Mental Health Professionals Are Asking People To “Take Responsibility” For Surviving Their Suicidal Crisis – Even When Sectioned In Psychiatric Hospital

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Ella and I were patients on the same psychiatric ward. We were both detained under section two of the Mental Health Act. She was perhaps the quietest and most withdrawn patient on the ward at the time. She seemed deeply depressed.

We all felt very protective towards her, because she seemed so young and vulnerable. Indeed, on the day I was discharged, I recall hugging her tightly and wishing I could take her with me.

A few weeks later, Ella took her own life. She was still sectioned in the psychiatric hospital at the time.

Ella had been allowed to gain access to items which she used to end her life. At her inquest, the psychiatrists said they had not restricted her access to them because they wanted her to “take more responsibility” for her own safety. But surely the state had taken responsibility for her safety at that point – she was detained under the Mental Health Act.

It is known that restricting access to lethal methods reduces the number of suicides: https://www.psych.ox.ac.uk/publications/168536.

I run a Suicide Crisis Centre which is independent from mental health services. Clients often tell us that mental health teams are emphasising that they need to take personal responsibility for managing their own crises. Perhaps the teams feel that this will discourage service users from becoming dependent or expecting that a service will “save” them.

It’s possible to argue that we should all take responsibility for trying to stay as mentally well as possible and use as many strategies as we can in order to do that. Indeed, that can feel very empowering. But we may all reach a stage when our strategies no longer work, and we need significant help. When we reach that point of crisis, it may be the least appropriate time to expect someone to be able to “take responsibility”.

When a person is in mental health crisis, their ability to think clearly is very often impaired. That’s the nature of crisis. Our thinking may be chaotic at that time. It is not always going to be possible for someone to think clearly enough to take steps by themself to start to navigate their way out of the crisis.

At the point of crisis, it is the time when you are least likely to be able to see a route forward, without support and care to do so.

There are ways to help empower people who are under the care of a service so they do not become dependent on it. These alternative methods do not involve telling someone in crisis to “take more responsibility.” Giving people more control over their care at an earlier stage, when they are not in crisis, can be an effective way of doing that.

As I wrote last year: “Our approach is to give clients as much control over their care as possible, but to actively and tenaciously work to protect them and help them to survive, when they are in crisis and at risk of suicide” (“Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”).

Requiring someone in crisis to “take more responsibility” may heighten their despair, because they simply cannot do so at that point.

They have taken the step of asking for help, but have been told instead that they need to find their own resources. Surely they need to feel reassured that if they seek help, there will be support, kindness, empathy and care.

I know that the other patients on the ward continued to wrap Ella in care and kindness. They watched over her and alerted staff to the fact that they were extremely concerned about her suicide risk. But that responsibility of watching Ella should not have fallen on other patients.

Ella’s death should make us question to what extent the emphasis on service users “taking responsibility” has gone much too far, and risks causing a failure to adequately protect life.

As Ella had died while under the care of the state, in a psychiatric hospital, there was a jury at her inquest. The jury concluded that her death was a suicide which was “contributed to by her ability to gain access to items to aid suicide”. They took a very different view from the coroner, who in my opinion accepted too readily the mental health service’s justification for not restricting access to certain items. The coroner commented that such restrictions would be “draconian.”

Please also see this article which challenges the approach of clinicians who tell patients that it is their “choice” or “their decision” to end their life : Suicide: why do mental health professionals tell patients ‘It’s your decision’?

In memory of “Ella”. Ella’s name has been changed.

Joy Hibbins is the CEO of the charity Suicide Crisis: www.suicidecrisis.co.uk

Republished by kind permission from Saving Live Blog

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Fake News: What Psychiatric Wards Aren’t Telling You On Twitter

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Did you know that psychiatric wards run their own Twitter accounts now? What’s next, Instagram?  Perhaps we can lose the Care Quality Commission and start carrying out reviews of hospitals on Trip Advisor instead.

