Friday, 29 August 2008

MH4A: A Caring Compassionate NHS? No!

Once I was naive. I believed that, I knew that, regardless of how strapped for cash was the NHS the one thing upon which we could rely was to be treated with compassion and caring. Very soon after I started accompanying Mrs Carr to medical appointments I was disabused of my silly and naive ideas.

Caring? Compassion?

They couldn't even do courtesy and respect and these two properties come before caring and compassion. Unless a patient is treated with respect and courtesy, forget anything better. We had to forget anything better.

I have been prompted to write because Deb Acle has raised the issue in two posts (1 and 2) highlighting the views of two eminent doctors - Dr Youngson (more here and here) and Prof Goddard (more here and here).

In this post I will list a few examples of Mrs Carr's treatment by the NHS failing to reach even the lowest level of acceptability. These are not necessarily the worst examples but they illustrate difficulties in 4 different areas of the NHS (GP, psychiatrist, consultant psychotherapist and NHS bureaucrat). The more I learn the less surprised I am. If doctors can't even access proper care for themselves or their family what hope do we have?

1. GP

The high water mark of my naivety, of my belief in a caring and compassionate NHS was reached in May 2007 on my very first accompanying visit with Mrs Carr to her GP. At this time, Mrs Carr was coming to the end of sessions with a psychologist who worked with cardiac patients. Mrs Carr and I were very concerned that there were no plans in place for on-going support beyond the ending of the current sessions. The GP was very supportive and mentioned 4 options:

• she would ask the psychologist to continue with Mrs Carr until support could be put in place

• Mrs Carr could see a psychologist privately

• Mrs Carr could have sessions with the GP as support only and not therapeutic

• Mrs Carr could approach her MSP to complain about the lack of services

At this time I was delighted. There was no doubt that Mrs Carr would get support.


When next we met Mrs Carr's GP the position was turned upside down as follows:

• the psychologist would NOT see Mrs Carr

• Mrs Carr should NOT seek private help whether psychologist or counsellor

There was no mention of the GP providing time and, of course, no mention was made of the MSP.

Clearly the GP was in possession of additional information which supported the change of heart. We suspect, but have no evidence yet, that the nurse therapist who assessed Mrs Carr at the specialist eating disorder clinic was the source of the negativity.

We were too stunned then to ask why but later we asked and asked and asked and asked. From that day on, no-one has explained why support and treatment was denied.

Did that GP show compassion and care? At the first appointment mentioned, yes but never again. In fact, Mrs Carr was not even shown courtesy and respect because not once did that GP even show that she understood the major difficulties with which Mrs Carr had to live. She didn't even listen to concerns.

Another important example concerned a self-screening test for depression (PHQ9). This has 9 questions each of which which has to be rated on a scale of 0 to 3. The highest (most sever depressive score) is 27. I handed in a form from Mrs Carr in which she scored 25. Any score over 20 is considered to indicate severe depression. Also any form with 5 questions scoring 2 or 3 each indicates a major depressive disorder. Mrs Carr had eight questions scoring 3 and one question scoring 1. The GP took the form and said and did NOTHING. Interestingly, some months later when I had an appointment with the same GP because I was concerned that I might have mild depression she gave me a blank PHQ9 form to take away and complete. Therefore, this form was used and was considered relevant as a screen for depression but not for Mrs Carr despite her huge score.

If there were a form to rate the GP on care, compassion, respect and courtesy, she'd score 4 big zeroes.

2. Psychiatrist

In June 2007, Mrs Carr overdosed but, fortunately, I returned much earlier than expected and, after I dialled 999, she was admitted to A&E. During the late morning, after I had returned home, I was contacted by a young (SHO I think) psychiatrist. I was impressed. She seemed interested, empathetic, helpful and caring but how different she was when I arrived to bring Mrs Carr home!

She was distant, cold, uncommunicative and unhelpful. She said that Mrs Carr was to stop her anti-depressants immediately and there was to be no support on her release. I was virtually speechless. How could she leave a fragile hurting patient to her own devices when she had just tried to take her life. She'd probably succeed the next time. I told the psychiatrist that, without support, I would not be surprised if Mrs Carr took her life. I apologised to the psychiatrist before I said, "If anything happens to Mrs Carr I will sue your collective arses off!"

Fat lot of good that did! The psychiatrist had decided that she would just sit there and say little and let me speak myself out.

The one bit of information I did get was that between my morning telecon with her and my arriving to collect Mrs Carr, she (psychiatrist) had spoken to the assessing nurse therapist from the eating disorder clinic. Again there is no hard evidence but now there is a pattern.

A few days before the suicide attempt Mrs Carr had completed another PHQ9 form and this time she scored 23 (from a maximum of 27) but still in the severely depressed / major depressive disorder range. I can't remember if I gave copies of these two forms to the hospital psychiatrist but I do know that I told her about them. She too was totally uninterested in the results.

Here again I faced a clinician who showed no concern at all about Mrs Carr's condition. I was, at least, afforded the luxury of being in the psychiatrist's company for about 1 hour but I was shown no respect. The decisions were made and I was not going to be told anything about the basis for them. Also I must point out Mrs Carr was not given any information either.

Compassion, caring, respect - 0

Courtesy - 0.5.

I contacted Social Services, charities, anyone I could find that might just about be able to offer something but I drew a blank. This was the point at which we felt that using our MSP was the only way to get help.

3. Consultant Psychotherapist

This man I am sure was by far the worst clinician I or Mrs Carr have ever met. He was downright dangerous and I am sure Mrs Carr could easily submit a formal complaint about his behaviour. I have posted about him twice (in April and May this year). Here I append part of my May post which contains the very worst of his abuse.

"Yesterday, the psychological abuse reached a new and very dangerous level. After about 30 mins the consultant said that he had all that he needed. Mrs Carr asked what he had found and he said:

CP: "Psychotherapeutic relationships are damaging to you and should be avoided"

Mrs C: "What about normal emotional relationships?"

CP "They too can be harmful and should be avoided."

Mrs C: "Are you saying that I should be denied relationships?"

CP: "There are some for whom it is harmful. You should consider this"

Mrs C: "Are you saying that I should be denied the basic human need of relationships?"

CP: "We are all individuals?"

Mrs C: "Are you saying that it is not a basic human need to have relationships?"

