issue 09
Summer/autumn 2010
Inner space for women’s mental health & wellbeing (across Surrey and the south east)
Digging yourself out of a hole gardening for heart and soul
No clean knickers – let alone a toothbrush the indignity of being sectioned Painting yourself into the picture art therapy creates self knowledge
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New website for mental wellbeing www.letslinkmentalwellbeing.com Let’s Link, publishers of Sanctuary are launching a website that will provide news and information on mental health and wellbeing. Also included will be links to national and local organisations plus details of events and consultations with which you can get involved. Whilst its focus will be on Surrey services and support, the range of information and support for people who experience mental ill health and for those who care for them will be a resource for many in the south east. You will be able to download issues of Sanctuary magazine, other mental health related publications, the latest national and local health documents and in due course there will be a forum where you will be able to comment on local mental health services. Setting up the website is underway but it takes time to have everything in place. Please visit www.letslinkmentalwellbeing. com to see our progress and if you have any initial comments, please email us at info@letslinkmentalwellbeing.com
Coming up on the website and in your local area: Service user and carer monitoring of the Crisis helpline: in the next few months you will be able to take part in a survey to find out what patients/service users and carers think about accessing the mental health Crisis helpline in Surrey. There will be opportunities in various locations – CMHTs for instance – to participate in the survey, a simple questionnaire of around 8-10 questions, and online on the Let’s Link mental wellbeing website. Details will be posted on the website in due course.
g Editorial comment Depending on your political / social / economical viewpoint the envisaged and planned developments in healthcare (being hailed as the biggest change in the NHS since it began) could be the best or the worst time in history for mental health. What will ‘Equity and Excellence; Liberating the NHS’ mean for mental health? Will it be a welcome sea change, bringing understanding that there is no health without mental health, sitting as it should in public health, or will it be a tsunami of utter chaos and devastation? The view of which direction we are heading in is fuzzy to say the least. Plaudits abound in some areas of the mental health field; deep mistrust and criticism circle in others. One thing we know for certain: GPs will be commissioning a wide range of mental health services. Somewhat alarmingly though, and at their own admission, only 31% of GPs feel equipped to commission secondary care services for mental health. But optimists suggest GPs are, nevertheless, being provided with great opportunities for developing practice-based services
provided by frontline professionals like counsellors and specialist mental health nurses. All they need to do is ‘skill up’. So, with such variance of views and predictions, here is a ‘call to arms’ to all our readers! Whether you are someone with direct experience of mental health services, as a patient, carer or member of staff, or whether you come into contact with mental health services as part of your work e.g. local authority, voluntary sector etc, we are asking you to keep a watching brief and be Sanctuary’s women – and men – in the field. Report anything you think is getting better, or worse, as the changes start to hit where it hurts – or benefits - the patient. Tell us your news, ideas, stories. Together we can build a picture of mental health from where it matters – you – and use it to show politicians, commissioners and providers how things really are – at the frontline of mental health. Contact details below. Meanwhile, at Sanctuary, we know exactly which direction we’re headed. Whilst we are not afraid to highlight the bad
and the ugly, we also want to continue to bring you the good and positive in mental health and wellbeing. In this issue we look at the benefits gardening and art therapy can have; how women and men from black and minority ethnic groups, are being supported to access mental health services; we also cover the Personalisation ‘agenda’ and what it can mean for patients / service users wanting more control about what they do in their lives. There’s a relaxation technique to help you – well – relax! And we hear two stories from two women who both experienced being sectioned under the Mental Health Act. One experience led to helping others in an acute psychiatric inpatient unit and the other to finding a voice for justice. Just looking at the wealth of experience, knowledge and expertise among our contributors and readers who have contacted us, makes me think that GPs need look no further: we can skill them up in mental health matters…
Megan
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Send your news and information to Megan Aspel, Sanctuary magazine, Let’s Link, PO Box 533, Betchworth RH4 9FL. Text: 07824 364703. Email: info@letslinkmentalwellbeing.com. www.letslinkmentalwellbeing.com
Sanctuary is free to everyone. Managing Editor: Megan Aspel Assistant Editor: Louisa Daniels Sanctuary is commissioned by NHS Surrey
Design by Aspects: studio@aspectsgd.com www.aspectsgd.com Printed by Reliant Colour Solutions: www.reliantcolour.com No part of this magazine may be reproduced without prior permission of the publishers. Copyright © Aspects 2010.
