Monday, June 30, 2003

More on East Loan, the rehabilitation unit.

Contact. If you have something to say about this blog then send a message to BTW Contact is also a charity for people with mental health problems run in Morpeth that meets at the Bridge Street Centre on Tuesdays and Thursdays. Its seems ok even if the average age is way above what I'm used to on the wards.

I've been asked to keep the NHS people completely anonymous. So I will use Magic Roundabout names for some and more apt code names for others.

My key worker Emily, I've anonymised in honour of Emily Pankhurst the suffragette - this is because she has a sticker which says "women who seek equality with men lack ambition". Emily is an experienced mental health nurse who takes a lead role in deciding what happens to me - she looks after my weekly planner deciding what's going to happen during the week, co-ordinates some things does other things that I don't remember or even know about. The things that "happen" on my weekly planner are therapeutic activities (typically handled by a nurse, nursing assistant, occupational therapist (OT) or technical instructor (TI) ). If you're dealing with symptoms then activities are an interesting diversion but they've got a long term aim of helping you when you leave hospital. Other things that end up on my weekly planner are meetings. Meetings with Drs. Meetings with OTs, TIs, clinical psychologists. At the moment me & my clinical psychologist are covering info about hearing voices and are looking into the Hearing Voices Network.

All nurses write things down in confidential files like manic privacy obssessed bloggers - except instead of using 1024 bit encryption they decide that computers aren't secure enough for them and write everything down in pen.

The uber-blogger would have to be my consultant psychiatrist Dr Quatermass. Encounters with her are currently rare because of a car crash and pressing matters but she does seem to know an awful lot about people and probably posseses something like Dungeons and Dragons magic item which makes her so perceptive. She writes things down, determines medication and has another Dr, Dr Strangelove, who keeps an eye on the East Loan unit for her while she is away. Dr Strangelove is amiable and gets on with people ok but people miss Dr Quatermass when she is away.

Catherine (the great) runs East Loan, looking after the manic bloggers, sorry nurses and the nursing assistants, sorting out shifts and generally running the place. She's frequently stuck in manager's meetings and stuff like that.

The nurses run East Loan in three shifts, night shift, morning, and afternoon. Although its a little more complicated than that, this simplified model is sufficient for some one asking for milk and tea bags - critical supplies in the great game of drinking lots of tea. Some staff seem to prefer working on night shifts - pale faced creatures that are seen by me at the beginning of the night, preferrably to tell some dodgy joke that I've picked up from work and never seen again for the next 24 hours.

Morning shift people are rarely seen by some patients Oh BTW terminology warning. Patients aren't called patients anymore they're called clients and they use hospital services. Strange I know especially as most clients spend an inordinate amount of time just waiting for things to happen - appointments, trips to somewhere, for medication to be dispensed - that calling them patience would be really really apt. Except they are called clients. Some clients wake up really early and go for walks or go to East Loan's clubhouse to watch music TV or read the newspaper (Daily Mirror or the Journal). Most clients get up around 10am which is when the first batch of meds (medication) is handed out. People stay in houses listening to music, drift around having conversations, go into No. 1 (the clubhouse) to watch music TV or drink tea/coffee. It can be quite a hectic life, getting up at 10, getting dressed, having breakfast, taking meds and then setting off to No.1 to read the paper to see how the Normals are trashing the planet. If clients ruled the world, nobody would get out of bed before 10am and everyone would watch music TV drinking tea or coffee. No work would get done but then neither would crime, wars or political parties so there's something to be said for such a system.

Lunch is at 12 mid day. When you go to East Loan you're typically on hospital food so you don't have to think about things like logistics or cooking. Eventually you get moved onto a system called self catering where initially for a couple of days you do your own cooking then eventually you have to do your own cooking 7 days a week. You get 3 pounds a day spending money for food so you have to budget carefully. Typically this involves shopping at Lidl's (cheap food supermarket) as well as Safeway (expensive food supermarket). The hospital menu is repeated every two weeks so the food can become pretty boring after three months. But if you're busy thinking about other things then hospital food is great because you just eat when you are told and you've got one less thing to think about in life. Useful if you're going through a psychotic episode and you think people are transmitting messages into your mind with high tech equipment and that people are out to get you. Incidentally, I have been kidnapped by little green men. During my 2nd psychotic episode - in 2001 - I was taken to a "place of safety" (the hospital) by paramedics who just happened to be dressed in green overalls. The afternoon shift tend to do various things like go on trips, take people shopping etc. So it seems to be a more active shift than the others. It knocks off about 8:40.