CP: "We are all individuals"

Mrs C: "Now I know exactly what you mean, there is no more to say" At this point Mrs C walked out.

It is clear that the counsultant DID mean that Mrs C should not have relationships in her life.

Now, EVEN IF the consultant's view was correct, EVEN IF, this should have been handled with immense sensitivity but it wasn't. Immense insensitivity!

Imagine saying to anybody that you should never be emotionally close to anyone ever again. Imagine their shock. Imagine their distress. Now imagine saying this to a psychologically fragile person who has already attempted suicide twice. If anything is likely to push one over the edge it is this.

[I thought I had calmed down but as I write this I feel my anger rising and RISING - apologies]

The consultant's behaviour, at best, is crass, cold, calculating, callous, uncaring and unprofessional. At worst ..........."

I think it's clear that, given the words I have used to describe him ,this clinician would score zero on compassion, care, respect and courtesy!

The information so far shows that there is a massive dearth of positive characteristics in the NHS or, at least, being shown to Mrs Carr.

4. NHS Bureaucrat

Mrs Carr's direct contact with NHS bureaucracy came about through her MSP who wrote on Mrs Carr's behalf to NHS Lothian. To demonstrate their utter disdain for all human decency I append an entire post from May this year.

"The two NHS responses to our MSP's letter require a degree in "reading between the lines" before the true meaning is deciphered. Apparently straightforward and reasonable sentences, on analysis, show a very different meaning.

I'll give one example from NHS Lothian's second reply to our MSP: a reply which, I'm sure you remember, took 6 months to arrive. Tomorrow I'll give another classic.

The MSP said, I think, "The important issue of Mrs Carr's suicide attempt and continuing self-harm are mentioned only in the last paragraph of a 5 page letter and then only obliquely."

Six months later the NHS managed to push out a reply which contained words like, "We didn't intend to dismiss Mrs Carr's suicide attempt but rather we responded to the points you raised in the context of the information provided by the clinical team."

I must admit this is a classic of its type. What the NHS replier is really saying is,"You asked about Mrs Carr's suicide etc but the clinical team did not give me any information about the suicide and so I was unable to answer your question." If we accept that the replier was not given any information about the suicide the replier could, and should, have gone back to the clinicians and insisted that they give appropriate information. Of course, this didn't happen because they did not want to answer the question.

This gets even better. Having explained in the second letter why there was no information in the first letter about Mrs Carr's suicide etc the replier still did not answer the question in the second letter. I hope you followed that.

Therefore, despite having been asked twice, the NHS in two letters avoided saying anything about Mrs Carr's suicide attempt and on-going risk of self-harm although they explain (if you believe it) why they didn't answer in letter 1.

There really should be an award for writing in such an apparently clear and reasonable way but actually in a very obstructive manner."

At no point is Mrs Carr written about as though she is human or even alive. The obstructive way in which the letter was written indicates that NHS Lothian has never had any interest in, or intention of, helping Mrs Carr.

NHS Lothian may smile now because Mrs Carr is no longer registered with NHS Lothian but is now with a GPs' practice in a different health area.

My words to NHS Lothian are, "Don't smile too soon. Since I posted about the Mental Welfare Commission of Scotland's investigation into Mr G (1 and 2) this blog has had 10 visits from the Commission.

Perhaps they, the Commission, realise just how dysfunctional are mental health services in Scotland.

Perhaps the Commission sees that Mrs Carr's case has many negative features which make it worthy of investigation.

Perhaps NHS Lothian will get its comeuppance.

Come on the Mental Welfare Commission for Scotland!

Investigate NHS Lothian 's maltreatment of Mrs Carr.

Tuesday, 26 August 2008

It's Simple Really: No British Football Team in 2012 Olympics

In the last few days much has been made - 'papers, radio, politicians, bloggers - about whether or not a British football team should be entered for the 2012 Olympics and about the reasons why so many Scots (and I assume Welsh and Irish) are very much against the idea.  So much comment has been uninformed guff and mischief-making. 

My position and, I assume that of many Scots, is very straightforward but, firstly, let me say what is not involved.  That I am against the idea of a British football team for the Olympics has:

-  nothing to do with never supporting a GB team

-  nothing to do with not supporting a team full of English players

- nothing to do with Scotland having few, if any, players in a GB team

-  nothing to do with any other sport.  Comparisons with, for example, the British Lions are invalid.

-  nothing to do with the Olympics being in London

-  nothing to do with politics.  Politicians, regardless of what they say are playing politics

-  nothing to do with devolution

-  nothing to do with independence for Scotland

BUT has EVERYTHING to do with not putting at risk Scotland's independence as a footballing nation.

Only in football, as far as I am aware, has there been any suggestion within the ruling body - in football's case this is FIFA - that the four "home" nations should play as one in international competitions.  Entering a unified team for 2012 could be taken as a precedent for having a unified team in other major competitions.  Despite Sepp Blatter's assurances that this would not happen I am not prepared to take that risk.

I make no comment on why the English FA and, apparently, many English, have a different view.  I am in no position to understand their thinking.

I cannot ever risk - however unlikely -  Scotland's right to play football as a separate nation. 

Monday, 25 August 2008

British Aerospace Bin 'Green Bullets'

Yesterday's Observer carried a couple of paragraphs about BAe one of which stated.

"Britain's biggest arms manufacturer has abandoned plans to produce 'green bullets' two years after promising major investment in ecologically sound weaponry. British Aerospace had wanted to produce bullets tipped with tungsten instead of lead but sources say that higher production costs made the venture unprofitable."

'Green bullets'  - an oxymoron if ever I saw one.

Would I / should I feel better to know - if I could - that I have been killed by a green bullet rather than a normal bullet.  It doesn't really matter what kind of bullet or whose bullet has killed me.  I'm dead!

What comes after green bullets?

free-range artillery?

organic ordnance?

I looked up the original BBC story from 2006 and BAE were quoted as saying that they were trying to develop:

"products that reduce the collateral damage of warfare."

It's easy! Get out of this market! Don't make weapons!

Somehow I don't think this is what they meant by reducing collateral damage.

Sunday, 24 August 2008

Not PhotoHunt - Wrinkled

I'm not part of PhotoHunt nor do I wish to be because I couldn't be bothered with the hassle of finding a photo every week.  I do, however, enjoy, the wide range of images which others present each week.
Regardless, I'm putting up one pic this week simply because I stumbled across it and it fitted in with the current keyword - "wrinkled".