No clean knickers
–let alone a toothbrush
4
Being admitted to an acute psychiatric unit under section of the Mental Health Act – especially for the first time – can be a frightening and traumatic experience; on top of the traumatic experience of finding yourself mentally unwell! And when you arrive with nothing, just the clothes you stand up in, maybe because you arrived in the back of a police car, the entire experience can be an affront to your dignity and self worth. Sanctuary’s editor, Megan met a young woman who’s been there, done that, wouldn’t mind the T-shirt (on the ward as a change of clothes!) but also, passionately, wants something else… I first met Julia after she contacted me to say how much she had enjoyed reading Sanctuary. So much so that she was keen to get involved in some way. We met. In a very short space of time we had gabbled our way (constructive gabble!) through a myriad of subjects and issues linked to mental health and wellbeing and other things totally unrelated. I soon discovered that Julia is full of ideas. But not just ideas: Julia has a real ambition. Two very different experiences of being hospitalized in a private and an NHS acute unit highlighted a real need in Julia’s mind. She thought everyone admitted to NHS units should have the quality of experience she had received in the private unit. She explained: “I had arrived at a psychiatric unit after being compulsorily detained under Section of the Mental Health Act. I had nothing but the clothes I stood up in. I was feeling very low anyway, as you can imagine; being without personal belongings or a change of clothes made me feel a lot, lot worse.
“I had to ask for soap and stuff, and worse, sanitary wear – traipsing through a ward full of men, going to the office, requesting Tampax and going back through the ward clutching them – hardly dignified to say the least! Julia was able to transfer to a private clinic however, because of a health insurance scheme.One major difference stood out for Julia. When she went to her room at the private clinic, it was like stepping into a hotel (with a few exceptions!) and in the en-suite bathroom was a beautiful box of toiletries from the White Company. Everything she needed for a few days or so. Sadly, the NHS ward just didn’t compare. Items might have been available but not in individual packs for each patient. But it was how that simple gesture of fresh smelling toiletries made Julia feel that was the real eye-opener. “To have something – slightly pampering – and extremely ‘normal’ had a profound effect,” Julia told me “Suddenly I felt I was being treated with respect – my sense of dignity was intact again. And I thought, ‘I wish everyone admitted to a mental health ward could have this’.”
Cutting the long story… The work of my organisation Let’s Link, publishers of Sanctuary magazine, echoed what Julia was saying; everything we do is about promoting dignity, privacy and respect for people who suffer mental distress. Together, we felt the time was right to really see if we could get something going. Julia, along with Occupational Therapist (OT) Bryonie from the Joseph Palmer Centre in Molesey, Surrey set up a meeting with one of Surrey & Borders Partnership NHS Foundation Trust’s (SaBPFT) key managers and myself from Let’s Link. I think it was
probably one of the swiftest ‘done deals’ I’ve ever known. In a matter of half an hour, the trust manager and I had said we could joint fund a pilot! So began a partnership between a patient, a charity and an NHS mental health trust: ‘The Wellbeing & Dignity Partnership’ was born.
It gets better Funding was limited. What could be provided were ‘hotel style’ packs of essential toiletries – shampoo/ conditioner/shower gel/dental kit etc – with simple, caring messages of hope, for everyone admitted over a 6 month period onto the wards at the Department of Psychiatry in Epsom. A few months down the way of organising this though, came some good news. Let’s Link has been awarded a Comic Relief grant. This will enable us to produce leaving hospital information packs to complement the toiletries packs. Work is now underway to get the pilot up and running as soon as possible. The beauty of this project is that it will include people in the community who have ‘been there / done that’ as well. Clients of the Joseph Palmer Centre will help assemble the packs. So people in hospital will have the added benefit of knowing the toiletries packs were put together by fellow sufferers / survivors: a message of hope in itself. For Julia and everyone concerned it is an exciting project based on a gesture of kindness, respect, privacy and dignity: the simple gift with the big heart. Julia’s next ‘Big Idea’ is to build a retreat in the Peak District – and possibly Italy: form an orderly queue everyone!
See the article starting on page 16 for another woman’s experience of being sectioned.
I went to a CPA (care plan) meeting – on my own, I didn’t know I could have someone with me, and they told me I had to go into hospital straight away. I felt alarmed and horrified. But they knew best I thought. I asked to go home and pack some things. They said no, I couldn’t do that. I said what about if someone comes with me. No was the answer. So they bundled me off to a secure psychiatric unit. I felt very frightened and so alone. I was in total shock about being admitted, and to have nothing – no personal belongings – made me feel even worse. It was three days before a relative could bring anything in for me.”