"Meds" are served in stages. There are different stages, starting off with people giving you medication at the appropriate times. My meds kept on being changed so this turned into a bit of a lottery with people forgetting that I had to take medication at 2pm (hardly anyone takes meds at 2pm).Ultimately you are given the responsibility of looking after your own meds. They have these little packs called "dosettes" which contain enough medication for a week. Each dosette has 7 little daily "fingers" which can easily be slipped into a pocket. The finger has compartments for meds at breakfast, lunch, dinner and bedtime. If the patient wants to check if they've taken their medication then all they have to do is look at their dosette finger. To reduce the risk of confusion, each dosette finger is labelled with a day name. The system works and is simple.

Oh, and lets not forget the nurses blogging ritual of the handover. Three times a day (I think) they Can Not Be Disturbed as they gossip wildly on the clients activities and scribble endless notes down in confidential files. No, they discuss the shifts events, pass over relevant information to the following shift and generally debrief. The handovers occur at regular times in the day which I can never remember.

In general clients lead a docile, stress free life. Which if you're suffering from schizophrenia is an ideal thing because you can tackle delusions much more easily if you're not having to struggle to deal with day to day activities. The disease has ironically named positive symptoms which include hallucinations (typically auditory) although for ages I was walking around the place incensed saying "I do not hear voices! They're hypnotically induced messages!" but that was a long time ago on the acute wards and delusions which are the thing that really tripped me up. The brain is a fairly fault tolerant device (Dr Strangelove doesn't like my idea of the brain as an artificial intelligence implementation - "the brain is not a computer" etc well if the brain is not a computer, how come I'm running Windows 3.0?). So far my delusions have included hypnosis, sex, mind control, kidnapping, gender dysphoria and conspiracies. If its alright by you I don't think I'll go into the details because it would shock some acquaintances of mine who weren't conspiring against me but I thought they were. In fact I had memories of it and flashbacks and hypnotically induced messages from them about it. You've probably figured now that a psychotic episode is a very troubled, occasionally dangerous part of life that most people don't want to experience again. Well if I'm truthful, dealing with life in the community after a psychotic episode is just as bad as a psychotic episode for me because you've got a chance to see just how far down the ladder of life you have fallen and its a long way up. There are more +ve symptoms but I'll not go into them. They're the kinds of things that Emily or Fuchsia have noticed, here are my early warning symptoms of relapse I'm sullen/withdrawn, abrupt, make inappropriate comments to other people, don't show consideration to other people's feelings, poor concentration, isolate myself quite a bit, sleep pattern changes, paranoid/suspicious of other people, looking at inappropriate job applications (usually in other parts of the country).

The stress vulnerability model is used quite a bit. Thats a theory that says that you can become unwell when stress reaches a certain level. That level is reached sooner for people with a mental health problem. The rehab process involves getting used to increased stress levels (caused by normal life events like taking a bus or moving house or by illness events like hearing voices, having visions) by applying "coping strategies" at the right time. Coping strategies vary but some are "grounding self in present" - looking around and telling yourself where you really are and what's really going on around you, trying to ignore panic symptoms or hallucinations, "distraction" - looking out of a window, holding an ice cube tightly, pinging an elastic band against your wrist, "watch TV or listen to a radio" or "use medication". There are other coping strategies as well.

Occupational Therapy on East Loan involved many things but they initially corresponded to travel (on buses & trains), cooking/shopping and talking. Other activities were moving house (packing/unpacking), orientation to a new area, exploring employment options and easing back into employment. We also looked at higher/further education courses but I'm not sure if my memory is up to that yet and developing leisure interests - typically art & crafts related things which I didn't neccessarily jump up & down with joy at. Why are all OTs obsessed with arts & crafts? We'll never know. Fuchsia & I did other things as well like going on the bus to the Baltic art gallery, going to the cinema to see Lord of the Rings, going to Newbiggin Beach to have an ice cream, getting used to Newcastle and eating ice cream in Mark Toni's parlour. When I moved house, Fuchsia & Emily both helped with the practical aspects of the move, doing things like putting up curtains (hammering,sweing and screwing things into place). I'll miss them both when I leave.

