Mental Health: Insight and experience

After a close friend "Mary" struggled through a depressive illness, I have always shown interest in mental health.

I recently watched Don't Call Me Crazy, a BBC 3 documentary about an institution for young people with mental illness. Over the three part series, the program followed the lives of patients with a range of condition from OCD to eating disorders. Several patients had been sectioned under the Mental Health Act and were being detained against their will. It was mostly how I had imagined; with many patients displaying what is  perceived as 'normal' teenage behaviour most of the times with some unstable outbursts. 

There was one particular female patient with depression, who had to spend time in the locked unit. This really made me think of "Mary". It made me remember what she had told me about the 24 hour surveillance- whether she was in the shower or on her period, there was always someone watching her. I fully understand that this was necessary as she was a risk to herself, but I still can't quite imagine living like that. In fact, it would be naive to think that I can understand what she was going through at all.

I've been to an adolescent mental health unit before, but it had been quite different from the one featured in the programme. Whilst "Mary" was in hospital, I had visited her. There were the same high staffing levels as shown on the TV but it looked nothing like a hospital. It was set in a manor house with huge grounds and lots of outside space. I distinctively remember the grand, sweeping staircase surrounded by big orange safely nets. That was what reminded me that it was a psychiatric hospital and not a hotel.

The thing is if we, as the general public, have had no experience then we will never know if the media is portraying the world correctly.

Having spent over six months of her life in two different institutions, I was really interested in what "Mary" thought of the programme. I was quite surprised that she had mainly positive things to say. She did however note that the programme hyped up the outbreaks; in reality it is far less eventful. Where she was staying there was a lot of sitting doing nothing, but I guess that doesn't make very interesting TV.

I'm going to conclude this blog post by sharing "Mary's" success story. I find it hard to express in words how proud I feel. After she was well enough to leave the hospital, "Mary" started at boarding school to complete her A levels. Despite her previous social anxiety, she made new friends and focused her attention toward to gym to lose the weight that she had retained through medication and being in the institution. Exercise and fitness became increasingly important to her and she has since ran in several marathons. She has secured her place at university to study sport science and has just completed her IronMan, coming in 1st place for her division and qualifying for the World Championships. 

Seeing what she has experienced makes me so glad I could be there for her through the harder times. She really is a true friend. It's onwards and upwards now.

My first HCA shift- An Outsider on the Inside

This morning I worked my first 6 hour shift. I was apprehensive because, not only had I not done this sort of work for 12 months, this care home had been in the media and was under close observation. 

When I turned up at 7.30, I was greeted by a frantic nurse who uttered the word 'CQC' to me- they had been inspecting the establishment since 4am. I instantly suspected that this wouldn't be a 'normal' shift. I spent the morning working in the dementia unit with a senior carer and 2 HCAs, similar ages to myself. After the initial routine of getting clients up, washed and fed breakfast, things started to change. 

I noticed an increase in the amount of people in the unit. It wasn't long before the home was full of social workers, inspectors, relatives, paramedics & the press: the home was shutting down. My duties shifted to packing suitcases and stripping beds, whilst trying to keep the frightened clients under control. 

I could tell that both the staff and the service users were having a difficult time. It was strange for me to be on the inside of the drama in  their personal stories. Although today I was working with them, I knew my day hadn't been the same as theirs. I wasn't being forced to leave the place I called home by men in ambulances nor was I about to lose my job as my workplace fell apart. 

Nobody likes to be moved against their will; we are creatures of comfort and we don't take kindly to change. Especially not those with dementia. For this confused and often aggressive group of people, routine is all they have to offer security. I wondered how the lady I had spent all morning with would cope in her new home, when she knew the layout of this one so well. She spends her days patrolling the corridors and lounges looking for 'Henry' which could mean anything from a blanket to glass of squash (she also called me and everyone else around us Henry). How well would she adapt when all her Henrys are suddenly different?