Young woman at a Sanctuary women’s group
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Sometimes it’s difficult to ground yourself. There is a way though, almost literally, by participating in a little gardening. The Old Moat Horticultural Services in Epsom, Surrey helps people with mental health problems dig deep for recovery...
y. e butterfl h,’ said th g u r.’ o e n w e o t fl o g is n d a little ‘Just livin en edom, an s e r fr e , d e n in A have sunsh Hans Christian ‘One must
Run by Richmond Fellowship, The Old Moat is a garden centre with a difference. Many of the people who work there suffer mental ill health. It is a haven for anyone needing some calm, thoughtful, safe and supported occupation. Achieving the sowing, growing and maintenance of plants and flowers is satisfying in itself. What it does for lifting the spirit, boosting self worth and taking away some of the pain of mental ill health is immeasurable. But the Old Moat isn’t just about recovery and restitution. It is a not for profit, but nonetheless commercial enterprise and offers training in the real world of garden centre work and management. Contract gardening, park maintenance, conservation work, stock growing, propagation, vegetable and fruit production, retailing and
administrative work are all available to train and become expert in. For the visitor, the Old Moat provides a wonderful array of all the plants and flowers you need: shrubs, ornamental trees, roses from David Austin are all there. Up to 80% of the plants are grown in The Old Moat’s own nursery, reducing plant miles, with bedding plants grown in biodegradable pots, showing further consideration for the environment. You will find a wide variety of vegetable and fruit plants and trees in stock, and if you don’t fancy growing your own, you can buy seasonal, freshly picked produce from The Old Moat shop.
Find out more about the training The Old Moat offers. It’s a kind of down to earth thing to do!
Contact The Old Moat to enquire about referrals or you can visit the garden centre anytime. The Old Moat Garden Centre, Horton Lane, Epsom KT19 8PQ. T. 01372 731971 (office) or 01372 731970 (retail); email: oldmoatgardencentre@richmondfellowship.org.uk Visit the Richmond Fellowship website to learn more about our work http://www.richmondfellowship.org.uk
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Digging yourself out f a
7
Getting it right for the BME community 8
Helping people from black and minority ethnic backgrounds (BME), particularly refugees, to access mental health services demands a special understanding of how mental health is perceived in countries like Africa. Lorraine is a community development worker who knows that building relationships is the first step to supporting this community. She explained some of the issues to Sanctuary...
“The key issues
that prevent people from African/Caribbean communities – and from elsewhere such as Asian communities – accessing mental health services,” says Lorraine “are stigma, racism and lack of awareness and knowledge of mental ill health.” Whilst some of the issues reflect those experienced by a white community, such as stigma and even a lack of awareness around what happens to you when you receive mental health services, there is far less acceptance of the condition. Mental health simply doesn’t translate properly in other languages and attracts misconceptions of witchcraft and other negative attitudes linked with tradition. Put simply, a mental health problem translates as someone who has ‘lost it’. Mental illness is associated with shame and stigma and a fear of being labelled, isolated or alienated by friends or family members. In addition, it is seen as a sign of failure or something to be feared. And perhaps pertinently ‘madness’ is thought to be incurable, unlike our view that people can recover from mental ill health. It is not surprising then that language is the key contributing factor to misdiagnosis. Lorraine also sees a circle of fear surrounding mental health. “If you combine the different layers of fear – fear of mental illness and fear of mental health services, you witness a vicious circle,” she explains “A circle that impacts negatively on the
engagement of black people with services and vice versa.” Social risk factors impede engagement with the right health and social care services as well. Poverty and homelessness (many refugees seeking asylum for instance are living destitute in the UK with no recourse to public funds); loneliness and isolation or contact with the criminal justice system all put people at risk. African Caribbean people for instance are more likely to be held under a section of the Mental Health Act. They are also over-represented in Special Hospitals, secure institutions, medium secure units and prisons. For those who do get to see someone, there is hope and enlightenment. However, services don’t always get it right: there is evidence that BME patients are more likely to receive medication rather than be offered talking therapies. As mentioned, compulsory admission to hospital is prevalent and families and carers have difficulties accessing help. Lorraine and her colleagues believe the way forward is for better working relationships with faith leaders to promote inter-cultural understanding of race equality in mental health and better involvement of communities in the planning and implementation of services from the outset. In this way people will begin to benefit in a very real way from being supported and cared for, and respected for their culture and race rather than misunderstood and abandoned.
Contact the team: Lorraine Yates – CDW, African/Caribbean, Refugee & Asylum Seekers; 01483 459292, ext. 214 Charmaine Valler – CDW, Gypsies & Travellers; 01483 459292, ext. 235 Kate Johnson – CDW, Asian, Chinese & Nepalese; 01483 459292, ext. 203
9
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Directory Sanctuary magazine started in Surrey,
commissioned by Surrey PCT. With extra help from Care Services Improvement Partnership in the south east, the magazine has a small circulation across Kent, Sussex, Hampshire, Isle of Wight, Berkshire, Buckinghamshire and Oxfordshire and Milton Keynes, as well as Surrey. We will continue to list organisations and help lines in Surrey in this directory but we’ve added each mental health trust in the south east and will include other important contact details as we can and space permitting.
Mental health NHS trusts across the south east................................................
