Aug 5, 2014
Is the risk of suicide by patients putting doctors off choosing psychiatry?
Is one of the reason young doctors might be put off choosing psychiatry as a career the thorny issue of suicide? Are psychiatrists automatically blamed too much when a suicide occurs? Why is it Cardiologists can lose a patient from a heart attack, and no immediate investigation into their clinical practice results, whereas when a suicide occurs, which might be the psychiatric equivalent of a heart attack, the doctors in this case are often blamed? Do we as a society have a strange view of suicide and psychiatrists bear the brunt of this?
A recent article which was originally published in The Huffington Post and which may be of interest:
How NHS Mental Health Care was failing, as patient Nicola Edgington killed again
Dr Raj Persaud and Dr David James
The media coverage over the savage killing of Sally Hodkin by psychiatric patient Nicola Edgington has, yet again, failed to uncover the real collapse in NHS mental health services.
Edgington walked out of hospital in the early hours of October 10th, where she had gone seeking help, apparently explaining that she was hearing voices. Later that day she slit the throat of Sally Hodkin with a meat cleaver and nearly decapitated her, after earlier pinning Kerry Clark down with a knife.
Oddly enough, because cases such as these grab headlines - which is understandable given the scale of the tragedy - the suffering of those who are not a danger to others, gets ignored. But in neglecting the mental health care of the vast majority, the conditions are created where rare fatalities become more likely.
A recent report and survey by MIND the mental health charity found four in ten mental health trusts have staffing levels well below established benchmarks and only a third (33%) of respondents who came into contact with NHS services when in crisis were assessed within four hours, as recommended by the National Institute for Health and Clinical Excellence (NICE) . Only 14% of people said that, overall, they felt they had all the support they needed when in crisis
Because the media only become interested in mental health care when fatalities grab the headlines, this drives Government policy. As a result of over-emphasising the link between mental illness and dangerousness, there is a concentration on treating a small number of offenders in secure hospitals. This costs £1 billion per year - 15% of the total NHS investment in the mental health of working-age adults.
The number of NHS psychiatric beds has gone down by 60% in the last two decades, while the number of involuntary admissions has gone up by 60%. In other words, it is increasingly difficult to gain access to psychiatric care when acutely unwell.
There is hushed talk in the corridors of NHS power that certain psychiatric hospitals in our inner cities will shortly become 'sectioned only' institutions - in other words soon no one in them will be voluntary.
Psychiatrists Patrick Keown, Scott Weich, Kamaldeep Bhui and Jan Scott found in a study entitled 'Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study' that any reduction in NHS psychiatric bed numbers was strongly correlated with a parallel increase in involuntary or 'sectioned' patients the following year.
The terrible irony at the heart of the Nicola Edgington case is that she was in fact a voluntary patient - she apparently wanted to be admitted. This may explain why she found it so easy to walk out of the unit during the admission process.
As psychiatrists with experience of this kind of case in the NHS we believe the opportunity to treat someone early in their illness is no longer there, and they have to become a risk to themselves or someone else, before they can now get a psychiatric bed.
As psychiatrists used to dealing with similar patients, we wonder if Nicola Edgington had had the same symptoms, but if their digitised records were not that she had previously killed her mother - even if she was equivalently dangerous and with the same psychotic symptoms - we wonder if the system would have the capacity to admit her. The lack of NHS mental health care provision means it's often impossible to get proper attention if you are merely suffering - but not an immediate danger to anyone.
The search for psychiatric beds, in our experience of trying to admit patients in London, may extend across the whole of the South East of England. Even when a bed is eventually located - because someone will have to be discharged (or sent on emergency leave) in order to liberate that bed - usually you are merely bringing someone in who is a danger to themselves or others and sending someone else out who has only marginally recovered from that self-same predicament.
Community Psychiatrist Professor Peter Tyer from Imperial College London, quoted data in an article in the British Medical Journal in 2011, that the suicide rate in the first 28 days after discharge from psychiatric hospitals is over 200 times greater for men and over 100 times greater for women than that for the general population. Suicide rates are meant to be declining in the general population but the rate after discharge from a psychiatric unit still remains too high. Precipitate discharging from NHS units probably contributes to this, Professor Tyer argues.
Doctors are also marginalised in care of patients - occupational therapists, nurses, social workers - there are any number of different 'case workers' you will be allocated to in your hazardous expedition into NHS mental health care, but encountering someone who went to medical school gaining scientific expertise in psychological problems, is becoming impossible.
The media seems to believe that doctors hold all the power in the NHS, and therefore hunt for a physician to blame when tragedies such as the Edgington case hit the headlines.