This 20 year-old photo shows a wrinkled rock formation from the Craignish peninsula in Argyll.

Saturday, 23 August 2008

How Not to Apply

After my two very long posts it's time for another short and light post.  On the same page of the print Guardian as my Nosing About post was an article giving advice on how to, and how not to, apply for jobs.  This post lists some of the "funnies" seen in applications.

One applicant wrote the following in a covering letter:

"Hope to hear from you shorty."


Another boasted:

"I possess excellent memory skills, good analytical skills, memory skills..."


Yet another, who, it seems, wasn't as sure as they believed, said:

"I am someone who knows my own destiny but I have no definite long-term plans."


One must be careful not to claim to have had too much responsibility in a previous job.  The following candidate did not follow this advice.

"I was closely involved in every aspect of my former company, right up to its bankruptcy."


I think it is safe to assume that none of these four applicants was offered a position.

Friday, 22 August 2008

MH4A: Personality Disorder - Major Failings in Care Part 2

Recently, in Part 1, I wrote about the failings in medical care afforded to Mr G whose case was the subject of an investigation by the Mental Welfare Commission for Scotland [download the full report here].  Today, in Part 2 which is another massively long post, I detail major failings in other areas.  I should make clear, as does the WMC report, that:
"The [WMC investigation] team were struck by the considerable efforts made by front-line care staff, often in very challenging circumstances, to provide proper care and treatment for Mr G.   They appear, in most instances, to have been let down by the same system failings that Mr G himself was subject to.  It is our hope that these individuals do not feel criticised by the content of this report."
Before I list more failings it is interesting to detail how different carers perceived the effect of a diagnosis of personality disorder on the level of a patient's care.
"3.2.9 When we interviewed a variety of individuals and groups involved in Mr G’s care, we were struck by the different perceptions of the impact of a diagnosis of personality disorder on the care and treatment a person receives. For example:
• Dr1 told us that he did not think it made a huge difference to the quality and quantity of care;

• CMHN1 [Community Mental Health Nurse 1] however, who was part of the same team as Dr1, told us that the effect of the diagnosis was for Mr G to be viewed as “untreatable,” leading to the rejection of subsequent approaches for assistance by social care agencies;
• CCSW2 [Community Care Social Worker 1] said that the diagnosis could be a “death-knell”, suggesting imperviousness to treatment or any investment of time;
• Staff from homeless services commented that the diagnosis was an obstacle to obtaining healthcare care and often used as a “get out clause” in managing difficult people."
Only Dr 1 is out of line with the other three respondents.  Did he not know the truth? Was he incompetent?
Did he know the truth but did not tell the truth?  Was he lying?
From the report there is no doubt that the front-line staff knew and told the truth about the effect of the diagnosis on Mr G's care.  Where does that leave Dr 1? 
The report highlights examples of information held in one system which is not available to those from other disciplines.  For example,
"We found that information about Mr G’s presentation in prison was held in separate records held by the health care team and the social work team. Some of the information held in the social work records could have been valuable to visiting psychiatrists but was not available to them."
It is inconceivable that the recorded problems occurred only in the case of Mr G and in those geographical locations.  With goodwill problems such as these could be resolved quite easily but, and it is a big "but", organisations can only resolve if they are aware that there is a problem.  However, as we shall see goodwill towards Mr G was lacking and between Local Authorities.

The rest of this post will concentrate on the following faults:
•  recommendations made but not fulfilled
•  prejudice towards Mr G by Local Authority A
•  bare-faced refusal by Local Authority A to act in Mr G's interest
•  deliberate flaunting of guidelines by Local Authority A

Recommendations Made But Not Fulfilled
There are several examples where Mr G would have been helped had recommendations been carried out. A typical example is:
"2.4.20    Prison staff struggled to manage Mr G but tried to ensure that proper discharge arrangements were made.  Despite being invited, no-one from Local Authority A attended the pre-discharge meeting and support workers and the Homeless Team were left to manage him.  The Homeless Team contacted the MWC advice line on 30th October 2003. It was suggested that Mr G may have an underlying psychiatric illness and that another psychiatric assessment would be required to determine if that was the case. Again, this appeared not to have taken place."

Prejudice Towards Mr G by Local Authority A
The very end of Section 3.2 carries the following two points which summarise terrible prejudice within Local Authority A:
"When Local Authority A decided to withdraw from accepting any responsibility for Mr G’s care, they stated the lack of an identified mental disorder as one of the major reasons for this.  Had a person with another mental health diagnosis displayed the same level of apparent need, we do not think that the authority would have made such a decision. [Calum's emphasis]
Overall, we were left with the impression of a man who was seen as difficult and challenging. Faced with this, many practitioners and services appeared keen to accept any opportunity to distance themselves from his care." [Calum's emphasis]
Local Authority A was not in the least concerned about Mr G's well-being.  All that was important was to shift the responsibility for his care to another body, any body.  Isn't this just typical.  The more needy one is the less chance there is of receiving appropriate care.
The next point highlights how frontline services were denied access to full information about Mr G.
"3.3.5 Mr G was removed from the CPA [Care Plan Approach] despite evidence of significant problems and needs for services. This was on the basis that mental health services believed that they had nothing to offer Mr G.  The effects of this included removal of clear lines of communication with the Police and Local Authority A left to try to support Mr G without psychiatric assistance."
Talk about being cast adrift?  Agencies and Mr G struggling because of my two favourite words at the moment - "incompetence" and/or "prejudice".

