Study shows restraint

By admin on August 28, 2011

I was disturbed this week by a study out of Ontario.

Is this the best we can do for people in crisis?
The report highlights that 80 per cent of people with distress around mental health issues were admitted to general hospitals rather than to specialised psychiatric sites.

On the surface that does not sound like a problem, however we are told that “Compared to psychiatric hospital patients, the study found that control interventions were 1.5 times more likely in a general hospital setting, while the use of physical or mechanical restraints occurred 2.5 times more frequently.”

I am not surprised that the short newspaper article notes there is trauma associated with the use of restraint. I don’t know of the situations being faced by the participants but that doesn’t restrain me from being a little appalled by a few facts.

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Eulogy

By admin on July 16, 2011

A much loved Melbourne football coach died this week, Allan Jeans. Many from the sporting fraternity shared their tributes in the daily paper. Kim Hughes, a former Australian Test Cricket Captain, said “He’s one of the greatest people I’ve ever met. I just wish I’d got to know him a lot more.”

When I read that comment I immediately felt annoyed, on reading it again now I am less annoyed. I think it was the regret Hughes expressed that disturbed me. I am troubled that we harbour regrets after someone dies, and of course there are always regrets.

It seems to be a natural thing to be surprised by death. It is almost as if dying is something that happens to others, and there’s something unexpected in the experience when we are touched by death. I wait for death everyday, I still expect others to die rather than me, but I know it is around. It’s not that I’m dreadfully morbid but maybe realistically so.

Sometimes when the phone rings at night I answer with trepidation expecting sad news. I try to prepare myself for the unexpected. I am saddened by every loss but rarely surprised, and even less often do I feel regret about what I could or should have done.

It might be something I have come to terms with since Mottsu’s death. In the aftermath of the loss of him I felt incredible shock and surprise and regret, for almost everything I had and everything I hadn’t done. Grieving is different altogether to regret and it’s easier now, years later, to accept that people to go when it is their time.

Allan Jeans died at age 77, when exactly was Kim Hughes going to get to know him better? For me it’s an odd, uncomfortable, regret, and I can’t know what Hughes really meant from one brief quote in the newspaper.

Eulogies should celebrate, when eulogies are published and read, it is too late for regrets.

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Footnote

By admin on July 8, 2011

A short follow-up, a footnote, to the complicated and distressing scenario
I wrote about a few days ago.

I am relieved to read that William Monroe is recovering after being shot and his condition has been upgraded from critical to fair.

Officer Dane Reister,the Police Officer who fired the shots and inflicted the wounds on William Monroe is on administrative leave.

There is no word of the people in the park who dialled 911 because a young man was acting in a peculiar manner.

The Department of Justice is investigating the incident, reviewing the use of police force when Officers are called to encounter people with mental health issues.

The threatener, the threatened, the protector using force, the aftermath of a community crisis. I am hoping more collaboration will be possible in future so that the inherent duty of care for one and another can be better exercised. That we can better support all sides, as a priority, when each encounters the other. Support, right there in the moment, with fewer 911 calls, less shots fired, and no DOJ investigations required.

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A note from a bystander

By admin on July 3, 2011

It was reported in the news that a man with a history of mental illness was shot by police in Portland on June 30th.

The story reads as a complicated and distressing scenario. The Portland Major described the shooting as a ‘tragic mistake’. The police chief said the situation was a ‘terrible tragedy’. What went wrong – probably a lot of things…

One thing reported as wrong was that the police officer’s gun was loaded with inappropriate ammunition, more dangerous shots than it was supposed to use. Lethal rounds were loaded in a less-than-lethal-gun, something strictly against standard police procedures.

“It was human error that caused this tragedy,” the Police Chief said, “we are human.” That’s a statement that upsets me, the man who was reported as “acting in a peculiar manner” is also human. I expect more from the police and I know it is complex and dangerous for both sides. Mental illness is not a policing problem, necessarily, and it is obviously a policing problem, even with just this one story as evidence.

The policing of people with mental is recognised as a significant challenge, and one that has fallen to the police. It is not ideal but who else can help?

