Well was it in Easy Rider, or in "The Shining" (who will forget his cry of Here's Johnny)? I think for many people his most exciting or indeed mercurial performance was in the movie adaption of "One flew over the Cuckoo's nest". He plays the part of one Randle McMurphy sent to an institution for evaluation. The rest is well known and I won't repeat it here. Suffice to say the adaption of Ken Keseys book (also a top read) won many plaudits and awards.
Its influence has been vast and for many that depiction of 1950's institutional care has become synonymous with mental health care "full stop". I was once interviewed for a place on a Masters Degree in mental health and the first question to me (as a nurse in particular) was "Why do you think Nurse Rachet behaved as she did"?
I watched the film (and enjoyed it) and I guess filtered it through a nurses values and culture. I saw clear brutality of a subtle and insiduous nature on behalf of Nurse Rachet. and also the actions of the male orderlies (am I right in remembering one using a cosh?), were really grim. They seemed to be not only institutionalised but also willing to engage in pretty forceful and dehumanising actions.
The patients themselves, well again pure drama and a good drama to, but a more sensationalist collection of stereotypes you couldn't hope to find. Does it have merits though? I guess it does, its pretty realistic in some senses, Its critique of psycho-surgery to ameliorate difficult behaviour is pretty accurate and the numbing routine of a neat and tidy ward is captured well. Perhaps this was because it was filmed in an actual hospital location.
There's much to commend the film as drama, my problem comes when its the main point of reference for peoples understanding of mental health services today.
Don't get me started on the infamous "Titicut follies" whatever you do. Well perhaps another time!
Thursday 23 February 2012
Friday 17 February 2012
Form an orderly queue
I was intrigued to see a book review recently that referred to the author (British) as an "orderly" in a mental health secure unit. It is an account of his time in a service in the 1980's and is apparently a cracking read. My curiosity was aroused so I read the review a little closer to see who he was. As I read further I found he is also referred to as someone who had been "nursing" and doing so in his capacity as a "nursing assistant"! So now this poor fellow has had three tiltles foisted upon him and quite possibly only one he would have chosen for himself.
I guess its pretty obvious that the strap line containing the term "orderly" was considered more attention seeking and indeed a better fit for the tone of the book. Yet its so very unhelpful and to those in the "trade" an absolute howler of a mistake.But what effect was the copy write of the advert trying to gain?
When I hear the term I think of films such as "One flew over the cuckoos nest" (OFOTCN) and orderlies in white uniforms with bow ties and a penchant for coercive approaches. It leaves me cold and at the same time cross. I consider it a real distortion of what we do.The topic of OFOTCN will be a blog subject later on as i consider it a really damaging movie.
So the effect sought? Probably that of a spectre of locked rooms, secrets and howls of anguish.
Sorry to dissapoint the advertiser but the only howl of anguish was mine!
I guess its pretty obvious that the strap line containing the term "orderly" was considered more attention seeking and indeed a better fit for the tone of the book. Yet its so very unhelpful and to those in the "trade" an absolute howler of a mistake.But what effect was the copy write of the advert trying to gain?
When I hear the term I think of films such as "One flew over the cuckoos nest" (OFOTCN) and orderlies in white uniforms with bow ties and a penchant for coercive approaches. It leaves me cold and at the same time cross. I consider it a real distortion of what we do.The topic of OFOTCN will be a blog subject later on as i consider it a really damaging movie.
So the effect sought? Probably that of a spectre of locked rooms, secrets and howls of anguish.
Sorry to dissapoint the advertiser but the only howl of anguish was mine!
Monday 13 February 2012
NHS in shock evidence based revelation!!!
I guess like most people you have been told about the "wasteful and unproductive" NHS. Indeed the current "reforms" (like stripping out £20Billion over the next 4 years) are predicated on this kind of rhetoric. How unfortunate then that a paper profiled in todays press that has been published in that organ of leftist dissent The Lancet by Prof Nick Black (I jest about the political leanings of that august journal) gives the lie to that assertion. In fact it produces evidence quite to the contrary. I quote from todays Guardian online.
" Black produces a slew of evidence that questions the analysis of the Office of National Statistics used to work out the productivity of the health service. The ONS looked at the return for taxpayers by comparing public expenditure with how much patients used the health service and what the outcomes were.
Black's work, the first of its kind, argues that the measures the ONS used do not reflect the substantial improvements in NHS care. It points out that between 2000 and 2009, such were the advances that a baby born in 2009 could expect to live three years longer than one born in 2000.
Black says far fewer people were dying in specialist procedures in the NHS. He notes declines occurred in adult critical care (2.4% a year), dialysis (3.3% a year), and coronary artery bypass surgery (4.9% a year).
Patients' experience of how they were treated also improved. There were annual relative increases in the proportion of patients treated within four hours in accident and emergency departments (2.5% a year) and in the numbers operated on within 28 days of their operation having been cancelled for non-clinical reasons (10.4% a year).