Sussex Partnership Foundation Trust has an extensive Twitter network, with official ‘ward twitters’ and multiple ward staff running their own accounts. They call the patients ‘service leaders’ – language that denies the actual status of patients, often detained against their will, on psychiatric wards. The staff are referred to as ‘leader leaders’, trained through the ‘Leader Leader Academy’ which promises ‘quality improvement through Clarity, Competence, Control and Courage’ (is satire dead?). These ideas are taken from an American naval captain, turned public speaker, who suggests every business should adopt a ‘leader-leader’ model of management rather than a ‘leader-follower’ approach. The aim is to push responsibility as low on the organisational hierarchy as possible and for all employees to take ownership of leading the business. I somehow don’t think he was talking about patients detained under mental health legislation when he came up with that.

Am I really a ‘service leader’ while locked on a ward with little say about when I leave, whether I take medication and what belongings I have access to? If we flatten hierarchies to the point that we deny their existence, aren’t we just gaslighting those at the bottom? My own experience in a Sussex Partnership hospital was not one of a ‘service leader’. The problem with using such dishonest language is that it obscures the power and responsibility of those who can actually wield it. For example, a Sussex Partnership nurse tweeted a debrief form that had been filled in by a ‘service leader’ after they’d been restrained. What led to such poor judgement? Perhaps an unintended consequence of this language change is that staff begin to actually believe that patients have equal power, and that it’s OK to share their private, medical information on Twitter.

One of the wards using these terms is a psychiatric intensive care unit at Mill View Hospital. I was appalled to see multiple pictures of ‘service leaders’ posted on their Twitter feed, with smiley emojis superimposed on their faces. One of these pictures was posted by the ward manager, then ‘liked’ and retweeted by the CEO of Sussex Partnership, Samantha Allen. The patients would be clearly identifiable to anyone who knew them and the photos were humiliating, degrading and in clear contravention to multiple data protection laws (not least, that staff had the original, unedited pictures of patients on their phones).

Who are these Twitter accounts serving? Every kind of ‘professional’ Twitter sphere can come across as self-congratulatory, but the stakes are so high here. While I can understand the value in mental health professionals using Twitter to share best practice, it should never be at the expense of dignity and confidentiality. The tone of these ward accounts is all wrong – happy, smiley emojis covering the faces of those detained, talk of infantilised fun with the ‘service leaders’ – it paints an idealistic picture of life on the ward that is pure fantasy. I don’t go into hospital looking for ‘fun’. I hope that I receive timely care, that my human rights will be upheld, and that my dignity and confidentiality will be respected. Sadly, none of this has been the case in my own recent experience of Sussex Partnership hospitals.

The emoji pictures of patients have since been removed, after an uproar from professionals and service users alike. However, data still remains that could be used to make a jigsaw identification of a patient. The ward ‘newsletter’ includes a patient blog section where details about patient’s care and life stories are shared, and so-called ‘service leaders’ are still visible in some pictures.

It is all the more galling because the problems at Mill View Hospital have been well documented in recent years. There was a death on one of their wards as recently as December last year, that resulted in a coroner ordering an immediate investigation into safety. She described the ward involved as “mismanaged and chaotic”, and accused Mill View staff of giving the subsequent police investigation “the run around”. I am left wondering how the families of those who died there would feel about this kind of gratuitous self-promotion on social media.

Another problem on Twitter is that the ideas shared can be lost in their repurposing. One ward in Leicestershire, posted a picture of postcards with motivational quotes on, stating they were writing a personalised crisis plan on the back for each of their patients being discharged. A nurse from Sussex Partnership took this idea and recreated it, but instead of a personalised crisis plan, they listed generic crisis numbers on the back. What was a nice idea – personalised crisis plans on more than just hospital stationery – lost all it’s substance and became just another opportunity for ‘likes’ on Twitter. I left a Sussex Partnership hospital earlier this year without a proper care plan. If they had given me a motivational postcard with generic crisis numbers taped to the back, it would have felt like a punch in the face.