Perhaps the police are called to often, because the average person in the street is too readily unsettled by someone behaving a manner deemed somewhat odd, peculiar or disturbing.

This report notes that in confrontations the safety of the police and the person are jeopardised: “In 1998, people with mental illnesses killed law enforcement officers at a rate 5.5 times greater than the rest of the population.” and “People with severe mental illnesses are killed by police in justifiable homicides at a rate nearly four times greater than the general public.”

If you ever encounter the police in heated situation you should know it is not a fair fight, the police are trained to win the battle. In their role as protectors of the public they have to win. We, the public, expect that. Interactions are between more than the police and the person, the are public are inevitably involved. Tense situations involve bystanders. The police carry a lot of responsibility, and as a bystander I’d like them to be more responsible.

The man who was shot is described as critically wounded. As a bystander, I am alarmed and concerned.

Part of my concern is that this incidence was in Portland where, in 2006 after a man with a schizophrenia diagnosis died in police detention, the city took action to change police responses. I know a little of Portland and I know that there is ongoing concern to do things better . The Portland Police introduced some reforms in 2007, including a training program, Project Respond. There’s a radio discussion of that training here thanks to Madness Radio. I am distressed that this recent incident happened in Portland with their training efforts and their want to police better. The issue is not Portland’s alone, or even a US one. Similar tragedies happen here in Australia.

The police need support around crisis intervention how to step in to tense situations without unnecessary force. All of us need more freedom to do peculiar things without someone calling the police to sort it out. More tolerance, more empathy rather than more control? I don’t know but any police shooting is a tragedy for all of us.

I know I need greater mental health awareness, the police need to feel less threatened by someone in an altered state. So do I.

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No way to communicate, no way to understand

By admin on June 28, 2011

I was going to talk about Marsha Linehan in my previous post and I got distracted by something the journalist wrote. Today back to Dr. Linehan who said of her own experience with depression: “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.”

Tin Man, there is something about depression that, like the Tin Man, has no heart, no feeling. With all that he was experiencing and feeling Mottsu was convinced he couldn’t connect with anyone, that he couldn’t feel anything. Not knowing how to reassure him and feeling confounded about how be in any way helpful I cast myself as the Scarecrow with no brains, no ideas. Wally, our timid terrier, was the Lion without courage. Shortbread was just going to tag along, our own Toto.

I didn’t appreciate how helpless the Tin Man was or the depth of what must have been a hopelessness. I was a bit consumed by my own helplessness, I didn’t know what to do. His despair bought him to a crisis and left him isolated and without hope. I couldn’t make things better with a story, not even a cute one where we might dance down a yellow brick road.

I can’t quite reconcile that he didn’t feel anything, that’s what he believed and I don’t know for sure. I do believe he was overwhelmed as the full force of his feelings were all turned inwards back onto himself. Unknown dark feelings. There is a line from a very odd song by America that has been playing in my head “But Oz never did give nothing to the Tin Man, That he didn’t, didn’t already have… “. The dear Tin Man in my life had no way of knowing what he already had, he was convinced that he was malfunctioning and he was wretched. I couldn’t reach him, and he in turn didn’t find the words to tell me how it was for him.

Dr Linehan’s approach, when faced with a suicidal Tin Man, is acceptance, she has “…found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and suicide attempts make some sense.”

By understanding and accepting as she listens to her clients experiences, maybe Dr Linehan restores their voices, and in doing so provides some hope.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

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Normal is as normal does (with thanks to Forrest)

By admin on June 26, 2011

An article about the life and work of Marsha Linehan, a therapist and researcher at the University of Washington. Her work is centred on ‘radical acceptance’, her own method for working with suicidal people . As a therapist she is an ally to her clients rather than an adversary. Radical acceptance of oneself and one’s own feelings, accepting who and how you are rather than how you’re supposed to be.

Radical? It sounds simple, and not really – acceptance is a radical thought. I find I am sensitive to a lot of feedback about what I need to change. Trying to accept who and how I am is not so simple in the face of the opinions and (not so) helpful suggestions of family, friends and beyond…

Perhaps self acceptance is a bit like a building block, if I can find part of me that is good enough (I mean not bad, stupid, wrong, abnormal etc.) then others might discover that good in me too.