Bare-faced Refusal by Local Authority A to Act in Mr G's Interest
Local Authority A comes in for stick in the report and this post mirrors that.  Ddespite its length, I believe it is worthwhile to quote the next paragraph in full. 
"3.3.7 We found no Community Care Assessment, no risk assessment or risk management plan in the community care notes from Local Authority A. We also found no risk of harm assessment or risk of sexual harm assessment in Local Authority A’s criminal justice records. These are serious omissions." [Calum's emphasis]
Why were so many assessments and plans missed?
3.3.7 [continues] The housing agency in Local Authority A requested a case conference as they had community safety concerns when Mr G was described as a ‘paedophile’ by neighbours.  This never took place as he was remanded in prison. Local Authority A still had responsibility for his care and CCSW1 [Community Care Social Worker 1] informed the service manager that “The problem is simply being shifted and not dealt with.”  There was no response to this memo in the case records, no multi-agency vulnerable adults care conference convened and the police were not part of any formal discussions despite their increasing involvement.
It's become clearer now. Mr G is not wanted and Authority A is ignoring him.  The same paragraph continues again:
"3.3.7 [continues again] There is insufficient evidence that anyone at an operational or senior management level in Local Authority A took charge of the situation. One of the operational managers told us that we were incorrect in assuming that the above memo [i.e. of the problem being simply shifted] required a response. There was no evidence of a shared approach between agencies as to how to respond when Mr G presented problematic behaviour."
I believe the report is partially correct when it suggests that no senior person took charge. No one took charge to help Mr G but someone did take charge to deny help to Mr G and to shift the responsibility onto another Local Authority.
Even the police were left unhelped by services.
"3.3.13 Prior to his move to the care home, Mr G came to the attention of the Police on several occasions. The Police passed on their concerns to social work colleagues, but no Vulnerable Adult’s case conference was ever held. The Police Constable identified that “no-one wanted to take responsibility for Mr G, either social services or health, leaving the police to deal with an ill man.” This was another missed opportunity for all the agencies concerned to share information and make management/contingency plans for Mr G."
Whilst talking about Local Authority A the report states:
"3.3.9 The homeless provider made a formal complaint in December 2002 to the Social Work Director of Local Authority A. The letter stated, “I wish to make a formal complaint about the inappropriate manner in which Mr G has been treated by your department. It became rapidly apparent that the current accommodation was unacceptable for Mr G’s care. This was immediately brought to the attention of your staff and a case conference was requested to deal with the inappropriate behaviour of Mr G and to consider how we could access something more acceptable. We were constantly given assurances … ‘we accept responsibility for Mr G’. Unfortunately this did not materialise. In essence we believe that an extremely vulnerable man was off-loaded by your department because they were unable to address Mr G’s complex needs.”  This complaint was never formally answered and no senior manager took responsibility for the situation."
Dumped and then when a complaint was made they ignored it.  We know we're in the wrong but if we forget about it possibly it will go away and it did go away ..... until the MWC came in.
Is there no shame?  When does a patient cease to be a person and become a "thing" to be flushed out of their system?
Shameful!!  Shocking!!  I believe that the MWC was much too weak in its criticisms of Authority A but there are two more examples of their inhuman treatment.
"3.3.18 When Mr G was placed in Local Authority C, background information was requested from Local Authority A.  They took over three months to reply. Following receipt of the request, a first line manager contacted the senior manager asking if existing information should be sent. The response given was: “No. I have spoken to … who is preparing a report for them. In the meantime, least said the better as I have encouraged … to take these issues of home authority up with the Scottish Executive as our duties have been discharged under criminal justice legislation”.  It is our view that this response was unacceptable.  No one was thinking of Mr G’s social care needs: he had needs other than those served by Criminal Justice services." [Calum's emphasis]
"3.3.19 While Mr G was in the State Hospital, their social work department invited representatives from Local Authority A to attend case conferences and sent a copy of a social circumstance report for information, to assist with future care planning requirements for Mr G.  A senior manager from Local Authority A replied, “I appreciate that you have kept staff … advised of Mr G’s progress. This was not invited as (we) continue to dispute any responsibility for him.”  We find this response inappropriate as it, yet again, did not focus on the needs of Mr G." [Calum's emphasis]
Of course, it didn't!  They were far beyond the point of seeing Mr G as a human.  This is where so many of us find ourselves; a problem to be avoided, a dog turd to be scraped off a shoe!  Why?  Because we are needy.  Because our problems are complex.  Because it is simply easier not to have to deal with us!
This post is so long now that there is much damning material which I cannot include but I must include more.

Deliberate Flaunting of Guidelines by Local Authority A
"3.4.6 An email from the Director of Local Authority A was forwarded to Local Authority C. It stated, “I understand that Mr G has been assessed by medical professionals as not having a mental health problem. When previously resident in Local Authority A, his behaviour resulted in eviction and he has exhausted the services that the Council is able to provide. In these circumstances he is considered to be responsible for the consequences of his actions … If he presents at any Council offices in Local Authority A, he should be advised that the Council will not take responsibility for his accommodation and that he must make his own arrangements.”   We formed the view that, by this juncture, it was highly unlikely that Mr G had the capacity to make decisions about where he wanted to live or the capacity to arrange accommodation for himself. We found no evidence that formal consideration of capacity issues had ever been undertaken. In any event, we believe that Local Authority A acted in breach of the Homeless Persons Advice and Assistance (Scotland) Regulations 2002." [Calum's emphasis]
But Local Authority A did more (or should it be "less"?
"3.4.9 Mr G was effectively left with no Local Authority prepared to accept on-going responsibility for his care and treatment.  The State Hospital social worker stated that he could think of no other similarly protracted case or one without resolution.  CCSW2 [Community Care Social Worker 2] also stated that, he was “aghast at the way his (Mr G’s) case bounced around the Local Authorities at a senior management level.”  He sensed that energies were being spent in “passing the buck, rather than dealing with the situation.”
3.4.10 We concur with this statement and find that Local Authority A eventually reached a point where they failed to accept ongoing responsibility for this vulnerable man, with complex health and social care needs. In our view, Local Authority C accepted appropriate responsibility for assessment and care management as the “authority of the moment”. Local Authority A was responsible for Mr G’s placement in NH1 [Nursing Home 1] but acted in breach of paragraphs 11 and 12 of Scottish Office Circular No: SWSG 1/96. They neither accepted any ongoing responsibility for Mr G nor had they informed Local Authority C of his placement. Mr G did not “subsequently move without Local Authority involvement” – the placement broke down as a result of NH1 and primary health services being unable to meet his needs."
This is really just more of the same but it demonstrates how easy it is for a patient to be not only abandoned by many of those who should be caring but to be no longer human - a problem to be dealt with.
I apologise for including so much material from the report but I feel that it is hard to understand just how badly treated was Mr G without putting in vast amounts of detail.
Why have I written these posts?  Most of us who are fighting the systems for ourselves, for loved ones or for those unable to fight for themselves will have experienced similar actions and attitudes from the so-called caring services but to see these actions and attitudes described in an official report validates our own issues.
Mr G's case may be more extreme than most but I have no doubt that other health boards and Local Authorities have acted, are acting, and will continue to act in similar ways.  His is the case which has been scrutinised.  If only all our cases were subject to the same level of detailed scrutiny.
Before I finish there is one more paragraph to copy.
"2.7.10    The Mental Welfare Commission were contacted by Dr8 and, independently, by the Healthcare team at HMP B over the first few weeks of July 2004. They expressed concerns that Mr G appeared to be suffering from mental illness but had been rejected by mental health services."
At last, here were people with the gumption, honesty and the caring to raise their concerns with an appropriate body. 
If only the others had acted in a similar way.
Too many knew the problems but did not pursue them. 
Too many knew the problems but did not care.
If only those with whom we are dealing / fighting would respond with honesty and caring.
A big bloody IF ONLY