As for the carers, I really felt for them. The ladies I had been working with were good, honest and compassionate people who became overwhelmed when one by one the clients were taken away. What really stood out to me was how, despite the fact that they would be left without work, their real concerns sat with the clients. I busied myself clearing lunch plates and washing down tables as carers kissed and waved their clients goodbye, blubbing at the window. At my old care home, I had never seen anything of the sort, but then again i guess I'd never experienced a home being shut down by the authorities.

Seeing the film crew outside as I set off home, made me question the things that they  may be exposing in the media. Okay so I did notice that the carers didn't perhaps wash their hands a much as they should, but I did see real compassion from the few I was working alongside.

In a lot of ways it is a shame that the home had closed. However, without regulation where would we be? It's hard to make a proper judgement with such a narrow window, but we can only assume that the home was closed for good reasons. I really wish the people I met today all the best for the future, regardless of what happens.

StreetDoctors- Student BMJ May 2013

StreetDoctors is an organisation run by doctors and medical students to teach young offenders how to save a life. CPR tends to be the focal point of most first aid courses, however for this target audience, a bleed-focused itinerary is more appropriate. The sessions include discussions of personal experiences alongside formal teaching on how to deal with bleeds. With most of the pupils having witnessed a stabbing, the young people engaged well with the material and understood the importance of protecting the health of their friends and family.

StreetDoctors- established at Liverpool University 2008 

The main message appears to be emphasising the importance of preventing blood loss: if you lose blood your heart and brain stop working, the only place to get more blood is at the hospital. This simple concept is used to teach the children the importance of reducing bleeds and calling for an ambulance.

Personally, I think this is a great scheme. From my experience of teaching at local schools with the BrightWAMS society, young people really engage when provided with fun and relevant interactive sessions. Informing people, particularly those at risk,works to demonstrate that you don't need medical training to be able to save someone's life. Through basic procedures such as calling for an ambulance, raising a limb, applying pressure and bandaging, even young people can potentially make a difference.

The scheme is growing and is currently running at several UK locations. Hopefully it will continue to grow (and come to Brighton!)- I'd love the opportunity to get involved. For more information go to http://streetdoctors.org/

Image: http://www.lucianaberger.com/2012/10/meeting-liverpools-street-doctors/

Carter S.'StreetDoctors; teaching first aid to young offenders'. Student BMJ 2013;21:f2241. Available from URL: http://student.bmj.com/student/view-article.html?id=sbmj.f2241

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Care Assistant Work

Finally back home, after a very busy term!

This summer I will be working as a care assistant again. I have joined an agency where I will be allocated to local residential and nursing homes, as and when I am required. I am interested in how my experiences may differ now that I have had a year of medical training. I like the idea that I should now be able to understand the clients notes better. Hopefully I will be able to apply my pharmacological knowledge to make sense of the clients' side effects and predict what medication they may be on, based on their past and on-going medical history.

Right now I feel like a need a bit of a break from the whole world of medicine. However after I have recovered from my first year and got some more sleep I'm sure it will be a great opportunity to practice my knowledge, develop my bedside manner and earn a little money.

Recovering from a busy term.

An Amazing 1st Year at BSMS

So here we are, a year down the line. I've had some new experiences, made lots of great friends and even learnt how to use my stethoscope.

I don't think  I could have asked for a better start. The transition from my gap year, spent working full-time in care settings, could not have been smoother. Interestingly, most of my flat mates were in the same position as me. Having had a year out to re-apply and gain some life experience seemed to make everyone eager yet a little anxious about returning to an academic setting. It's amazing how little time in takes for you to become attached to people you have only just met. By the end of our first week, we were speaking to each other as if we'd known each other for years! 

The thing that really makes BSMS is the people. I honestly I could not have wished for a nicer year group! Everyone is so friendly which gives the whole medical school a great atmosphere. This is something I really noticed as being different to sixth form; all the students here seem to be passionate, out-going and hard working. On reflection, it wasn't until I started that I quite realised the value of medical school interviews. By looking at the type of students on my course, it seems quite obvious what BSMS were looking for in their candidates. Interview days seems like such a long time ago now!

