soteria both show better outcomes from these alternative paradigms compared to treatment as usual.
Bola, J. et al. 2009, Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature, Psychosis
http://psychrights.org/research/Digest/Effective/PsychoSocialMoreEffective2009Psychosis.pdf

Calton, T. 2008, A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed With Schizophrenia, Schizophrenia Bulletin
http://schizophreniabulletin.oxfordjournals.org/content/34/1/181.full

for persuading policy makers and doctors the review of Soteria is more persuasive than the John Bola review (because it is a systematic review and is published in a reputed peer reviewed journal) how the results for Soteria in the Bola review seem to indicate it may offer the worst of the outcomes of all the sites reviewed (if I remember right it had the highest number of suicides). The Soteria review persuaded a friend of mine who used to be a GP in the UK and completed a Masters in Public Health policy and Harvard.

The NHS is meant to be delivering world-class mental healthcare. That's what all the policy stuff says. The NHs is far behind is this area. People to speak to are Rufus May and the Soteria Network. There's a strong argument for any new paradigm to first be done in London because of the large population and high rate of psychosisi (2x higher than other cities according to the well regarded AESOP trial).

My advocacy of alternative approaches for first episode is based on my personal experience. In the New Horizons consultation, in my letter to Openmind which wasn't published, in my work to better the NICE schizophrenia guidelines 2 years ago and my current work on NICE's guidelines and schizophrenia treatment in general I am always promoting the possibilities of alternative approaches.

The simple reason is the trauma I experienced. There is evidence that hospitalisation can cause PTSD symptoms (no reference - it was from a talk by Jacqui Dillion, chairperson of the Hearing voices Network). It is my desperate hope that these alternative paradigms avoid the trauma and, as the small body of evidence shows, may offer better outcomes in the long term.

5 - ECT
This doesn't really work and it harms patients. Sham ECT is almost as effective during treatment and as effective on follow up. On the other hand ECT induces seizures which is geenrally a bad thing and it also means electricity is run across the brain which is another generally bad thing. This Read and Bentall review is causing a stir in international practice regarding ECT. Katherine Darton would be able to explain the significance. Essentially this barbaric treatment doesn't work better than the same treatment but without the electricity used. It has killed many people.

http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/irish-times-read-bentall-ect
(Link to paper at the bottom)


Hope that info is of use to the campaign. Acute care is a very important area which is so desperately in need of progress.