We must stand together .
We must shout together.
We must fight together.
If we do not then all we will be left is "If Only".
But I am not prepared to accept "If Only"

I will accept only:


Please stand and shout and fight with me.

Wednesday, 20 August 2008

Nosing About

Writing Part 2 of my post on the case of Mr G is taking quite a while and so I need a post for today.  Unfortunately, once again I demonstrate my poor taste when it comes to blog posts.  Today I reproduce in full an article from yesterday's Education section of the Guardian.

As the 21st century arrived, two distinguished psychiatrists offered mankind proof, written proof - in a study called A Preliminary Survey of Rhinotillexomania in an Adolescent Sample - that most teenagers pick their noses.

Dr Chittaranjan Andrade and Dr BS Srihari, colleagues at the National Institute of Mental Health and Neurosciences in Bangalore, India, were inspired by an earlier published report by scientists in the American state of Wisconsin. The Wisconsin research claimed that more than 90% of adults are active nose-pickers. But it was silent as to whether teenagers are less or more picky than their elders.

Andrade and Srihari decided to find out. They had a serious purpose. Virtually any human activity, if carried to excess, can be considered a psychiatric disorder. Nose-picking is no exception. "While nose-picking behaviour in general appears to be a common and normal habit," they wrote, "it is necessary to determine the extent to which rhinotillexomania amounting to a disorder exists in the adolescent population."

They prepared themselves by reading other medical reports about nose-picking. With few exceptions, those reports dealt with spectacular individual nose-pickers, most of whom were psychotic. Andrade and Srihari learned that nose-picking, as practised by disturbed individuals, can be chronic, violent and associated with nosebleeds. The two psychiatrists studied Gigliotti and Waring's 1968 report, Self-Inflicted Destruction of Nose and Palate: Report of Case. They scoured Akhtar and Hastings's 1978 report, Life-Threatening Self-Mutilation of the Nose. They marvelled at Tarachow's 1966 report, Coprophagia and Allied Phenomena, noting from it that "persons do eat nasal debris, and find it tasty, too".

Those cases all had their points of interest, but they could serve only as background material for the work Andrade and Srihari had in mind. To determine the nose-picking who, what, where, when, why and how of a community, one must statistically sample the picking practices of many individuals.

Sampling is what the Wisconsin researchers did with adults. Sampling is what Andrade and Srihari knew they must do with adolescents.

Their meticulous survey of 200 students revealed that:

· Nose-picking practices are the same for all social classes.

· Less than 4% of the students claimed they never pick their noses.

· Half of the students pick their noses four or more times a day. About 7% say they indulge 20 or more times a day.

· 80% use their fingers exclusively. The rest are split almost evenly in their use of tools, some choosing tweezers while others prefer pencils.

· More than half said they do it to unclog nasal passages or relieve discomfort or itching. About 11% claimed they do it for cosmetic reasons, and a similar number do it just for pleasure.

· 4.5% said they ate the nasal debris.

Those are just a few highlights.

Andrade and Srihari were awarded the 2001 Ig Nobel prize in the field of public health. At the ceremony, Andrade explained: "Some people poke their nose into other people's business. I made it my business to poke my business into other people's noses."

Couldn't they have picked a more appropriate subject for their  research?

I don't imagine many of you reached here. I guess most will have picked their spot and pulled out much earlier.



83! Bloody Hell !

A nothing post despite the tempting - possibly - title.

A month or so ago I posted about a personal best on my blog (40 page views in one visit) but another unknown visitor has blasted that apart and set a new Olympic and world record. OK, OK, I know that's a bit OTT.

83 page views in one sitting!  Poor soul! 



I've removed the IP address just in case anyone recognises it.









Thank you for visiting and spending so much time here.  I hope you found the visit interesting.  I don't think your record will be broken for a while!

Hope to see you back again.

Oh No!

For 7½ weeks of school holidays I've had today -  20th August  - etched in my brain as the day the schools re-started after the summer holidays and I'm just back from Tesco at 22.50  having had to buy a pencil case for C2 ..... but wait ..... what's this?

Oh no!

Industrial action!

Some schools closed!

C2's school is closed - my break doesn't start until Thursday.

Oh shit!

C1's school is open.

One at school says, "Not fair!!!"

One off says, "Yes!!!"

Result: conflict


Isn't life just wonderful!!!!!!


Deep breath, Calum.