A large team of psychiatrists recently wrote an article entitled 'Wake-up call for British psychiatry' in the British Journal of Psychiatry, where they referred to the 'downgrading of medical aspects of care' in the NHS.
We believe they are agreeing with us; even if you are becoming severely unwell, you get at best in the modern NHS what is referred to as 'non-specific' psychological support (ie tea and sympathy) rather than proper medical care.
Doctors have not been in charge of NHS psychiatric care for some time now. Bureaucrats and managers, who never seem to be in the firing line despite scandal after scandal in NHS care, need to be held more accountable.
Because in terms of the poor management we witness, the lunatics have taken over the asylum.
How NHS Mental Health Care was failing, as patient Nicola Edgington killed again
Dr Raj Persaud and Dr David James
The media coverage over the savage killing of Sally Hodkin by psychiatric patient Nicola Edgington has, yet again, failed to uncover the real collapse in NHS mental health services.
Edgington walked out of hospital in the early hours of October 10th, where she had gone seeking help, apparently explaining that she was hearing voices. Later that day she slit the throat of Sally Hodkin with a meat cleaver and nearly decapitated her, after earlier pinning Kerry Clark down with a knife.
Oddly enough, because cases such as these grab headlines - which is understandable given the scale of the tragedy - the suffering of those who are not a danger to others, gets ignored. But in neglecting the mental health care of the vast majority, the conditions are created where rare fatalities become more likely.
A recent report and survey by MIND the mental health charity found four in ten mental health trusts have staffing levels well below established benchmarks and only a third (33%) of respondents who came into contact with NHS services when in crisis were assessed within four hours, as recommended by the National Institute for Health and Clinical Excellence (NICE) . Only 14% of people said that, overall, they felt they had all the support they needed when in crisis
Because the media only become interested in mental health care when fatalities grab the headlines, this drives Government policy. As a result of over-emphasising the link between mental illness and dangerousness, there is a concentration on treating a small number of offenders in secure hospitals. This costs £1 billion per year - 15% of the total NHS investment in the mental health of working-age adults.
The number of NHS psychiatric beds has gone down by 60% in the last two decades, while the number of involuntary admissions has gone up by 60%. In other words, it is increasingly difficult to gain access to psychiatric care when acutely unwell.
There is hushed talk in the corridors of NHS power that certain psychiatric hospitals in our inner cities will shortly become 'sectioned only' institutions - in other words soon no one in them will be voluntary.
Psychiatrists Patrick Keown, Scott Weich, Kamaldeep Bhui and Jan Scott found in a study entitled 'Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study' that any reduction in NHS psychiatric bed numbers was strongly correlated with a parallel increase in involuntary or 'sectioned' patients the following year.
The terrible irony at the heart of the Nicola Edgington case is that she was in fact a voluntary patient - she apparently wanted to be admitted. This may explain why she found it so easy to walk out of the unit during the admission process.
As psychiatrists with experience of this kind of case in the NHS we believe the opportunity to treat someone early in their illness is no longer there, and they have to become a risk to themselves or someone else, before they can now get a psychiatric bed.
As psychiatrists used to dealing with similar patients, we wonder if Nicola Edgington had had the same symptoms, but if their digitised records were not that she had previously killed her mother - even if she was equivalently dangerous and with the same psychotic symptoms - we wonder if the system would have the capacity to admit her. The lack of NHS mental health care provision means it's often impossible to get proper attention if you are merely suffering - but not an immediate danger to anyone.
The search for psychiatric beds, in our experience of trying to admit patients in London, may extend across the whole of the South East of England. Even when a bed is eventually located - because someone will have to be discharged (or sent on emergency leave) in order to liberate that bed - usually you are merely bringing someone in who is a danger to themselves or others and sending someone else out who has only marginally recovered from that self-same predicament.
Community Psychiatrist Professor Peter Tyer from Imperial College London, quoted data in an article in the British Medical Journal in 2011, that the suicide rate in the first 28 days after discharge from psychiatric hospitals is over 200 times greater for men and over 100 times greater for women than that for the general population. Suicide rates are meant to be declining in the general population but the rate after discharge from a psychiatric unit still remains too high. Precipitate discharging from NHS units probably contributes to this, Professor Tyer argues.
Doctors are also marginalised in care of patients - occupational therapists, nurses, social workers - there are any number of different 'case workers' you will be allocated to in your hazardous expedition into NHS mental health care, but encountering someone who went to medical school gaining scientific expertise in psychological problems, is becoming impossible.
The media seems to believe that doctors hold all the power in the NHS, and therefore hunt for a physician to blame when tragedies such as the Edgington case hit the headlines.