Overall I feel that the work has been hard, but I've enjoyed the challenge. Plus it feels great to actually be able to recognise medical conditions and abnormalities, as well as understand how and why things work in our bodies. Dissection has been great, I have learnt so much anatomy and developed my cutting skills- I'm still far from a pro, but I'm getting much better at using the bone saw! Also I've become good friends with my dissection group-working as a team has brought a real mix of people together through the unique experience. 

In terms of social life, BSMS is simply amazing! From Freshers Week right through to the end of the year, MedSoc has organised an interesting array of nights out, most of which have included a hilarious fancy dress theme. I also love the Medic Parents scheme, which was introduced to us in our first week. My parents (2nd year students) have been great to me, they've cooked dinner for my Medic siblings and I and throughout the year they've  really looked out for us. I can't wait to be a parent in September, when I'll have my own Medic children to look after. Also, I hope I can keep in contact with my medic parents; this will be a little bit harder as they will be based at the hospital for their 3rd year of teaching. 

 It amazes me at how much I have learnt in just 30 weeks of term-time teaching. As well as learning about the thorax and abdomen, we have also been taught clinical skills. We have recently had our first OSCE which required us to examine the cardiovascular, respiratory and alimentary systems, take peak-flow & blood pressure readings and demonstrate our focused history taking skills. Through our clinical placements we have had the opportunity to practice these skills on real patients in the GP setting, which makes you feel like a real doctor (well sort of!). We also have been on secondary care visits to various hospitals to get an insight into some of the different specialities. In terms of patient contact, in addition to these visits, we have had the opportunity to follow the development of a new born child and the impact it has on their family. I really enjoyed talking to the mother about her experiences as well as having a few cuddles with her beautiful daughter.

Throughout the year I have got involved and joined new societies such as belly-dancing, Sexpression and paediatrics. I have been to local schools through the Teddy Bear Hospital scheme to help reduce reception children's fears of doctors, as well as taking part in dissection art classes and doing a naked calendar to raise money for our chosen charities. This year I have acted as the first year representative for BrightWAMS society, this included writing lesson plans and having meetings with older students to run sessions to teach primary school children about the human body and to inspire them to consider medicine as a career. 

Next year should be just as good, if not better! The work will be tougher, but with placements within A&E, psychiatry and paediatrics, there will be lots of exciting things going on. I will continue to work as a member of the BrightWAMS committee and have been elected the position of secretary. I'm excited to  be moving into a lovely student house in Brighton to live with my wonderful flat mates again. 

After making a silly campaign video, which we filmed in our flat, my best friend and I have been elected as Freshers Reps. This means over the summer we will be working hard to plan the most exciting week of social events in the Medsoc Calendar! We will need to design booklets, wristbands and choose some exciting themes, in addition to organising this year's Medic Parent scheme and communicating with club promoters to book venues. 

Roll on  September!

Ban on Bargain Booze

 

The Government has proposed to enforce a minimum charge of 40p per unit to reduce the nation's binge drinking habits. In the last decade deaths from liver disease has risen by 25% with over 1 million people being admitted to NHS hospitals each year. It is also thought that over 1 million acts of violent crime each year are linked to alcohol.

The minimum charge is unlikely to affect most pubs and large brands. It will be mainly affecting cheap supermarket own brand produce, super-strength drinks and huge bottles of cheap cider which are currently being sold for around 20p per unit of alcohol. For example a 2 litre bottle of 5% cider which is sold at some shops for £1.60 will increase to a minimum of £4.00.
Hopefully the new laws will help reduce the number of casualties resulting from the effects of binge drinking.


Image- http://www.dailymail.co.uk/tvshowbiz/article-1268706/Cut-price-Curran-WAG-stocks-cheap-alcohol-Bargain-Booze.html

Can cooling the brain help our stroke victims?