Monday, 18 August 2008

MH4A: Personality Disorder - Major Failings in Care Part 1

At the end of July, having read an article in the Glasgow Herald, I posted about the prejudices experienced by sufferers of Borderline Personality Disorder (BPD). The article referred to the case of a Mr G whose case was investigated by the Mental Welfare Commission for Scotland (MWC) which is ".... an independent organisation set up by Parliament with the responsibility of protecting the welfare of people with mental disorder (including learning disabilities and dementia) in Scotland. We have a duty to anyone with a mental disorder whether they are in hospital, in local authority, voluntary run or private accommodation or in their own homes."
The Herald article was a powerful condemnation of the way in which the services had failed Mr G and I was drawn to read the MWC report into Mr G's treatment. [The full report can be downloaded from here] Despite knowing the basics of his case - from the Herald - I was shocked - not surprised though - to see the detail. To those fighting The System, the report will not be surprising because it confirms many of the points which we have been making.
That the failings have been made in an official investigation lends them massive credibility. Too often the NHS, Social Services and other Local Authority Services act as though they are the absolute fonts of knowledge and are unchallengeable. This MWC report shows just how disastrously poor these services can be and how they can act in their own, rather than patients', interests.
In this post - Part 1 - I highlight many of the medical failings because it is very important that they be more widely known. Part 2 - now published here - will deal with failings elsewhere. Unfortunately, this is a very long post but, hopefully, others can dip into these posts rather than having to read the 75 page MWC report.
I realise that the length and detailed content of this post is likely to be of interest to only a few of my visitors but the issues raised are so important that I am prepared to "turn off" some visitors.
The basics of the case are that Mr G, who did have some very challenging behaviours, was diagnosed as having a personality disorder when, in fact, he was suffering from dementia. Much of his mistreatment followed on from the mis-diagnosis of Personality Disorder but medical and Local Authority incompetence and buck-passing were crucial failings.
Interestingly the report is entitled,
"Not My Problem - The Care and Treatment of Mr G"
and there follow two quotations:
Instead of responding to the person, we typically react to the behaviour
(Herb Lovett) [Clinical psychologist died 1998]
"We want the facts to fit the preconceptions. When they don't, it is easier to ignore the facts than to change the preconceptions."
(Jessamyn West) [American writer 1902 – 1984]
The report found 5 problem areas. One of them is very common to those who are fighting the NHS: Mr G's History was distorted to fit the diagnosis of personality disorder.
The report states in Paragraph 3.1.6:
Five incorrect accounts of his forensic history, with statements such as “long history of anxiety and sexual offending” (Court report 2001), “displays aggression and sexual disinhibition in keeping with his behaviour over several years” (hospital admission February 2004) and “numerous convictions dating back to 1979” (Court report February 2004) distort the truth as Mr G was actually admonished in 1979 and never prosecuted or convicted again until 2002;
• A significant error in his personal history. From around April 2004, the account of his previous history recorded that his wife left in 1998. This was used as an explanation for his decline since then. She actually left in 1988;
• Distorted accounts of his previous psychiatric history. Most Court reports contained accurate accounts of his previous psychiatric contact. A significant exception is a report that alleged “extensive contact with the psychiatric services over the last forty years.” It stated that this contact “has not brought about any modification in his behaviour. There is a danger that further treatment will just foster dependence and encourage further sexual deviance” (Court report 2002). This report also referred to abnormal sexual behaviour in 1972 to support the claim that such problems were longstanding. This behaviour occurred once in the context of a brief spell of disturbance immediately following treatment with electroconvulsive therapy and was not a feature of his behaviour at any other time prior to 2001.
If the MWC can uncover the true background one must ask why so many mistakes were made. Were the distortions deliberate or due to simple incompetence?
Paragraph 3.1.7 summarises the position:
3.1.7 It was therefore evident that the lack of a complete and consistent longitudinal account of Mr G’s life and previous mental health contacts seriously impeded the process of accurate diagnosis. During our investigation, we found that the account of his history became distorted to become consistent with the accepted diagnosis of personality disorder. [Calum's emphasis]
Many will not be surprised to read this. Get a negatively viewed diagnosis or label and you've got it ... forever!
The incorrect diagnosis could have been picked up but
3.1.1 We examined the process of diagnosis when Mr G came to the attention of mental health services in NHS Board A. Following this, there were numerous opportunities to reassess the diagnosis during contacts with mental health practitioners in various services, including practitioners providing Court reports.
Paragraph 3.1.5. details those opportunities:
Subsequent contacts with mental health services included:
• A seven month period of community follow-up by Dr 1
• Five further hospital admissions
• Ten Court reports
• An independent forensic mental health report requested as a “second opinion”
• At least four emergency psychiatric assessments
• Three psychiatric assessments at the request of prison staff
Seven months under Dr 1 - I'll come back to Dr 1 later - AND twenty-three separate opportunities not taken. Not only were these opportunities to reassess not taken but at the very end of Section 3.1 the report states:
There was evidence that the diagnostic process was based on inaccurate and unsubstantiated information and assumptions that lacked corroborative evidence from a careful analysis of previous case records and/or information from informants.
In many cases, there was a failure to consider and document a differential diagnosis that would have been useful as a guide to the need for further investigations and interpretation of their results. This includes an apparent failure to consider a second diagnosis in a person with pre-existing personality difficulties.
This is important because
3.1.11 The diagnosis of personality disorder is notoriously unstable and many people can have other co-existing mental disorders (Ref 10)[Calum's emphasis]. In Mr G’s case, we found evidence that diagnostic statements appeared to accept the previous diagnosis of personality disorder too readily and without proper consideration of other possibilities. Further, insufficient consideration was given to the possibility of co-morbid disorders.
Again this will be very familiar to many. There is a "story" and, by God, everything will be made to fit. Nothing else will be considered.
Worse was to follow. Not only was the history distorted and the diagnosis not reassessed but once the diagnosis of personality disorder was made all symptoms were ascribed to this disorder.
3.2.6.This unquestioning acceptance of a diagnosis of personality disorder was also evident in further forensic assessments from April to June 2004 and on his admission to hospital in June 2004 and subsequent arrest and return to prison.
3.2.7 The last of these is of particular concern. Mr G was described as being disorientated for time and place, incontinent of urine and manually evacuating faeces which he offered to staff. This behaviour was new and had not been a feature of his previous admission yet it was explained as another feature of his personality disorder. We are confident, had it not been for his previous diagnosis of personality disorder, that the emergence of these features would have aroused a high level of suspicion of an organic brain disorder. [Calum's emphasis] Unfortunately, we were not able to interview Dr 9 to explore this further.
Well Dr 9, whoever you are, I hope you have learned but, more importantly, I hope that you are hurting over your mistreatment of Mr G. More examples of the personality disorder diagnosis over-riding everything else are given:
3.2.2 In June 2002, psychiatric services withdrew from his care ....... We found no discharge summary by the mental health services, no clear statement as to why he was discharged and no detailing of what circumstances could lead to re-referral. It appears that there was a decision that Mr G was “untreatable.” [Calum's emphasis]
3.2.3 Around this time, two psychiatric reports stated that he did not suffer from a mental disorder (within the meaning of the 1984 Act). Here, and subsequently, we found statements that providing services to Mr G was likely to foster dependence and increase his offending behaviour.
3.2.4 Following his release from prison in October 2002, Mr G was seen on two occasions by psychiatric emergency services. Despite the fact that he was on medication and some suggestions were made as to the dosage, no psychiatric follow up was organised. Given that follow-up would have been organised if the diagnosis had been, for example, schizophrenia or bipolar disorder, we consider that the diagnosis of personality disorder was a major factor in denying Mr G the benefit of psychiatric follow up. [Calum's emphasis]
3.2.5 From this time until his placement in NH1 [nursing home 1], there were several brief contacts with mental health services. Mr G had two brief admissions to hospital in the summer of 2003 and an assessment in prison in October 2003. He presented with self-harm and inappropriate behaviour that showed clear lack of social judgement. However, all assessments commented on his diagnosis of personality disorder and that further mental health contact was unlikely to help. We consider that, had such behaviours occurred in the absence of such a diagnosis, Mr G would likely have received further assessment and treatment. [Calum's emphasis]