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• Sussex Partnership NHS Foundation Trust. T: 01903 843000 • Kent & Medway NHS Social Care Partnership Trust. T. 01732 520400 • Isle Of Wight Healthcare NHS Trust. T. 01983 524081 • Hampshire Partnership NHS Foundation Trust. T. 023 8087 4300 • Berkshire Healthcare NHS Foundation Trust. T. 01344 415 600 • Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust. T. 01865 778911 • Milton Keynes PCT. T. 01908 243933 • Surrey & Borders Partnership NHS Foundation Trust. T. 01883 383838 • Age Concern Surrey – 01483 458732 www.acsurrey.org.uk
Alcohol and drugs........................................ • Drinkline, 0800 917 8282 • Al-Anon, support for family and friends of alcoholics, find a local group 020 7403 0888. • Alcoholics Anonymous, find a local group – 0845 769 7555 • Drugscope, for information, www.drugscope.org.uk • Frank (for young people and parents) www.talktofrank.com • Surrey Drug & Alcohol Action Team – for local services, www. surreydat.org.uk
We are building on this directory all the time. If you have anything to add that you think will benefit women’s mental health and wellbeing in Surrey, please let us know. You can contact Santuary magazine c/o Let's Link, PO Box 533, Betchworth, RH4 9FL. Tel. 07824 364703; email; meganaspel@sky.com
Bereavement and loss................................... • Cruse 08701671677 www.crusebereavementcare.org.uk
Counselling..................................................... (please note, waiting times can be long) • British Association of Counselling & Psychotherapy, 0870 443 5252 www.bacp.co.uk (for details of local practitioners) • Heads Together (young people 14-25) 01737 378481. No fees • Croydon Pastoral Foundation, 020 8760 0665. Negotiable rates according to means • North Surrey Community Counselling Partnership, 01932 244070 www.nsccp.co.uk A sliding scale fee basis operates (up to £40.00 per session) • Pathways Counselling Centre, Epsom, 01372 743338. Professional counselling, normal rates apply • Redhill Counselling Centre, 01737 772844. Negotiable rates • RELATE, relationship counselling, 0845 4561310 www.relate.org.uk, for a local branch. A fee is charged for appointments. • Relateen, Epsom (part of RELATE but for young people disturbed/worried about parent’s relationship problems) 01372 722976 • Seastone Possibilities, Trauma Resolution Treatment 01306 640073 / 01737 249364 email: seastone@talktalk.net
Debt counselling...........................................
Domestic abuse...............................................
Other useful contacts.................................
• Surrey Domestic Abuse Helpline (24hr) – 01483 776822 • East Surrey Domestic Abuse Services (covering Reigate & Banstead, Mole Valley & Tandridge) - 01737 771350 Email: support@esdas.org.uk Website: www.esdas.org.uk 9am – 4pm, Monday to Friday, confidential answer phone out of hours. • North West Surrey Outreach Service (covering Woking, Runnymede & Surrey Heath) run by Surrey Women’s Aid 01483 776822 (24hr) • North Surrey Outreach Service (covering Epsom & Ewell, Elmbridge & Spelthorne) run by Walton & Hersham Citizen’s Advice Bureau - 01932 260690 Email: nsdvoutreach.walton@cabnet.org.uk Website: www.waltonadvice.demon.co.uk 9.30 am – 4.30 pm Monday to Friday, confidential answer phone out of hours • South West Surrey Outreach Service (covering Guildford & Waverley) run by CAHA - 01483 577392 9.00 am - 3.00pm Monday – Friday, confidential answer phone out of hours
Crisis numbers; • Samaritans, 08457 909090 www.samaritans.org.uk • Sane Line (12noon – 2am daily) 08457 678000. National out of hours helpline for anyone coping with mental illness – sufferers, carers, relatives or friends. • Surrey & Borders Partnership NHS Trust, 0300 456 83 42; text for hard of hearing – 07717 989024 (24hrs) • Childline; 0800 1111
Survivors of childhood abuse................... • C.I.S.‘ters for adult women sexually abused as children Run by survivors for survivors – helpline Saturdays 10am – midday 023 80 338080
Eating disorders........................................... anorexia, bulimia • Eating Disorders Associations, 0845 634 1414 www.eduk.com
Employment For people who do or have suffered mental ill health: • Employment, Support, Re-training Agency (ESRA) for East Surrey area: 2nd Floor, Rawlinson House, 9 London Road, Redhill RH1 1LY. Tel/Fax: 01737 772115 Richmond Fellowship covering the whole of Surrey: • Mid Surrey (and queries re West Surrey) RF, Manor House, 19 Church Street, Leatherhead KT22 8DN. T. 01372 363934 • East Surrey RF, Rawlinson House, 9 London Road, Redhill RH1 1LY. T. 01737 771 282
Hearing Voices................................................
Primary Care Mental Health Teams (PCMHTs) • for long term and complex mental health needs and for referral to specialist services such as Crisis Assessment & Treatment Team, Eating Disorders service, Continuing Needs services. Open Monday – Friday 9am – 5pm • East Elmbridge PCMHT – 020 8873 4300 • Epsom, Ewell & Banstead PCMHT – 01372 204000 • Mole Valley PCMHT – 01306 502400 • Redhill PCMHT – 01737 272301 • Tandridge PCMHT – 01883 385481
• Rethink, 020 8974 6814 www.rethink.org
Anger.................................................................
