A Big Moan on Behalf of Lots of People

A friend of mine has recently been admitted to an NHS mental health unit. I went to see her yesterday. For someone who's not a healthcare professional I'm fairly clued up on good ways of addressing mental health problems. I think a healthy diet, gentle exercise, plenty of activities, regular counselling, advice about potential medication and a peaceful environment are the most obvious things that should be offered. My friend has so far seen none of these.

She described the food as "minging" but was told I couldn't bring fresh fruit in for her because "I might have injected it with alcohol" - the irony being that I did have alcohol in my bag when I went in and no-one even checked. At breakfast she was told she could have either butter or jam on her toast, but not both (while ketchup and mayonnaise are not rationed so it's not even a health or budget thing). She said very little food was provided and for instance she was required to choose between dessert and a piece of fruit and ended up having to choose the dessert because it was more filling. Vending machines with crisps and snacks are next to the place where food is served.

The only place to exercise is a tiny courtyard. There is a small gym clearly visible next to reception but no-one recalled anyone being allowed to use it and some people thought it might be for staff, not patients. She does not feel safe going out into the courtyard alone as she has already seen fights and staff do not maintain watch.

No activities offered except that she was told there would be karaoke at some future date (what about art, yoga, meditation, exercise?). She was told on admittance there was a DVD room but when she asked to use it they said there wasn't one (and then it emerged there was, and eventually they let her use it). There is one TV for around 80 patients and because most of the bigger, more aggressive patients are guys, the football is always on which she has no interest in but has been watching out of boredom.

No counselling. Nor any mention of when any would be provided.

One doctor's consultation during which she was asked to give a blood sample and asked if the TV talks to her and if she hears voices and basically nothing else.

The general environment ... where to start? Within ten minutes of arriving a man was stood with his face ten inches from mine shouting "There's mad people in here, I'm Adam, I'm Saddam, you wanna be careful you could meet a mad person in here, we're all mad". The same guy grabbed my hand and creepily kissed it, and stroked another visitors back uninvitedly. My friend is quite glamorous usually but had asked friends to bring in frumpy, longer clothing and stopped washing her hair and wearing make-up in a vain attempt to deter the other patients from a providing a constant barrage of sexual remarks and harassment. When an elderly female relative came to visit her, other patients wolf-whistled at her. Yes - at the elderly relative. Most of the abuse was sex-related although my friend said some patients were also on the receiving end of aggressive racial abuse. Staff did nothing to stop the abuse.

How exactly does anyone think this is helping? I'm not blaming staff, I'm sure they are overworked and ultimately willing to do the best thing. But surely we have to distinguish between patients likely to frighten and intimidate others and patients needing a peaceful supportive environment. Screaming sexual abuse at mental health patients just doesn't seem like it's going to solve anything.

The Truth About Antenatal Classes

Re-posted from The F-Word where I am currently guest-blogging.

A report out from Sweden says that attending classes teaching breathing techniques and relaxation methods has exactly no effect on your likelihood of needing an epidural. And no impact on your likelihood of needing a C-Section. And no impact on your overall satisfaction with the birth.

Now that's not to say that there aren't some worthwhile things to be taught to expecting parents. To get the low-down I spoke to my sister (Lynda) who had a baby almost a year ago and attended both NHS and NCT (National Childbirth Trust) classes before the birth. She said neither even mentioned breathing techniques or relaxation as discussed in the Swedish report. But she did have some good points about several aspects of them. Here is what she had to say:

1) NHS classes: free but a total waste of time. Around 40 individuals and couples in a theatre-style auditorium. During question and answer sessions she couldn't really hear what other participants were saying and they ran out of handouts. Pain relief methods were discussed briefly as more or less a list of options.

2) NCT classes: £140 for 2 days and one evening, much more useful. Eight individuals and couples with practical opportunities to try things, etc. The most useful thing was the focus on the emotions around birth and new babies, for instance talking about how the mother's partner might feel coming home to find the house a mess and the mother exhausted and desperate to hand the baby over. Provided lots of useful advice for the birth itself - such as bringing along glucose sweets for energy and a kneeling cushion if you wanted to try a kneeling position. Probably much of this is available in books on maternity but also in this class friends were made and a support network accumulated.

As far as pain relief was concerned she was expecting there to be real pressure on women to reject pain relief. In the event there was a run-through of different options with participants asked to make a list of the pros and cons of each type. This might sound even-handed but in fact the "cons" is a long list of unlikely medical complications while the "pros" is one single item "reduces pain" which applies in most cases. Drawing the list like this gives the impression that one pro equals one con when in reality cons like "baby may be sleepy for first hour after birth" may well be pretty trivial against the pain thing.