Such was the NHS's popularity that in the annual British Social Attitudes survey, 70% of respondents reported they were overall satisfied with the NHS. This was the highest figure ever recorded by the long-running survey – the lowest was 34% in 1997, at the end of the Conservatives' 18-year tenure in office."
An impressive record is it not?
If all that seems a bit technical then cast your mind back to how long people waited for a hip replacement in the 80's. it seemed quite the norm then to wait 2-3 years.Now we seem content with a wait of 18 weeks.
Could this paper herald the advent of evidence based policy? Now that would be a breakthrough!!
" Black produces a slew of evidence that questions the analysis of the Office of National Statistics used to work out the productivity of the health service. The ONS looked at the return for taxpayers by comparing public expenditure with how much patients used the health service and what the outcomes were.
Black's work, the first of its kind, argues that the measures the ONS used do not reflect the substantial improvements in NHS care. It points out that between 2000 and 2009, such were the advances that a baby born in 2009 could expect to live three years longer than one born in 2000.
Black says far fewer people were dying in specialist procedures in the NHS. He notes declines occurred in adult critical care (2.4% a year), dialysis (3.3% a year), and coronary artery bypass surgery (4.9% a year).
Patients' experience of how they were treated also improved. There were annual relative increases in the proportion of patients treated within four hours in accident and emergency departments (2.5% a year) and in the numbers operated on within 28 days of their operation having been cancelled for non-clinical reasons (10.4% a year).
Such was the NHS's popularity that in the annual British Social Attitudes survey, 70% of respondents reported they were overall satisfied with the NHS. This was the highest figure ever recorded by the long-running survey – the lowest was 34% in 1997, at the end of the Conservatives' 18-year tenure in office."
An impressive record is it not?
If all that seems a bit technical then cast your mind back to how long people waited for a hip replacement in the 80's. it seemed quite the norm then to wait 2-3 years.Now we seem content with a wait of 18 weeks.
Could this paper herald the advent of evidence based policy? Now that would be a breakthrough!!
Saturday 11 February 2012
Orgone accumulator
"I've got an Orgone accumulator
and it makes me feel greater
its a one man isolator
made out of orgone"
So sang Robert Calvert on probably Hawkwind's greatest album "Space ritual" , and if you haven't heard it I thoroughly recommend it (in particular the original fold out sleeve is an exercise in 70's excess)
But this was a song based on an actual device that you were supposed to sit inside and somehow it would not only isolate you but capture Orgones and do you good (sorry about the lack of precision here). I came to think about this song (which I really must place on my I Pod) when I was on one of my usual long commutes to London to do RCN business. I am always impressed how we as humans choose to not engage with each other. In fact I would argue we seem to live in fear of the "other". Opprtunities to isolate the self in a public and indeed crowded place are now more numerous than ever. I like most commuters/travellers on the long haul to London have in my possession an I Pod and a Kindle (and probably a Guardian as well), and like a lot of others I probably use my IPod to erase or exclude the sound of the "others" around me. There is something really strange about being party to private conversations in public places facilitated by mobile phones.
We travel forced by circumstance to be with strangers and isolate ourselves by means of technology.
I wonder is this isolation healthy?
and it makes me feel greater
its a one man isolator
made out of orgone"
So sang Robert Calvert on probably Hawkwind's greatest album "Space ritual" , and if you haven't heard it I thoroughly recommend it (in particular the original fold out sleeve is an exercise in 70's excess)
But this was a song based on an actual device that you were supposed to sit inside and somehow it would not only isolate you but capture Orgones and do you good (sorry about the lack of precision here). I came to think about this song (which I really must place on my I Pod) when I was on one of my usual long commutes to London to do RCN business. I am always impressed how we as humans choose to not engage with each other. In fact I would argue we seem to live in fear of the "other". Opprtunities to isolate the self in a public and indeed crowded place are now more numerous than ever. I like most commuters/travellers on the long haul to London have in my possession an I Pod and a Kindle (and probably a Guardian as well), and like a lot of others I probably use my IPod to erase or exclude the sound of the "others" around me. There is something really strange about being party to private conversations in public places facilitated by mobile phones.
We travel forced by circumstance to be with strangers and isolate ourselves by means of technology.
I wonder is this isolation healthy?
Wednesday 8 February 2012
Can someone explain this to me?
Interesting piece in the propoganda war that now surrounds the NHS Bill, you know what I mean , all of a sudden research and reports are produced that support a certain view. All published under the guise of news. I was really fascinated by this piece in the online Guardian today. It reports that a collection of NHS directors are arguing the elevation of the private commercial earning ceiling to 49% will benefit NHS patients. they say......
"Examples of these benefits include developing treatment innovations and specialisms - such as complex paediatric treatment, robotic surgery, and employer-funded mental health treatment - and mean that trusts will be able to provide services on the NHS that can no longer be commissioned or are now rationed, including IVF."