Not only did all of this follow on from the initial diagnosis but that initial diagnosis of personality disorder was incorrect and incompetent.
MMSE tests which ruled out the possibility of dementia were inappropriate. Clinicians were unaware of the limitations to the test's usefulness! [The details of this test are unnecessary here]. Paragraph 2.3.6 states, for example, that:
A good score was obtained on the MMSE and this was taken to indicate that he was “certainly not dementing”.
3.1.9 The MMSE (ref 1) is a much-used screening and assessment tool. However, it has its limitations and is a poor diagnostic instrument(ref 5). It is only useful once its limitations are understood (ref 6). In the case of Mr G, we found extensive evidence of psychiatrists using the MMSE without realising its limitations. [Calum's emphasis]
Not just one psychiatrist but "extensive evidence that psychiatrists". We put our trusts in the "hands" of so-called experts like these and, as the report shows, they didn't know what they were doing.
And we're meant to have confidence in them.
And we're not meant to question them.
And we're not meant to challenge them.
And we're not meant to complain about them.
It is important to point out that not all clinicians displayed incompetence. One report did flag up a suitably wide range of possible diagnoses but at subsequent hospital admissions these possibilities were not considered [paragraph 3.1.11]. More incompetence or the personality disorder effect again!

I said that I would came back to Dr 1. Well, Dr 1, you're a cracker aren't you!.
3.1.4 .... Unfortunately, during this important period of time, there was a nine month period when Dr1 made no direct entries in the case record and entries by junior medical staff made no reference to Dr1 actually examining Mr G. This clearly falls below acceptable standards of professional practice. [Calum's emphasis] The case record contains no explanation for either Mr G’s behaviour or any consideration of differential diagnoses. In the absence of a clear record of the diagnostic process and any differential diagnosis that was considered, we therefore find evidence that the diagnoses of “depression and anxiety” and “dependent personality” given at the point of discharge were insufficient to explain all the behaviour that Mr G displayed during this admission.
Nine months without seeing a patient!
Not worthy of your time!
Not worthy of your "knowledge"!
Well, given the state of knowledge displayed, perhaps it's better that you didn't see him!
Dr 1, you're incompetent, aren't you! Did you suffer as a consequence of your inactions and lack of knowledge? I hope so.

The WMC report highlights a catalogue of failings - incompetences and prejudices - from members of a profession which holds itself in the highest regard. Just as well they do because I'm damned if I ever will again. Individuals possibly but as a profession NEVER.
I repeat here a variant of what I wrote a few lines above:
We put our trust in the "hands" of so-called experts like these and, as the report shows, they didn't know what they were doing. They were incompetent and prejudiced.
And we're meant to have confidence in them.
And we're not meant to question them.
And we're not meant to challenge them.
And we're not meant to complain about them.
And if we do any of the above we're shunned and labelled as being difficult.
I say, "Doctors, get yourselves and your own houses in order first before you dare to criticise those who suffer and come to you for help. Your job is to help us. If you can't do your job because you are incompetent or prejudiced then, for God's sake, get out and do something else where you will do less harm!"
Part 2 will follow in a few days.

Sunday, 17 August 2008

Post to Come Soon

Sorry about the delay in posting since my 2nd holiday pics.  A mental health post is coming in the next couple of days.


Watch this space!

Friday, 15 August 2008

No Option But To .....

show more holiday pics.

Since we've returned I've been both too laidback and too busy to post but now I want to post.  Unfortunately my brain is empty of anything serious and so I have to resort to photos ...... again.  Sorry about that.  Soon I'll get back to what I enjoy most but in the meantime feast your eyes on a few photos I've been able to save from the many with smeary marks.



This photo shows the marina in Ardfern just as the early morning calmness is breaking up.



I think this overlooks Loch Craignish.  Two basics of photography broken here: firstly, not being certain of the location and secondly, grossly under-exposing the shot.  Despite this, I think the photo works.



Monbretia grows wild in huge clumps.



I didn't get the exposure quite right but I liked the mixing of the trunks and branches.



One of the great sheepdogs on the farm.



One of the many prehistoric sites in Kilmartin Glen.  [sorry about the smeariness]

Undiscovered Scotland says of Kilmartin village, "There are at least 350 ancient monuments within six miles of the village, of which around 150 are prehistoric. They include burial cairns, rock carvings, and standing stones, as well as the remains of the fortress of the Scots at Dunadd and three more recent castles."


Well, that's the rescuable, or almost rescuable, photos - Is there such a word as "rescuable"?.  There is now! - except for the little taster below. 


My little "accident" happened within the area covered by this photo. 

Will I tell the story? 

Certainly not tonight - if ever!

Tuesday, 12 August 2008

Wanderer Returns


Back home safely after a wonderful holiday.  Despite the wet weather I've had an absolutely fabulous time and been wetter inside than out!  Looked after brilliantly.  Wonderful setting.

C1 was riding every day,  C2 quad-biking.  Me?  I just relaxed - Kakuro, crosswords or nothing.

Only downer.  Got home and found most photos ruined because of greasy marks on skylight filter giving light smeary patches on photos.  BIG lesson.

But this doesn't detract from our holiday.

I did have another "accident" which I might tell you about later but now I've got some blog visiting to do.

See you around.

Monday, 4 August 2008

SOMETIMES I ........