Is that it? On a societal level, I think I am saying that others are less likely to marginalise what I embrace… Stigma and marginalisation are symbiotic, one feeds the other – or I imagine a frenzied sort of feeding off of each other. Whatever it takes for stigma and marginalisation survive it is to the detriment of individuals, individuality and acceptance.

Is accepting myself an act of defiance? Possibly not what Dr Linehan is advocating through her work, but these are my own Sunday morning musings. me with lots to say and lots to learn, and defiance appeals to me.

Reading about Marsha Linehan’s life and work one sentence stands out as if written in neon lights. The New York Times journalist, and author of the article, comments that: “No one knows how many people with severe mental illness live what appear to be normal, successful lives…” That sentence, at first glance, may appear innocuous enough but it hits me right between the eyes. I start to think about the stigma surrounding metal health and a pungent whiff of discrimination is apparent. Is it just me who smells it…

Let me rephrase it to test it out:
- No one knows how many people who can’t swim live what appear to be normal, successful lives…
- No one knows how many people with thinning hair live what appear to be normal, successful lives…
- No one knows how many people with cats live what appear to be normal, successful lives…
- No one knows how many people with no imagination live what appear to be normal, successful lives…

What irks me about the statement? I think it is the assumption of what is normal. Worse is the appearance of normal – that I might look normal but really I am not. The deception implicit in maintaining a normal façade and looking successful, hurts me. There is also a discrimination built into the sentence that people with mental illness can not lead normal successful lives. Irk! I’m really irked…and I know it is an innocuous sort of statement that normal people wouldn’t question as not being a perfectly normal thing to say.

The sentence makes me think of Forrest Gump, the park bench philosopher, saying “Stupid is as stupid does”. I think Forrest was saying that having a low IQ doesn’t mean you are stupid. Now I want Forrest to say “Normal is as normal does…” Isn’t the tenet of radical acceptance to defy labels of ‘normal’? My normal may be different to your normal but that doesn’t make me, or you, not normal.

It can be a struggle to keep up appearances and look normal by being who I am expected to be. At the same time I want to bridge the gulf of perception around what is normal and what isn’t, and one way to that is to be less predictable and expected – pushing normal at the edges.

Sunday morning and at my house it’s normal is as normal does. Some days there is no normal.

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Tell it like it is or don’t tell it at all

By admin on June 22, 2011

A challenge for anyone visiting or talking to a friend who is unwell is what to say to them. Nobody knows what to say in those situations and as a word of warning, few people who are ‘in treatment’ or ‘in recovery’ or worse, perhaps ‘in treatment without hope of recovery’ want to hear upbeat cheery platitudes.

From dictionary.com:

Main Entry: platitude
Part of Speech: noun
Definition: dull, overused saying

I can’t count how many times I was told that in time I would better and grieve less. The advice was couched in different ways, and I believed none of it. Time was offered again and again as a healing salve. I felt like I was being put on hold, I was a little much to deal with right now, but maybe later, in time, when I was healed in some way we could pick up where we had left off.. Sure time passes, things change. I knew that my feelings and ability to cope would change over time, I was grieving and not stupid. What I needed was caring and empathy. For me consolation would have been found in someone saying something as simple as “Oh you must be so lonely…”

I wanted to be heard, I wanted my dear friends to listen to me – and the dear ones did – I didn’t want to see disappointment in their eyes or all over their faces when the best I could be was less than they might have hoped for. The pressure to be better, well, fixed, or back to normal was a burden.

From my friends point of view, it can be hard to be a good friend when you are worried and concerned, when you would wish to make things better. In that situation there is a tendency to say silly things, not helpful things. You might find yourself saying things that you hope no-one says to you one day.

As this article points out, sometimes saying nothing but listening is the best a friend can do. Here in another article are six things to never say, and four suggestions of things to say.

If you didn’t know what to say to someone who is going through something then try listening to them.