There are real people in vulnerable situations behind these Twitter blunders, that are having their human rights totally disregarded by Sussex Partnership staff – just for some ‘likes’ on social media. It suggests a culture where PR is valued over anything else. Until Sussex Partnership take raising their standard of care seriously, we should watch their Twitter rebrand with caution.

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More Evidence Of Service’s Suicidal Neglect

Thanks to Suicide Crisis and their founder Joy Hibbins for this excerpt, the full report can be downloaded HERE > Research Into Deaths By Suicide In Gloucestershire, Report of First Six Months (June to December 2017) Headline Findings

Patients with Emotionally Unstable Personality Disorder expected to “take responsibility” for their safety.

It appeared that a level of responsibility was being given to patients with Emotionally Unstable Personality Disorder (Borderline Personality Disorder) to keep themselves safe, even when they were detained under the Mental Health Act or “sectioned” in psychiatric hospital. “Keeping safe” was used in the sense of refraining from self-harm or suicidal acts.

However, it was not apparent what preparation or help they had been given to enable them to “take responsibility” for their safety.

Having spoken to family members, there are indications that there will be more evidence of this being repeated in other cases, in inquests to be heard in 2018.

In terms of the inquests already attended:-

AF was detained under the Mental Health Act in psychiatric hospital.  AF had been given a diagnosis of Emotionally Unstable Personality Disorder/Borderline Personality Disorder.

The psychiatric staff giving evidence spoke repeatedly about the need for AF to “take more responsibility” for maintaining her own safety. The coroner asked if she had “the tools” to do this.

AF had not been provided with therapies such as those referred to in the NICE guidelines for Borderline Personality Disorder e.g. Dialectical Behaviour Therapy (DBT). NICE refers to DBT as “an intensive psychological treatment that focuses on enhancing a person’s skills in regulating their emotions and behaviour. The therapy can help a person gain control of behaviours such as self-harm and substance abuse”. Psychiatric staff gave no indication of what they had done to prepare and support AF to be able to “take more responsibility” for her safety.

Therapies are particularly important as there is no specific medication. Indeed the NICE guidance (Clinical Guideline 78) states: “You should not usually be offered medication specifically to treat Borderline Personality Disorder or for any related symptoms or behaviour (such as self-harm, unstable moods and risky behaviour).”

SH had been given a diagnosis of Mixed Personality Disorder (Borderline Personality Disorder and Antisocial Personality Disorder). His family told us that they felt he had been given too much responsibility for maintaining his own safety and refraining from suicidal acts. SH was not provided with mental health care and support (such as the Crisis Team) after suicide attempts or self-harm incidents during the last few months of his life.

There was no indication at inquest that SH had been provided with therapies referred to in the NICE guidelines for Borderline Personality Disorder, including DBT which NICE states can help a person “gain control” of self-harm. There was also no indication that he had been given the recommended treatment for Antisocial Personality Disorder.

The NICE guideline on Antisocial Personality Disorder recommends psychological therapies for managing and treating the symptoms and behaviours associated with Antisocial Personality Disorder. “Group‑based cognitive and behavioural therapies help to address problems such as impulsivity, interpersonal difficulties and can help to reduce offending”.

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Unrecovery As KerPlunk!

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We have all played Kerplunk I hope. But as a recap there is a tube with holes, sticks are crisscrossed holding up some balls, and the trick is to remove the sticks without all the balls falling.

Our mental health is like a game of Kerplunk, and our issues are a combination of the balls and sticks. ‘Recovery’ is the ability to remove the sticks without the balls falling. As a slight adaptation to this analogy some of the balls can be removed by moving sticks, and ‘life’ adds balls all the time. The sticks are ‘safety’ adaptations that stop all the balls falling at once.