A large team of psychiatrists recently wrote an article entitled 'Wake-up call for British psychiatry' in the British Journal of Psychiatry, where they referred to the 'downgrading of medical aspects of care' in the NHS.
We believe they are agreeing with us; even if you are becoming severely unwell, you get at best in the modern NHS what is referred to as 'non-specific' psychological support (ie tea and sympathy) rather than proper medical care.
Doctors have not been in charge of NHS psychiatric care for some time now. Bureaucrats and managers, who never seem to be in the firing line despite scandal after scandal in NHS care, need to be held more accountable.
Because in terms of the poor management we witness, the lunatics have taken over the asylum.
END
http://www.amazon.co.uk/Mind-Users-Guide-Raj-Persaud/dp/0593056353/ref=sr_1_1?ie=UTF8&qid=1416470825&sr=8-1&keywords=raj+persaud
http://www.amazon.co.uk/Staying-Sane-Make-Your-Mind/dp/1900512041/ref=sr_1_2?ie=UTF8&qid=1416470825&sr=8-2&keywords=raj+persaud
http://www.amazon.co.uk/Simply-Irresistible-Psychology-Seduction-Perfect/dp/0553817779/ref=sr_1_3?ie=UTF8&qid=1416470825&sr=8-3&keywords=raj+persaud
http://www.amazon.co.uk/Motivated-Mind-Raj-Persaud/dp/0553813455/ref=sr_1_4?ie=UTF8&qid=1416470825&sr=8-4&keywords=raj+persaud
http://www.amazon.co.uk/Edge-Couch-Raj-Persaud/dp/0857501674/ref=sr_1_5?ie=UTF8&qid=1416470825&sr=8-5&keywords=raj+persaud
A biog of Raj Persaud follows below which may be of interest and a web link to his kindle blog and his huff post column.
http://www.amazon.co.uk/Dr-
http://www.huffingtonpost.co.
http://www.youtube.com/watch?
http://www.youtube.com/watch?
Dr Raj Persaud Biography
Dr Raj Persaud is a Consultant Psychiatrist who has worked as a
Consultant at the Bethlem Royal and Maudsley NHS Hospitals in
London
from 1994-2008, and as an Honorary Senior Lecturer at the Institute
of
Psychiatry, University of London. These are the premiere research
and
training institutions for Psychiatry in Europe.
He was also Research Fellow at Johns Hopkins Hospital in the
USA
and Institute of Neurology at Queens Square. His training in
psychiatry
since leaving UCH medical school in1986 was entirely at the
Institute of Psychiatry and the Bethlem Royal and Maudsley
Hospitals.
Unusually for a psychiatrist, he also holds a degree in
psychology,
obtained with First Class Honours, and 8 other degrees and
diplomas
including a Masters in Statistics. He was awarded the Royal
College
of Psychiatrists’ Research Prize and Medal as well as The
Maudsley
Hospital's own Denis Hill Prize, and The Osler Medal. The
Royal
College of Psychiatrists' recently also awarded him the Morris
Markowe
Prize.
In 2004 he was appointed Visiting Professor for Public
Understanding
of Psychiatry at Gresham College, and he was asked by the Royal
College of Psychiatrists to edit its first book aimed at educating
the
public on psychology and psychiatry. 'The Mind: A Users
Guide’ was
published in 2007 and reached the top ten best-seller list. All of
his 5
previous books have been top ten best-sellers.
His writing is in several established textbooks, including the
Oxford
Companion to the Mind and he has contributed a chapter in the
latest
comprehensive textbook of psychiatry for trainees: Psychiatry –
An
Evidence Based Text. He has approaching 100 publications in
Journals
such as The British Journal of Psychiatry, British Medical Journal
and
The Lancet.
Recently he was elected Fellow of University College London and
the
Royal College of Psychiatrists. He is patron or supporter of
numerous
mental health charities including OCD-UK, The Manic Depression
Fellowship, Association of Post-Natal Illness, Childline,
Action
Aid and The Samaritans.
The Independent on Sunday Newspaper conducted a
poll amongst members of the Royal College of Psychiatrists and
the
Institute of Psychiatry to discover who were the top ten
psychiatrists
in the UK as rated by fellow psychiatrists. Dr Raj Persaud was
the
youngest doctor to make it into this esteemed list. The Times
Newspaper
also recently placed him as one of the Top Twenty
Mental Health Gurus in the world.
Raj Persaud is now joint podcast editor for the Royal College of Psychiatrists and also now has a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world. Download it free from these links
https://play.google.com/store/
https://itunes.apple.com/us/