Worryingly they were told that using the pain-reliever pethidine gives your child a greater risk of becoming a drug addict later in life. Both Lynda and I doubt this statement - though there may be a correlation between hospitals in underprivileged areas who dish out pethidine when they don't really have enough midwives around to cope with all the women in labour and the hospitals where kids turn up eighteen years later with a drug problem. In any case the information is nothing more than a scare tactic unless it says how much the risk increases and where the data is from.

3) Pain. No class can prepare you for the pain. To quote Lynda directly "The only way they could explain to you in a class what the pain is like is if they made you stand barefoot on upturned drawing pins while they loaded you with heavy sandbag after heavy sandbag to weight you down and the only way to make it stop was to shout 'EPIDURAL'!". ...and I am supposed to be the comedienne in the family!

4) Reality. The one thing no class really told despite asking repeatedly at the NHS one was what the most likely outcome was - what percentage of women manage without pain relief, etc and what percentage of pain relief interventions lead to problems, and what type of problems. In the end of five women Lynda is still in touch with, including herself, there were two without epidural and three with epidural. In all three of the latter cases there were complications associated with the epidural (one didn't work - the pain continued, one the needle kept coming out and having to be refitted and one woman was left on crutches for several months with a small baby to look after!). Of course without access to the relevant data we just can't know how much of that is to be expected from an epidural and how much is down to bad luck or overworked staff, etc.

5) Birth plans. Apparently the NCT went on and on about how important it was for women to write a "birth plan" to take with them to hospital. Now it's understandable that women would want to have a document in hand to tell nurses what they want in different scenarios, to avoid having procedures they didn't want forced upon them when they are in too much pain to discuss things. However of those in the group who made a "birth plan" (Lynda refused despite repeated demands by class instructors) 100% ended up not sticking to it and then feeling they had somehow "failed" to have the birth they wanted. In any case who would write a birth plan that says "experience extreme pain, demand an epidural, discover it's too late, baby's heart rate slows, rushed in for emergency cesarean". Everyone writes "no pain relief, baby slips out in 2 minutes, I look stunning", and then nobody lives up to it. So sure take in some notes about particular things you're worried about seems to be good advice, but stay open minded about what happens - don't make too many plans!

6) What they don't mention. There were a few things that didn't seem to get mentioned. Particularly some of the graphic details. Like for instance "you will definitely sh!t yourself at some point". Not to freak women out but so that when it happens they know not to be surprised or embarrassed. Maybe just reading out a few accounts from women who have had babies recently would help.

So in conclusion, there seem to be some real positives from a supportive class covering what to expect throughout maternity, birth and the first year or so of a child's life, although clearly such classes should be available freely (although the NCT does offer discounted classes if mothers have financial difficulties). Information on pain relief doesn't seem to be getting through so well. What is needed in this area is accurate information about all the options and how likely the various outcomes are both nationally and by hospital and clinic so that women can make a considered choice. What is not needed is a load of piffle about trying to relax while you're in excruciating pain.

Footnote: The moment I put this up someone messaged me on Facebook to say they read it. This friend of mine said she had a planned cesarean because of problems identified earlier in the pregnancy. When they told her this she felt ... relieved. What a shame that a woman can't just decide she wants a planned cesarean and discuss that with her antenatal teacher. What's so bad about not wanting to go through a lot of pain? Give women all the information and let them choose what they want for themselves.

(By the way there is a response to this post by another feminist here).

Dying For Attention

I've just seen this post over at a My Private Casbah, about a woman left to die on the floor of a psychiatric hospital and Bint Alshamsa, the blog author's, own experiences in similar circumstances. It's just horrible to see the medical staff and the others in the waiting room sitting around doing nothing while this women evidently is suffering horribly.

I'm glad to say the one time I was in a similar situation I didn't do nothing, or at least not in the end. Around 1998 or 1999 I broke a finger playing basketball and went to Guy's Hospital emergency room to get it x-rayed and treated. When I got there I was sent to the waiting room and asked to fill out a questionnaire by the triage nurse who was sitting in a little booth off the waiting room. While I was doing that the only other patient in the waiting room, a small, very thin blonde woman of about 30 was sat in the corner curled up on the floor twitching slightly. Two nurses were watching and I assumed they had the situation under control. After a while the twitching got worse and the woman was rocking so much she was banging her head repeatedly on the floor. Her face was streaming with snot and tears. The nurses were just watching. I figured they must know best. I'm sure I've read somewhere about how you shouldn't restrain someone having a fit, but I was wondering whether moving metal chairs away from them and putting a cushion under her head would have been a bad move. She was looking at me imploringly and I gave her a tissue to dry her face and kept looking at the nurses who weren't even watching.