...... wonder why I bother


and I .....  think awhile


then I ......   wonder why I bother.


Today I ...  wondered


and I ...... thought awhile


then I .....  wondered why I fucking bother!


Why do I?

Holiday Beckons - Last Post for a Week?

Tomorrow (Tuesday) we go off for another week's holiday to Argyll again.  I've so much to do before we go that I imagine I'll not post again until we return.

Having said last week that I have no more stories left and having had lots of requests for more - well two actually - I have found two more stories (possibly four if I split one into three). 

But will I tell you or should I keep them to myself?

Why should I continually expose myself - in the nicest possible way - to your possible derision when none, other than Liz, does likewise?

If a few more of you show your "nakedness" then I'll tell you more.  Is it a deal?

Who has got the "balls" to follow suit?

Enough of such matters. 


Where am I going on holiday?  Not saying other than it will be within 10 miles of the place I took these two photos twenty years ago.




and then a few minutes later



We're visiting a lovely part of the country and I'm sure we'll have a great time.  I will think of you - promise.  My blog is too important to forget about for a week even if I can't post.

Shitty End!


What a way to end the day!

Except not finished yet 

More work then post

Deliberately cryptic

Want to say this

Need to say this


Saying no more.

Saturday, 2 August 2008

Football Starts Today: Come On Ye Pars

A new season; new hopes; new fears; old butterflies. Nothing ever changes. I guess all football supporters feel the same but today I wonder and worry how the season, which starts today, will pan out.

Many of you won't know who are the Pars and of those who do know many probably don't care. But I care ..... so much. The Pars = Dunfermline Athletic, my local team, the only club team I have ever supported: the only team I will ever support.

More than 50 years ago my father took me through Piggies Lane and along to East End Park. I never looked back. I think on that first day I had "The Pars" tattooed on my heart. I've seen good times, bad times, great times, the depths, the heights but through them all they've been my team. The success of larger teams has never drawn me away, never even tempted me.

To be so attached to one club, as I assume most supporters are, is illogical. What is it which ties us for a lifetime? I don't know and, to be honest, I don't care. Whatever it is, I have it - in bundles.

Until the late 1980s I was a regular, a season ticket holder but marriage and children pulled me way from attending. To many this might disqualify me as a supporter but they're wrong. Every season I dream, every game too but every game brings worry - from a distance now but I'm there kicking every ball, cheering every goal scored and despairing at each goal lost.

I remember in the mid-1990s the last game of the season, Dunfemline were on the verge of promotion to the Premier League, we were returning from holiday on Harris, I think it was, and driving south of Kyle of Lochalsh when I heard the result. Y .... E .... S .... S !

I stopped the car, got out and danced up and down this deserted country road arms in the air, punching the air, shouting, CHAMPIONE, CHAMPIONE, Y .... E .... S .... S !

Perhaps I was lucky in that the team had its most successful spell when I was a teenager: Jock Stein as manager, winning the Scottish Cup twice (1961 and 1968), beaten finalists in 1965, beating Everton in 1962. If I my memory serves me correctly the Cuban crisis "blew" up around the time of the Everton two-legged tie and I remember thinking, "Just let us get this game played, please."

Enough reminiscing. I may write a full Childhood Reminiscence post later. Today we play Partick Thistle in Glasgow, 3pm kick off. I'll be on edge. I'm on edge now. If I can't keep up-to-date on the radio I'll be checking a Pars website because they normally run an update service. On edge I'll remain until the end or until the outcome is settled and then it's up or down, read the newspaper reports if we won, miss them if we lost.

Crazy but that is life as a Pars supporter.


UPDATE 19.00 Saturday Inauspicious start: 1- 0 defeat. I should have kept my support to myself and my "mouth" shut..

Friday, 1 August 2008

MentalHealth4All: Real Suffering

All of you know how important to me is Mrs Carr's health and how angry I am about the unnecessary suffering she has had to endure because of the appalling way in which she has been left virtually untreated by the NHS - despite their untrue and obscene claims that they bent over backwards to deal with a difficult patient.  I have struggled hugely over the last 18 months or so but I have always known that my suffering is tiny compared with Mrs Carr's; that I can imagine but know what life is like to suffer so.

In the last few days I have read blog posts which describe real mental suffering in ways which are beyond me.  "Suffering" hardly seems to be the correct word: perhaps "torture" is nearer the mark.  There's no point my continuing to search for the correct word but better that you read the real words used.

Firstly, a post by Deb Acle.  The first part refers to my post about BPD but that is not the reason for mentioning here.  Skip past this part, if you wish, but stop at the second section - red print - where Dr Rita Pal describes with unnerving knowledge the thought processes which lead to the contemplation of suicide.  See the full post here.

In the third part of the post, Deb, herself, describes how an NHS cadre of doctors have twisted her story and denied her treatment.

Another recent visitor to this blog is werehorse who has a very new blog.  I could feel tears in my eyes as I contemplated her life.  You can read any of her posts and feel the pain but you could start with her first two posts (1 and 2)

Those of us who are healthy or almost healthy cannot know the depths to which sufferers tumble but a few minutes reading these posts may shine a dim light on their lives.  A dim light but still a light bright enough to see that the NHS must change massively how it treats those who suffer in these ways.

Note: Deb Acle and Rita Pal are both contributors to the NHSExposed blog as well as having their own blogs (Deb and Rita).

Microsoft Live Writer: Update

A lightweight practical post before another heavy mental health effort.  At least, I plan another post but whether it appears or not ....

For 10 days or so, and 7 posts, I have been using Live Writer to produce this blog - see here and my initial view was that the software was brilliant.  I still feel this!

Live writer is billed as a WYSIWYG word processor for blogs.  Well, I would say that for my blog layout that it is very nearly WYSIWYG.  I find that my published posts may have 1 word more or less in a line than I see in Live Writer but this is still such an improvement over Blogger that I'll happily live with this.

The key benefit to me is the total ease and confidence with which I can add photos, format the post, change font, font colour, add links.  In my original post I said that I didn't think one could add Blogger labels but I was wrong - they are called categories and Live Writer downloads all one's previously used labels.

As long as I have access to Live Writer I will not go back to using Blogger and I recommend it to all.


Give it a go.


Blogging - well the typing part - has become so incredibly easy.