• Christians Against Poverty; freephone 0800 328 0006 www.capuk.org
• British Association of Anger Management, 0845 1300 286 www.angermanage.co.uk
Depression.......................................................
Anxiety.............................................................
• Depression Alliance, 0845 123 2320 www.depressionalliance.org
• Association for Postnatal Illness, 0207 3860 868. www.apni.org; www.surrey.nhs.uk; www.babycentre.co.uk; www.netmums.com
Direct Payments.............................................
Self harm.........................................................
this is money allocated directly to a patient/service user to enable them to have more choice and independence about the support/facilities they can access in the community. For more information contact: • Surrey Independent Living Council (SILC), Astolat, Coniers Way, Burpham, Guildford GU4 7HL. T. 01483 458111
• www.selfharm.org.uk; www.lifesigns.org.uk; • www.rcpsych.ac.uk/cru/auditselfharm • Bristol Crisis Service for women (national helpline); 0117 925 1119. Friday/Saturday evenings 9pm – 12.30am. Sunday 6-9pm
• No Panic, 0808 808 0545. www.nopanic.org.uk; • National Phobics Society, 0870 7700 456 www.phobics-society.org.uk; • First Steps to Freedom, 0845 120 2916 www.first-steps.org; www.anxietycare.org.uk (enquiries@anxietycare.org.uk to find out about accessing free advice and support)
Community Mental Health Teams (CMHTs) • Spelthorne CMHT 01784 440204 • West Elmbridge CMHT 01932 266900 • Runneymede CMHT 01932 723392 • Woking CMHT 01483 756318 • Hollies CMHT 01252 312788 (8.30-5.30 Mon -Fri) • Surrey Heath CMHT 01276 671102 • Guildford CMHT 01483 443551 • Waverley CMHT 01483 517200 • Godalming CMHT 01483 415155 • Haslemere CMHT 01483 783090 • Farnham CMHT 01483 782095 • Conifers CMHT – cove, Fleet & Yateley area, 01483 783555 • Early Intervention in Psychosis, 01372 206262. For 14 – 35 year olds who have had a first episode of psychosis within recent years. • MIND, national organisation for mental health with local branches – www.mind.org.uk Infoline 0845 766 0163. Mind produce booklets on various mental health issues and campaign for better services • Mental Health Foundation, national organisation for information, campaigns, news, interaction, including information on the relation between diet and mental health; www.mentalhealth.org.uk
Post natal depression pregnancy and birth issues.......................
• Psychotherapy Service (Surrey & Borders Partnership NHS Trust). • Referral only but you can access an information leaflet; contact the Psychotherapy Service at Shaw’s Corner, Blackborough Road, Reigate RH2 7DG. T. 01737 277706 • Samaritans; 08457 909090 • Surrey & Borders Partnership NHS Trust, for mental health and learning disabilities services - 01883 383838 • Surrey Police; 0845 125 2222
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The stress
response system is a normal physiological mechanism activated by danger and threats to our survival. However, there are hardly any physical dangers or real threats to our day-today living. For most of us, worries and demands related to our lifestyle have become so pervasive and draining that our mind and body perceives them as real threats. Being so emotionally aroused, the stress response is activated. Taking a few ‘me’ moments each day is essential to de-stress and live healthily. At some point during the day we need to press the relief-valve to let the steam off. Whether your day is planned around a busy schedule or mental ill health
brings with it inertia, it can be difficult to have a positive approach to ‘working on ourselves’. Whatever your situation, developing new habits and making life changes can be daunting. Marina says “Many people like me have discovered the benefits of yoga and believe that the basic ideas of yoga are the key to wellbeing. Studies have shown that yoga exercises are very effective in relieving stress and depression as well as keeping our body young and flexible”. Through the practice of yoga and other mindfulness techniques, we can learn to pay attention to moment-by-moment experiences. A key principle of yoga practice is to focus on the breath, body sensations and movements as they happen
in the here and now rather than engaging in unrelated thoughts and feelings. As we are less distracted by background thoughts, we become more focused and more connected to our soul and basic needs. The mind stops from constantly roaming from topic to topic, over-working, obsessing about the past or worrying abut the future. This can help to disengage from long-standing beliefs about ourselves and ways of thinking that are not helpful and thus to making healthier life-style changes. However, unlike the celebrities and gurus, we do not need to spend long hours practicing yoga. The evidence suggests that even a few short exercises practiced on a daily basis are very beneficial to our physical and mental wellbeing.