Then another nurse came in and called my name to go through to see the doctor. Then I did say something. I said I really think you should see this woman first. My broken finger can wait, this woman is really suffering. They told me she hadn't filled her form in and I think as they said it they realised how totally ridiculous they sounded and then they had a quick conference and ushered the twitching woman through to the doctor.

Of course in retrospect I am horrified with myself for sitting there for the first twenty minutes filling in the form rather than screaming at the nurses to help this woman. It's so easy to see someone in an "official" uniform and assume that whatever they are doing is the right thing. Years later I read Stanley Milgram's Obedience to Authority - an amazing book that everyone should read (link in my Amazon favourites box, right) - in which he convinces members of the public to administer lethal electrical shocks to others (actually actors, not being shocked) because a scientist in a lab coat has told them to.

And then only the other week we had the spectacle of several hundred people watching comedian Johnny Vegas sexually assault a woman from the audience. Why didn't anybody get up and shout "Oi! What the hell are you doing?" - because they had accepted the authority of the guy onstage with the mic.

So I guess my point is - if you see something that isn't right happening, say something. And my other point is - we need better attention paid to the services we provide for those patients least able to stand up for themselves - the elderly, those with mental health problems and those too incapacitated to communicate effectively.

Parental Rights and Wrongs

There is yet another push afoot to force contraception and abortion providers to tell girl's parents if such services are being requested. Tory MP Angela Watkinson says parents have a "right to know".

Well I agree, parents do have a right to know. If they wish to exercise that right they need only raise their children in a loving supportive environment where they make it clear that they are there to help, not to judge. Do that and your kids will tell you what's going on in their lives. When kids don't want to talk to their parents, there's a problem. Usually fear. To be honest if kids are getting pregnant while they're still at school, that's one sign that the parents haven't done the best job to start with.

If such a law were passed it would lead to:

1) More runaways, pregnant teenage runaways sleeping on the streets getting ill, getting raped and murdered, getting co-erced into prostitution and drugs, babies born hooked on drugs, infanticide.

2) More domestic violence and child abuse when abusive parents find out about their childrens sex lives.

3) More late term abortions - because why tell your parents you're having an abortion at 8 weeks when you can wait til 14 weeks, just after your 16th birthday, and have one secretly then?

4) More teenage pregnancy - because girls dont' want their parents to know they're taking contraception.

5) Even more teenage pregnancy - when parents find out and confiscate contraceptives.

6) More STDs - because teenagers don't want their parents to know they asked for free condoms.

7) Less education on the subject - because teenagers who feel unable to ask their parents for sexual advice will be afraid to visit clinics for advice in case their parents find out.

But of course Angela Watkinson han't thought about this. She's such an expert on the subject that she even added "The first thing [parents] learn may be when their children are reported to have some form of sexually transmitted disease", which would only make sense if everyone who requested contraception or abortion ended up with an STD. Clearly at least those requesting free condoms are less likely to get an STD, and it's perfectly possible to catch an STD without getting pregnant or using contraception.

But finally the whole thing is of course about knowing when GIRLS are having sex. No-one wants to talk to the parents of the boys who are getting teenagers pregnant, and no-one wants to talk to teenage boys whose girlfriends might be using contraception, nor indeed who might themselves be asking for free condoms. Because of course sex is only shocking and awful when women do it...

Deeply Creepy

The government was half way through doing something about the wildly unregulated cosmetic "treatment" industry. Something much needed as the rates of people lining up for a quick shot of deadly botulism in the head. And now they've dropped the baton, can't be bothered, too much like hard work. They prefer to leave the industry to "self-regulation", which means no regulation at all, just let the cowboys carry on.

They say they're trying to avoid leaving medical professionals with too much "red tape" to get through, but reputable clinics are furious with the news, they want the chalatans who steal their potential customers and lead to media horror stories closed down.

So there must be some other reason for the issue being dropped. What could it be. Hmm, hmmm, still thinking ... how about backhanders, bribery and corruption? Just a theory.

Unbelievable...

A Muslim professor has said that the NHS should start offering faith-based medical services! He's suggesting that the NHS should record your religion when you register with a doctor and then refer to Muslim leaders to decide what drugs can and can't be administered to people. Of course as a patient on the NHs every individual already has the right to ask about any drugs they are offered and request, for instance, a female doctor. This of course isn't good enough for power-crazed religious leaders. No - they need to have some sort of legal control over individuals.

Now remember these religions teach that man is given free will by God and must then choose his/her own path. So there should be no need to bully people in this way.

Furthermore within these religious groups many people have different ways of practicing their faith. So you would essentially have to register the exact denomination and how seriously they were practicing it - which could vary over time.

But finally I had a thought that perhaps religious people should be registered as such with the NHS. Wouldn't it make sense to prioritise treatment for atheists - who don't believe in life after death?