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As I was saying…

By admin on June 10, 2011

I keep saying we should be talking about suicide as a way, maybe the only way, to diminish the stigma. Here is one discussion hosted by Australia’s longest running current affairs program Dateline. There’s a transcript of their recent show Talking Suicide and even more interesting is the talking done through comments.

Talking also seems insufficient, its a passive sort of activism.

A couple of days ago someone mentioned they had read my blog, and that he was surprised. “You have something to say”, he said “most blogs are about nothing much”. Oh?

I am drawn to do more than simply talk/write and I’m trying to work out where to start. In the meantime talking the talk.

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Stephen Fry is frank

By admin on June 5, 2011

Stephen Fry is a well known actor author and comedian. In an interview this week he revealed his fears that he might kill himself one day.

I remember reading of research about typical responses in the workplace to someone admitting they were depressed or suicidal. It was depressing research, with ‘get over it’ and ‘buck up’ being the regarded as most helpful by colleagues of someone with depression. Those same responses were probably regraded as least helpful by those affected by the condition.

A person with depression can’t just get over it or snap out of it. Rather than being helpful, those types responses highlight a lack of understanding about mental health conditions. Lack of understanding and misconceptions about depression contribute to the stigma associated with it, and to the isolation of those afflicted.

Reading the responses from readers posted against the Stephen Fry article I am dismayed. The research was many years ago and I thought, I hoped, we had made some progress. Maybe not. Reading those comments I can see the stigma around mental health is as pervasive as ever.

Stephen Fry was asked about his bi-polar condition in an interview and he was frank, realistic, in his responses. Empathy, it seems,from we the readers, is still too much to ask for.

*I have written about what you can do if a friend is suicidal. There are links to information about what to say, what not to say and how to support a friend in need.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

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Not selfishness or cowardice

By admin on June 3, 2011

To every action there is an equal and opposite reaction, that’s one of Newton’s laws of motion.

This post is required by Newtons law to balance the view expressed in my previous post. Back in May 2009 Andrew Stafford wrote of his own contemplation of suicide “…to level accusations of selfishness and cowardice against those who succeed in taking their own lives, however understandable, is simply not helpful to anyone.”

He explains with heart:

This is impossible to understand from a rationalist viewpoint. Attempts at self-harm and/or suicide are, by their nature, not rational.

When you are mentally unwell to the point you want to die, you are — quite literally — not in your right mind.

This is, in my view, the single most vital insight necessary for those dealing with depression — not only those struggling with it, but those around them.
I have battled depression on and off throughout my life. Interestingly, the most serious episodes come in an almost clockwork-like seven-year cycle (apparently, I’m told, due to hormonal changes in the brain as we age, which affect different people in different ways).

While at times the illness has been dangerously debilitating, since that act of serious self-harm I’ve learnt to recognise it for what it is.

Accordingly, I’ve developed medical and psychological strategies to deal with it when it arises. I treat it like I would treat any other illness: I go to the doctor, get a prescription, get a referral to a specialist, talk through the relevant issues and, most importantly, follow advice until I’m well again.

This can take up to six months or even a year. In the meantime, I do my best to remain personally and professionally functional.

But depression is an insidious bastard — insidious because you don’t realise what you’re dealing with until it’s got you in its grip.

Although the trigger can be pulled overnight — be it a death, a relationship breakdown, a family or career crisis — its onset is subtle.

And once you’re “down there”, getting back up is invariably a steep climb.
It’s also heartbreaking for those around you, who find themselves in a uniquely disempowered position.

Andrew Stafford. (May 13 2009). A death wish isn’t selfishness – it’s an illness. In The Age On-line. Retrieved May 30 2011, from http://www.theage.com.au/opinion/a-death-wish-isnt-selfishness–its-an-illness-20090512-b1xt.html#ixzz1OBphReNt

You can try to rationalise the actions of someone with a mental health condition or you try to empathise. It’s a difficult discussion, and necessary if we are to reduce stigma and engender understanding. I am talking about topics, that in my experience, we don’t talk about. Judgement is too readily made though, without discussion or perhaps instead of discussion and attempts at understanding.

With sadness, I note that both articles point out the real and heavy toll of suicide on those close to someone who chooses suicide.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

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