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Stressed? Pure calm is a breath away Few people today are in little doubt – and scientific studies have confirmed – that there is a link between stress and diseases. The risk of developing high blood pressure, heart attacks, cancer, ulcer, diabetes, depression and obesity – just to name a few – is increased by high stress levels. Some even argue that stress is the real hidden killer in the Western World. Sanctuary discovers some stress busters that you can almost do with your feet up! But first, what is it that causes stress? Yoga expert Marina explains…
The practice of a few yoga exercises does not need to take long, but it needs to be regular. We can start with just a couple of minutes every day at the same time. For instance, lightingup an aromatherapy scented candle in the evenings and practicing breath awareness. Exercises like that do not require any thinking, so thoughts no longer rule! In addition, taking long deep breaths is our most immediate defence against stress, as it helps to deactivate the stress response mechanism. Getting into a habit of pausing and taking nice, deep mindful breaths may seem minor. However, it is surprising how such a simple and small step can be a life-changing discovery!
Before starting any exercise consult your doctor - try a yoga class at your local yoga centre. Samsakta Prati Deva who teaches in London has more information and exercises available at: www.beginning-yoga.info
Candle light meditation Light a non-flickering aromatherapy scented candle - sit comfortably - in a quiet place - for at least 1 minute - with an attitude of love, respect, acceptance towards yourself. Eyes can be open focused focusing on the light or closed focusing on the experience of breathing. Or try both. Keep your regular 1 minute practice at the same time of the day. Do this at least once a day.
Yoga at your desk Sit in your chair with feet slightly apart firmly grounded, spine erect, shoulders & arms dropped with a positive attitude towards yourself: Part 1- Lengthening the out-breath: Inhale for a count of 4; Exhale for a count of 8 (repeat for 4 rounds) Part 2- Linking the breath to the arm movement: Inhale for a count of 4 stretching the right arm forward to shoulder’s height; Exhale for a count of 8 releasing the arm down; Switch arm (repeat for 4 rounds) (variation: make a tight fist on the inhale and release the fist on the exhale; bend & stretch the wrist, fingers pointing up on the inhale, release on the exhale; try to inhale for 5 and exhale for 11 counts) Part 3 – As above, this time lift and lower the arms at the same time Yoga as medicine – the yogic prescription for health and healing – a yoga journal book by Timothy McCall M.D.
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Sadly, many of you will know all about this woman’s experience but Sanctuary has highlighted it to show that still, in this modern day of ‘quality’ services, there is much to learn about patient respect and dignity.
A nice quiet break in a locked ward … ‘Just two days ago I received a couple of the best compliments I have ever had in my life. One was from a patient in a locked ward of a mental health hospital and the other from the hospital’s facilities manager. The patient said that: “…the hundred or so times I really thought I would die were all worth it to have a friend like You at last in my life;”; the manager told me that the garden(which I had transformed from a sort of circular ashtray full of cigarette butts into something patients enjoyed being in) had never looked better since the day that the hospital opened. And I will also always remember one special nurse. I told her that she was: “…like Mary Poppins as she was very- nearly- perfect in every way.” I can still see her smile...’ Six weeks before, I was standing as a Green party candidate in the local elections when I experienced something completely different, in the words of the Monty Python team. No, it wasn’t the Spanish inquisition, but it was the most terrifying experience of my life. Three six foot tall men (an approved mental health assessor and two psychiatrists) and two policewomen suddenly burst into my tiny house and – you’ve guessed – sectioned me. The worst thing about it was that my student daughter was there at the time and the whole, bizarre experience forced her to pay to see a psychoanalyst as there was nothing available on the NHS. What
got her was that she was not allowed to intervene, although she was days away from being 21, as it was thought she was too young (she is tiny and looks well under 18 – she tried to explain differently but was hushed up and pretty much in shock, she said: “Don’t worry Mum, I’ll get you out of there – I’ll get a lawyer.”)
Why? So what had I done to deserve five public servants spending their time on me? I had no previous “history,” as they say, of this sort of thing, was not under the care of a psychiatrist and had not committed a crime against any other person or indeed myself. And far from being depressed, I had just started to work again for the first time in more than two years, was very involved in the elections, plus at a personal level, very happy with a new partner. As it later emerged, the reason for my sudden plunge into the icy waters of the mental health system was a combination of misinformation together with the misapprehensions of a lot of caring people who didn’t know me from Adam, but believed that I would benefit from a “nice quiet break,” or “gardening leave,” as they said, in a locked ward. Before you start to go into a “well she would say that wouldn’t she” thought process, breathe deeply, and make no assumptions yourself. Assumptions, rather than facts, are what the whole decision was based on.