This game of Kerplunk is mostly played by us alone (in our own minds), so in this analogy the game is played in a room on your own. But we can always hear people telling us which sticks we ‘should’ remove, whilst we are sitting there looking at the problem, even though these people are not in the room with us. Government policy also demands we remove sticks, and moreover can add balls (as can other aspects of life), as well as remove sticks if we don’t keep an eye on them.

Unrecovery practices are an ad hoc practice, that is a temporary solution to keep control of our own Kerplunk game, knowing that a wrong move can send all the balls falling. ‘Bad’ recovery is one size fits all and insists on this or that stick must be removed, and then blames you when the balls fall. ‘Good’ Recovery, and other therapeutic practices, listens to your knowledge of what you can see of the game, and merely supports you with your autonomy whilst you play the game. This latter ideal however from our observation seems to be at odds with current government policy and market/ capitalist needs, as it doesn’t meet the outcomes measures of outside forces.

For those who don’t know the term, that I have added some changes to the games with sticks and balls being added and removed whilst you play, like a Heath Robinson machine, is what is called an assemblage. Unrecovery is an ad hoc practice with which to deal with such an assemblage.

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I Won by Sam Ambreen

{CN for suicide, self harm, mental health}

13 months after my personal independence payments were cut, I won my 2nd tribunal. 13 months of crowdfunding my rent. 13 months of reducing my food intake, buying the cheaper brand, going without, and feeling humiliated but on Friday, a panel ruled in my favour. There was no objection from the DWP representative who, I could have sworn, was even crying at one point. I felt bad for scowling at her after that!

I self harmed 4 times during that period, when I absolutely could not comply with the measures I’ve worked at to protect myself. I dissociated more frequently. I got as far as buying the instruments I would need to end it. Drew up a plan. Resisted writing the suicide note because that would make it final, and only because the people around me pulled through when I shared my invasive thoughts (a thing I was only able to do because I’d been taught, by my first therapist). They reminded me I’d managed to survive this long because people wanted to help me. They made me think about the people who look to me for strength and how my demise would impact on them. I didn’t really care in that split second but when the feverish urges passed I felt a bit sheepish I’ll admit. People do take strength from my courage.

When the DWP cut me off and sent me their decision, they said they were not disputing the fact that I had these disabilities just whether or not I qualified for personal independence payments. 13 months on and I’ve just been told I do. So was it really necessary to put me through this? What is its purpose otherwise? Survival of the fittest? It’s not strictly true anymore though is it? I’m nowhere near the fittest but I have recourse; to advocates, to friends who work in the public sector and health professionals who actually listen. Perhaps this mum didn’t?

Even with all the support I have, I came the closest I ever have to ending it. I didn’t enjoy asking for help, again and again, I was isolated and lonely as a result. I might be an anarcho-communist but I still have the hardwiring of a society that celebrates charity as a virtue but not if you’re on the receiving end. The shame still lingers. I didn’t want to die, I felt I had no other choice.

Recently I read about a young woman called Holly Cowlam who took her own life when she was diagnosed with depression. Holly had been studying psychology and so had some understanding of mental health. I get the sense, because she knew her chances in life would be greatly affected, as they are in a society that demonises mental health, she felt she had no other option. I know what that’s like; the shame and hopelessness. I refused to acknowledge my own mental health for 20 years, telling myself I was stronger than those others who had succumbed. In the end, you can’t really prevent it. I am the sum total of all the violence and treachery inflicted on me but with the right support, and freedom, and protection, I know I can get better.

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What I do not need, and could have really done without, was being treated like I’m making it up. As a repeat victim of sexual and domestic violence, gaslighting is a straight up trigger for my PTSD. Being treated like I am insignificant and somehow asking for more than what is my right, having paid into a system for many years and on an emergency tax code more often than not (I did a lot of temp work because I was sick even then only I wouldn’t admit it) eventually wore me down in a way my mental and physical conditions do not, because I believe I can overcome them (to an extent). I needed time and space to heal not to be hindered by a cruel and abusive process.