The care given to a patient is governed by a "care plan". In the past I've been invited to review care plans to see if I agree with them. I asked Emily what a care plan is and this is what she said "A care plan is an agreement between a named nurse & a client/patient and its about what a client wants to achieve, who is going to be involved in helping the client achieve their goals with detail of how the goals are going to be acheived. It may/may not have a time limit on it and it should be written in language that everybody can understand"

Well, thats enough information for now, I'll try and dig up some info on what my experiences on the acute ward was like.

Friday, June 27, 2003

Well this is it. Me a blogger. We all have labels to add to our names, one of mine is schizophrenic (see NHS Direct for more details and see Google News for recent events concerning schizophrenia). Mental health is a bit of a taboo area even in these so called enlightened days.

I've been stable for 24 hours now. Not as good a record as BSD but then even Windows 3.0 is a paragon of stability compared to me. How can I describe my world to you?

The hospital is a huge sprawling site of various types of building ranging from Victorian to modern portacabin. There's grass and plants all over the place. There's a horseshoe shaped road that runs up one bank, past the acute wards, past Lindisfarne wards, past the Kiff Kaff, past Cheviot, Hadrian and some other ward, curves around past Brinkburn (Dr's offices) meanders past the Occupational Therapy sewing rooms, past the Border Fayre restaurant & hospital kitchens then it curves around again past the main hospital building a Victorian edifice that is impressive and a labyrinth of corridors, offices and strange rooms. Then it goes past the main entrance and the pharmacy past the now abandoned church a couple of other abandoned buildings, past East Loan (a row of terrace houses and a 2 semi-detached houses - home for me for a couple of months) and then it curves down a horribly steep bank into Morpeth.

Then there's Bedlington. Where I do therapeutic work every week, answering phones for a friend of mine in his shop. Bedlington isn't Berwick Upon Tweed and that's one of my problems. Actually Berwick Upon Tweed is one of my problems too in a wrist slashing sort of way. But don't let that freak you out, apparently tons of schizophrenics attempt suicide (40-50%) and 10-13% of us succeed. That's not very nice. I've already been to one funeral - don't know if it was suicide or not but it was death by exposure which I've no idea about - don't know if it is painful although the verdict was misadventure. Actually I'm the worst person in the world for suicide. I don't want my stomach pumped, I don't want blood on the carpet, I mean who cares? Well a number of NHS people do and my family do but when you're feeling suicidal the last thing on earth you're thinking about is the consequences for other people. Sometimes I wish I could press ALT+F4 and move on to a higher plane of existence. Its the voices that make me do suicidal things. When you let on that kind of thing is happening you are offered additional medication (referred to as PRN medicines) to be taken at strategic moments. It (lorazepam,promazine) relaxes me, gets me thinking much slower if at all and disrupts the "kill yourself kill yourself" voices.

The NHS people in my life deserve anonymity because I'm not exactly the best judge of their actions and they do their best with a sometimes awkward person like me. Maybe just using their first names would be good enough. I'll ask Fuchsia (my technical instructor) for advice. OTOH, the NHS people in my life deserve recognition because they've saved my life on numerous occasions by persuading me that my life is worth living.

My family deserve anonymity as well. My sister Elizabeth helps me a lot and I'm really grateful for her help. I occasionally see my Dad and its quite a trek for him to come and see me.

My meds (medication) deserve a mention. There's amisulpride which is one of the newer atypical antipsychotics. It keeps me sane some of the time. And it gives me muscle pains in my back. Other times I get, *ahem*, shall we say unconventional ideas about the government and police and conspiracies. There's reboxetine which is an anti-depressant. There's senna which is meant to cure constipation also caused by my amisulpride but I've been having more luck with my liquorice (77p from the Co-Op, quite a slice of self catering money but worth it).

Well, thats it. Welcome to my world. I'll detail the NHS people in a future post, when I've got Fuchsia to say that first names are anonymous enough. They do deserve recognition so I hope I can do my bit in that respect.