What next? Question: What do you say to a woman who in three weeks has had her drink spiked twice, been burgled three times and her mobile phone(s) cut off because of fraud? (PS forgot to mention concussion, arm in plaster and a cardiac episode or three …) Answer: You say: “Gotcha, you heard of Section 3 under the Mental Health Act? No? Well never mind, it means that we can say you are schizophrenic, take away your basic legal rights and force you to take drugs against your will for up to six months …” BUT, you will say, you DO have rights to appeal against all of this, there are lawyers, there are Independent Advocates from charities like Mind, and you can elect to complain to the hospital’s Managers and/ or to have a Tribunal to fight the decision. True, but the thought of having to hold out for seven weeks or so before the said Tribunal takes place is mind numbing. And this is seven weeks with very little sleep, and no physical or mental freedom. The regime is so like being in prison. If you behave well and are a “good” patient, which means taking your medication and never arguing with the staff, you might just be allowed to go out for a few hours in the care of a next of kin or a responsible friend. That is, of course, if you have one living near enough to visit and free enough to get there. In time you become a sort of “Trustee,” to continue the prison analogy, who is allowed to go out for an
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hour or so unaccompanied. Behave very, very well and you can have a weekend break and then “home leave” of a whole week. If you remain consistently polite to the Home Treatment Team checking you each day, (they come to watch you take your medication and ensure you are living appropriately – ie no mess, no booze, no signs of rampant parties,) you may then be officially discharged. It is dire. No freedom, your laptop is confiscated, and you are allowed 15 minutes on the internet a week – or at least that was what actually happened in my case. You probably won’t sleep as there is always one or more patients kicking off all through the night. The vast majority of patients therefore stagger into the garden to smoke from 6.00am onwards (a good night is one when you are allowed to go outside to smoke after midnight to relieve the strain...) I have never smoked so much in my life; tobacco and ciggies are currency and so become the subject of negotiation, conversation and accusation of meaness, selfishness and theft.
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Patients can be mad, bad and dangerous to know All you want to do is to get out. You are not allowed any electrical object with wires (so no music, unless you purchase a battery operated CD player or have a tiny ipod). Neither are you allowed to wear a belt. Clearly this is because there is a risk that patients will strangle or hang themselves with any means available. Having a particularly bad sense of humour, I enjoyed wearing baggy jeans which frequently began to fall off. “Hey,” I would say to the staff, “Do something or I’ll lose my strides and inflame the men...”
Bizarrely, however, they didn’t mind me wearing scarves as a belt. The logic of this escaped me as scarves would have been infinitely more effective should I have had any desire to hang myself. When I asked why, staff told me the reason was that the The Rules said “no” to string and belts but “yes” to scarves and ribbon. As a consequence I closely resembled a hippy. In my case scarves were also worn around the head initially, in order to cover and apply pressure to my left eye which had become light sensitive following the cardiac problems. I looked like a pirate. Staff would not, or could not, provide an eye patch. Given that I was also sporting a purple plaster on my left arm, the general impression that I was mad was endorsed every day by my appearance. In the end I became so concerned that I looked insane that I covered one lens of an old pair of reading glasses with white tape to block the light, and used the scarves as sparingly as the pain would permit.
Purely physical? Physical problems, that is my pre-existing medical problems, were superseded by the belief that mental problems were more important. The reality of this attitude was that I was not permitted to go to hospital to have my plaster removed, despite the fact that my arm was in spasm. Neither was I allowed to see an opthamologist. More importantly I had to fight to get to a famous London teaching hospital for six hours of heart tests. Initially this was because the staff simply didn’t believe the problems were other than in my head: Staff: “Show us the documentation…” Me:“It’s at home and you won’t let me go there to get it.” Staff:“Get someone to go round and find it…” Me:“Who? My daughter
is away at university and my boyfriend is working all the hours God sends and can hardly get here in time to see me in the evening. And I have been burgled and my place is trashed.” Eventually I was allowed 1.5 hours to go find it. It took one hour to get home and back. I returned jubilant with the necessary documentation but it was 48 hours before anyone would actually read it. This was not due to obdurate behaviour but to the fact that the place was hopelessly understaffed and simply couldn’t spare the time –the whole system is run on an inadequate budget. Neither could they spare any staff to accompany me to a hospital just 15 minutes away to remove the plaster. Unfortunately, there simply wasn’t any next of kin for me to call on to take me. In the end my former Sister in law (I am divorced) trekked up from an hour away to get me there, bless her. She also talked about me to a doctor (not the Consultant, he was ill) saying that I really was not bi-polar, an alcoholic or into drugs (should my Ex have intimated any of the above, and we both suspected that he had, although this was never spelt out.) She explained that he had threatened her, her partner and indeed his children in a series of phone calls from another continent where he now resides with a younger and darker model of me. What she said, combined with other information the same doctor and one of the Nurses in Charge (the Consultant’s Senior House Officer (SHO)) found the time to read, changed my future dramatically. I am also very grateful for the intervention of people involved in various charities I have helped in communications over the last two years. However, my problems didn’t end there and then – hadn’t I appeared distressed? But wasn’t that a normal