Advocates for humanity must ramp up the pressure on this government and demand justice for all those who’ve needlessly died in our country. The architects of social cleansing must be tried for their crimes against our humanity.

You can judge a country by the way it treats its animals/poor/prisoners/women/disabled folk.

Republished (23/02/19) by kind permission, Sam Ambreen blogs at Left At The Lights

If you need help dealing with the DWP see our Advice Links page.

Note: PIP application processes generally require disclosure of diagnoses, medication, and supporting evidence, making it significantly discriminatory and arduous for many people. Professionals are often uninformed about how best to help people, this is a good guide.

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The unRecovery Excellence Framework #uREF2019 – A request for peer reviewers.

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Recovery in the Bin would like to invite allies and peers to review a list Rita Bins has collated of publications that reference Recovery in the Bin!

What did Rita do? (Methods)

Rita collated a reference list after making a public request on Twitter and after systematically searching google scholar, google news and google search.  These tools were chosen as they are freely available to all on the internet – they are not hidden behind paywalls and do not need to be accessed via membership of an academic institution.

Rita decided that she would include all types of publications in her reference list, respecting and privileging all forms of publication democratically.  This included peer reviewed journals, books and textbooks, theses, reports, magazine and newspaper articles, blogs, presentations and posters.

To be included in this list, all publications were required to reference Recovery in the Bin OR explicitly name Recovery in the Bin (via a secondary citation or without providing a reference).  All publications by Recovery in the Bin were excluded.

What can I do to help Rita?

Please contact us via email recoveryinthebin@gmail.com or by Twitter DM @RITB_ if you notice that your publication has been omitted from Rita’s work.  Or indeed, if you have any corrections.  The full reference list can be found here.

What will Rita do next?

Once we have received feedback from our allies and peers, we will publish the unRecovery Excellence Framework #uREF2019 as a blog in due course.

We will also be working behind the scenes, under Rita Bins’ leadership, to synthesise and analyse what people are saying about us.  We will be publishing the methods and results of our survivor led scoping review in a journal.  Rita Bins is an unacademic with some impressive methodological and literary skills.

Rita would like to thank all translators who have supported this work:

Andreas Vedeler – Danish and Norwegian.

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Neopaternalism – New Wave Paternalism In UK Mental Health Services

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Artwork by: @JADEELIZB

Neopaternalism refers to the practice, often seen in MH services, of professionals imposing their versions of ’empowerment’ and ‘independence’ etc. on individuals in their care regardless of the individuals own views. Typically, ‘independence’ in this context is near synonymous with discharge or cuts to care provision.

Neopaternalism prioritises the professional’s worldview, agenda, values and goals. As such, it mirrors traditional paternalism, but the content and language used is different. Emphasis on independence in neopaternalism is often framed as contrasting to traditional paternalism in which providing care is perceived as restricting a person’s liberty and autonomy. However, this obscures the fundamental similarity in which both approaches impose the powerful’s agenda on the less powerful.

Neopaternalism is in some ways worse than traditional paternalism, which at least resulted in some care. Traditional paternalism involved helping by ‘doing to’ an individual in their perceived best interests, whether or not the individual found it helpful. Neopaternalism involves ‘helping’ by not doing anything (supposedly ‘empowering’), whether or not the individual finds that helpful. Neopaternalism is oppression skulking behind an empowerment façade.

Neopaternalism pervades the co-opted neoliberal recovery approach which is every bit as coercive as other models: there is an obligation to recover, find certain things helpful & failure to do so is pathologised by both services (PD) & alternative models (sick role). Underlying neopaternalism is pressure on individuals to fulfil neoliberal policy outcomes, conflating individual/citizen needs with government agendas.

 Example:

“We’ve decided for you that you must not be dependent on us. Your opinion doesn’t matter because we are doing this for you, in your best interests. We are empowering you by discharging you to promote your independence. You must take responsibility. Nb We will not admit it has anything to do with neoliberal ideology or cuts”

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