According to an article reported in several of the national papers and on the BBC website; lowering the temperature of the brain can lead to a greater recovery for people affected by strokes. A pilot study has suggested that a reduction in temperature (35C) using cold saline or ice-packs on the body, appears to put the brain in a form of protective hibernation. It is estimated that this induced hypothermia will help over 40, 000 people in Europe each year; as the therapy has been considered suitable for most stroke victims. 

I have cared for several elderly people who have had strokes and not one of them had exactly the same symptoms. They suffered from a range of speech problems, paralysis and swallowing difficulties however each was affected differently. A treatment which is versatile in reducing the damage to the brain looks like really exciting possibility.

There is already strong evidence that cooling helps reduce the amount of permanent brain damage for those with serious head injuries. The pilot study shows that this technique had potential to help those suffering from strokes, however more research is needed.

Horizon BBC2: Out of Control?

After seeing this advertised, I decided to watch it on BBC iplayer.The programme looked at the role of the unconscious mind in a range of situations by studying human participants. I was particularly interested by how we react to bad news and risks- we are optimists!

 We have an unconscious mechanism which allows us not register bad news as effectively as we take in good news. For example we know that cakes contain 'empty calories' and could lead to us becoming overweight but we still eat them anyway! We often find ourselves living in the spare of the moment and not reading too deeply into the risks. In the study on the programme, the participant had to estimate the risk of developing a certain illness/disease whilst in a MRI scanner. He gives his prediction before finding out the real statistic, most things were grossly underestimated. When he was asked to repeat the set of questions, he did not use the information to change his results. For example when he found out that he was more likely ot be affected by cancer than he thought he still didn't alter his original prediction. The brain scans confirmed that we seem to have a dysfunctional ability to deal with negative information.

 It appears that we live in a world through rose-tinted glasses. Our optimism appears to have been developed for a reason. If we were forever worried that we would fail or take a turn for the worst then our anxiety levels would be through the roof which can contribute to a whole range of other problems (just for starters, think fight or flight mechanisms and how cortisol & other hormones interfere with your immune system). Also if we never thought we were capable of achieving anything then we wouldn't try. If we didn't have this optimistic way of life, I wouldn't have had the motivation to apply for medical school with only 5-10% chance of success from most of them, the odds were completely against me! That's enough for me to consider it an amazing mechanism.

I love watching this sort of thing, especially when I can link it back to my existing knowledge of science. I cant wait to get back into learning, only 6 months to go now!

Abortion Clinics Ads (Student BMJ March 12)

 

As of 30 April 2012, private abortion services which charge a fee will be able to advertise on the television and radio. Profiting companies will be allowed to broadcast their services alongside the existing non-profitable clinics. For some women this will make the termination of a pregnancy easier as they may be more aware of the services available however some worry that we may become desensitized to a very emotional and controversial subject. I think it is important that people think very carefully about their actions; the media may be portraying it as an easy and winning option, however we need to be careful not to over simplify such a life changing decision.

UK Doctors Abort on Gender Alone

 

The Abortion Act 1967 states that non-medical reasons for abortion are illegal in England, Scotland and Wales. Reports in The Daily Telegraph discovered that doctors have secretly been allowing the termination of a pregnancy based n the sex of their child. Secret filming found three clinics guilty of allowing sex-selection based abortions. Andrew Lansley has reported those involved to the GMC and to the police for their criminal actions. Doctors who partake in this illegal activity run the risk of being struck off and imprisonment.
Two doctors are needed to consent the abortion of an unborn child before reaching 24 weeks. The only accepted reasons for termination are that the pregnancy poses as a risk to the mother or her existing children's health (mental, physical) or that there is a significant risk that the child will be seriously disabled (physically or mentally). By abiding to these rules, the one way gender could play a part is if a) the child's sex significantly affects mothers mental health or b) there was a significant chance that the child may develop a disability based on X/Y chromosomes.