reaction to abnormal circumstances, like not being able to spend my daughter’s 21st birthday with her? I could say a whole lot more but more important is to make sure that anyone reading this knows what their rights are so they don’t have to learn the hard way like I did. They are: Medication: it is illegal to force anyone to take a drug they have an allergic reaction to, or, importantly, that is contraindicated for medical reasons (the pharmacist can provide information.) The reality is that it is damn hard not to be persuaded. Staff point out again, and again, that you will not be allowed out if you DON’T take the “meds.” One of the most serious concerns is dosage level. Clearly if you give the same dosage to a five foot nothing woman as to a six foot something man, she is likely to suffer more side effects than he … one woman was told she was suffering from anxiety when she was having a severe reaction to a supposedly therapeutic drug. Mental Health Act (1983): Sections 1, 2 and 3 of the Act are used for people who “are presenting a serious risk to themselves or to others.” (Or to people about whom serious misapprehensions are made.) An individual may appeal against a Section in two ways: a) to the managers of the hospital and/or b) to a Mental Health Review Tribunal. How to get help: Legal aid will fund a solicitor; the hospital will have a list of local solicitors available. The services of an “Independent Advocate” from a charity like Mind are also on offer. This is someone who is not necessarily legally trained but understands the legalities, for example, and who can act as a representative in a weekly review by the Consultant and his team as well as in Hospital Management or Tribunal appeals. Postscript: at the time of writing the author is home and formally discharged from Section 3. She is making a formal complaint about her treatment through the hospital’s Patient Advice & Liaison service. For more information about patient’s rights, contact: www.mentalhealth.org www.rethink.org www.dca.gov.uk/legal-policy/ mental-capacity/publications.htm
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It may have been talked about for some years, but the buzz word in social care is still ‘Personalisation’. What is it, how does it work and do you want it if you can get it? Sanctuary delved into the Personalisation ‘agenda’.
You pays your money, you takes your choice! 20
Arguably, Personalisation has its roots in the disability, mental health survivor and service user movements of the 1970s. For years, people with disabilities have argued for more control in their own lives and affairs. It is something of a conundrum that in today’s age of equality, technology and all kinds of advancements, there are still debates and vast manuals being written around ‘service user involvement’. Don’t we know how to do it, get it right, yet? The documents should surely have been relegated to the back of the shelves by now, because every individual who suffers and survives mental ill health is fully engaged with decisions about her or his treatment, care and support: no not engaged, in control! The reality is that that is not the case across the board, not for each and every individual. It would seem that despite all the written guidance and group debates, service user involvement (for many people the term ‘service user’
is abhorrent for a start) is still work in progress. Within that work though, Personalisation is something tangible and more importantly, do-able. Personalisation is the umbrella term for different ways to ensure social care clients have a direct say in how money allocated to their care is spent. Self directed support (SDS) is the term to describe the process of putting people in control of their lives by helping them access services, facilities and support that helps give them independence and choice. What kind of things can SDS pay for? It might be membership of a gym, someone to help with everyday needs, money to train in something or other practical ways to support day to day living and promote physical and mental wellbeing. More needs to be done to promote Personalisation in mental health services. Community networks provide the answer: the charity Together is tackling this nationally, with local
voluntary organisations, alongside statutory providers, promoting the benefits of SDS in their local communities. Organisations like supported employment agencies (Richmond Fellowship across Surrey and ESRA in East Surrey) and other voluntary organisations such as Let’s Link, publishers of Sanctuary are raising the banner for Personalisation and steering people in the right direction. Knowing what is available is of course crucial to being able to choose what you want to do in your life. It is here that communications, links and networks are being built between health and social services – which hold the budgets - and prospective providers. For instance how can anyone find help to join a drama group if they don’t know it is there? You can find out if you are eligible for SDS by talking to your care coordinator. Find out more about Personalisation at www.scie.org.uk and follow the link under Putting People First.
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The following poem was written by a young woman who had been in hospital following being sectioned under the Mental Health Act. She wrote this, some two months after admission. It shows how she was moving out of the dark and into the light. It is also a dedication to caring and compassionate staff...
Gratitude
Crumbs thrown at a distance, constant lacking and not being fed adequately. Nurture and care missing, presumed dead.
Lying, pulse racing, on a bed that may have been snow-covered down. Calming, restorative and held by handover. Responsibility curtailed, peace but shaking. Time out in a safety microcosm, the conceptual white: out of chaos and into light. Integration of a splintered mind, slowly, softly, grasped and taken, gently brought back from the underbelly of the brain Not a foot wrong, not a syllable misplaced, sledgehammer anaesthetises but cradling of the delicate a feat of undertaking. Sensitivity and cocoa, warmth and laughter, back to the land of the earth; dropped from the sky. Wings and security, angel in the haze of people, beacon flashing amid lost souls and aching brains. Fractures healing, time and time again, brought into the mould and sent into a lighter world. (Julia)
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Š ASPECTS 2010