Now my eye was drawn to the term "employer funded mental health treatment". What could that treatment be I wonder. I assume its psychological therapies that are currently delivered by Employer Assistance Programmes and which engage with independent contractors. Now this could be an absolute fillip to the psychology services couldn't it? They could recruit more and more psychologists and their assistants and deliver an IAPT style programme for the employers who would pay well for such a service.
But hang on Clin Psychs are a very small group and the low and high intensity workers are being trained to provide IAPT, and in particualr we are now working on a plans to develop that service into greater provision to people with a label of Serious Mental Illness, and indeed Young people.
Could there be a potential diversion of resources here? Could we see a client group neglected because there is more revenue (and less hassle maybe) in treating those employee clinets stressed out as they struggle with the impending recession
I think we need to keep a very careful eye on this one, it would be a real tragedy if a client group that has consistently called for such services sees the promise of delivery lost.
But hey thats the "Market" for you!!!
"Examples of these benefits include developing treatment innovations and specialisms - such as complex paediatric treatment, robotic surgery, and employer-funded mental health treatment - and mean that trusts will be able to provide services on the NHS that can no longer be commissioned or are now rationed, including IVF."
Now my eye was drawn to the term "employer funded mental health treatment". What could that treatment be I wonder. I assume its psychological therapies that are currently delivered by Employer Assistance Programmes and which engage with independent contractors. Now this could be an absolute fillip to the psychology services couldn't it? They could recruit more and more psychologists and their assistants and deliver an IAPT style programme for the employers who would pay well for such a service.
But hang on Clin Psychs are a very small group and the low and high intensity workers are being trained to provide IAPT, and in particualr we are now working on a plans to develop that service into greater provision to people with a label of Serious Mental Illness, and indeed Young people.
Could there be a potential diversion of resources here? Could we see a client group neglected because there is more revenue (and less hassle maybe) in treating those employee clinets stressed out as they struggle with the impending recession
I think we need to keep a very careful eye on this one, it would be a real tragedy if a client group that has consistently called for such services sees the promise of delivery lost.
But hey thats the "Market" for you!!!
Sunday 5 February 2012
We've only just begun
Now I am pretty sure that was the first line of a Carpenters song in the 70's, and was probably about the commencement of a new relationship or something equally slushy (as I am sure I thought at the time). It also is true if the Guardian can be believed true of another relationship. According to an article last week by Polly Toynbee (who still gets ribbed by her call for readers to vote Lib Dem in the Election of 2010), we are also at the start of something else, another less welcome relationship. A relationship with Austerity. According to her article only 6% of actual public sector cuts planned have yet occurred. thats right readers, only 6%. Now there was no citing of sources, no references (Geneva or Harvard), so maybe she got it wrong. Say for arguments sake she's out by 300%, so approximately 20% of projected cuts have occurred.
With a public sector payfreeze and an expensive reorganisation (marketisation) of the NHS occurring then what does this hold out for us? I wager its a bit more serious than the chatterati camping outside their Libraries in North London or indeed twice weekly bin collections.What will it actually look like? How we can envisage a rolling back of services at such a scale? How will it look in the sleepy hamlet where I live. Well mabe the libary is at risk, maybe the local schools will miss out on maintenance, day services for the vulnerable, or possibly a lessening presence of police. Could be rubbish collection, street cleaning, or public amenities will start charging like parking at the beach . Small stuff maybe, but an eroding feeling, public morale can be vulnerable to such an approach.
To push through this we all need a belief that it can be endured, that we can tolerate the hardships (bit like winter really), and that maybe its in some way tolerable because its inevitable or even fair (just like winter).
So is this approach fair , tolerable or even something that the ordinanry citizen has caused and should pay for? If the answer is no then where will the feeling of injustice go? Here in the UK the usual pattern is to internalise distress , that could mean calls for help to services that no longer exist. It really has only just begun.
With a public sector payfreeze and an expensive reorganisation (marketisation) of the NHS occurring then what does this hold out for us? I wager its a bit more serious than the chatterati camping outside their Libraries in North London or indeed twice weekly bin collections.What will it actually look like? How we can envisage a rolling back of services at such a scale? How will it look in the sleepy hamlet where I live. Well mabe the libary is at risk, maybe the local schools will miss out on maintenance, day services for the vulnerable, or possibly a lessening presence of police. Could be rubbish collection, street cleaning, or public amenities will start charging like parking at the beach . Small stuff maybe, but an eroding feeling, public morale can be vulnerable to such an approach.
To push through this we all need a belief that it can be endured, that we can tolerate the hardships (bit like winter really), and that maybe its in some way tolerable because its inevitable or even fair (just like winter).
So is this approach fair , tolerable or even something that the ordinanry citizen has caused and should pay for? If the answer is no then where will the feeling of injustice go? Here in the UK the usual pattern is to internalise distress , that could mean calls for help to services that no longer exist. It really has only just begun.
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