Fake mental health patients

Some of you might want to crucify me for mentioning ‘fake’ patients but hold on. Wait until you’ve finished reading this post.

Pauline

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I was still in my six month preceptorship period when Pauline was admitted to Lavender Ward, an acute inpatient mental health ward. She was neat and tidy, her hair and nails were spotless, she appeared cheerful and engaged easily with the other patients while waiting to be assessed. However, during her admission assessment she relayed that she had been living on the streets, she was paranoid, depressed, anxious and suicidal – she’d actually been seen by passers bye running across a main road several times, without looking out for traffic, according to the paramedics who brought her in.

Pauline was articulate, she maintained good eye contact with me and smiled appropriately during the assessment. She said she had no family at all and had lost her friends since becoming ‘mad’ and homeless – though she couldn’t remember for how long. Pauline reported that she slept well although she had paranoid dreams, which didn’t wake her. The paranoia she described was that someone was after her and wanted to kill her but she couldn’t be clear about when this happened or who it was that wanted to kill her.

Once seen and admitted by a nurse, the patient’s baseline observations are taken i.e. blood pressure, temperature, pulse, respirations, height, weight etc. All of which were stable. After this, the patient would be seen by the ward doctor, normally an SHO, a junior doctor who is on their six month rotation and has little psychiatric knowledge.

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We had a tall, handsome and smarmy (oops, I mean polite) young chap, Dr Wellar, who looked down his nose whenever a nurse approached him. This was only his second week on the ward and I did tell him one day, “these nurses know way more than you do, and you ought to treat them with the respect they deserve.” That marked my card with him, I’m afraid.

Dr Smarmy stood to greet Pauline and, shaking her hand, he invited her to sit in ‘his’ office for a chat. She was in heaven, all smiles and giggling like a teenager. So I wasn’t sure why, when they’d finished her assessment, he announced to the team that she needs to be on close obs (There’s lots of circumstances where patients may require one to one nursing i.e. the patient is acutely physically unwell and/or requires frequent observations, the patient is acutely mentally ill and/or at immediate risk of serious self harm/suicide etc).

Depending on the level of risk, one to one nursing can be carried out by either a qualified nurse or a nursing assistant. Pauline was classed as high risk of suicide so needed to be observed by a qualified nurse 24/7, which includes when the patient goes to the loo. This takes one person from the staff numbers i.e. reducing the amount of staff by one. If you are nursing one to one, you cannot be expected to care for your five patients on top of this. Sometimes, the Trust allowed us to have an extra member of staff, more often a nursing assistant, to keep costs down.

As I’d done Pauline’s initial assessment, I was allocated as her 1:1 nurse so I spent the rest of that morning’s shift with her. We chatted about the weather, her dog and how she was worried about him – she didn’t know where he was. Pauline’s mum works “oh, I mean worked” as a teacher but she couldn’t remember the name of the school. I just kept the conversation light and said how proud she must have been of her mum etc. But something just didn’t sit right with me and I passed all this onto the afternoon shift.

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On my next shift, I was allocated to Pauline, 1:1, as apparently she liked me and we’d built up a good rapport. Again we chatted amiably about her past – what she could remember of it – she said her depression was affecting her memory. Obviously I had to accompany her while she showered and went to the loo, but to give her some privacy and to maintain her dignity, I averted my eyes temporarily. However, she was inappropriate at times, dropping her towel, not able to find her knickers, could I pass her the toilet paper or her wet wipes – almost anything to keep my attention.

Let me tell you something now; it’s no fun being in a bathroom when someone else has to poop and it’s worse still when you have to get close enough to pass the toilet paper.

Towards the end of one shift, she told me how sad she was that I’d be off over the weekend as she really enjoyed out chats. At the end of my shift she really invaded my personal space when she threw her arms around me and planted a great big kiss on each cheek “Adios. Au revoir. Bye my angel nurse. I will miss you.” I kid you not.

I’d really enjoyed my days off but still looked forward to getting back to work. On my return, as I walked through the front door to the ward, I was almost past the Dr’s office when Smarmy called me in, “Can’t you even get one thing right? You only had to look after one person – how hard can it be?” he demanded and shook his head at me disdainfully. “Pauline said you left her in the shower for nearly 20 minutes and she tried to kill herself.” I shook my head back at him, I smiled and assured him that this was simply not true.

He continued berating and belittling me until he took a breath and I simply responded that I was off to see our Ward Manager. She believed and trusted me that it simply wasn’t true. He’d been ‘had’ but obviously this was the story he was re-telling the whole multi-disciplinary team, making me look incompetent. However, he took in what the ward manager said to him and conceded he might be wrong.

Psychologytoday.com

In the meantime, I felt like I’d been punched in the stomach. I was hurt by Pauline’s tale; I thought we’d formed a good professional bond. One of our senior nurses said not to worry, don’t take it personally and reflect on this; trust me, you will learn from it.

I had to work with Pauline a few more shifts and just kept up the banter but didn’t mention the ‘incident’ and nor did she. Had I been a bit more experienced I would have discussed it with her but right at that moment, I didn’t want to upset her – there was something going on for her? and I was still trying to work her out.

After a week, we had a phone call from her mother, asking if we had a Josephine on the ward. Yes, it turns out this is something Pauline does now and again. She frequents hospitals seeking admission because she said ‘she gets a bed and fed’. In the meantime, she saves up her benefit money while she’s in whatever hospital. Some might say that this is a mental illness in itself?

Ronnie

This young lad had been admitted voluntarily after he went to A&E saying he was paranoid and hearing voices. He was amiable and loved chatting with fellow patients and the staff. He could be heard asking other patients why they were in hospital and was interested in hearing about their symptoms. After a few days staff could see that he wasn’t displaying any symptoms of anxiety, paranoia or hearing voices and had hinted as much to Ronnie.

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Late one night shift, we watched as he paced the long corridor outside the nursing office. He had his head cocked to one side, looking up towards the heavens’, and was saying out loud “Sorry. Say that again. I can’t hear you.” He gave the odd sideways glance towards the office to see if anyone was watching him and continued, “Don’t say that. I’m scared. You’re scaring me.”

Me and Billy, my favourite nurse, found this rather comical and went to sit outside to observe Ronnie and start a conversation with him. Billy asked “What are the voices saying to you Ronnie?” and Ronnie cocked his head to one side, looked upwards again and asked “What are you saying? Ah, ok, hold on.” and in all seriousness, he turned to Billy and said “They’re saying they don’t like you. They don’t want me to talk to you.”

I could barely keep a straight face as I probed a little further, “Okay, tell me Ronnie, how many voices are there?” He did the cocked head thing and the upward glance then cupped his ear, as though he was listening, then counting on his spare hand he looked at me and whispered, “two – and they said they like you.”

We continued in this vein for around fifteen minutes before Billy and I just laughed out loud. Ronnie’s utterances were becoming more ludicrous by the minute and Billy said as much to him, “Hey, soft lad. You look bloody stupid. You’re not hearing voices are you?” Ronnie knew the game was up and pleaded with us not to tell the doctors, “Anyway, they can’t send me home, I don’t have anywhere to go. They’ll have to find me a flat, won’t they?”

Emergency Treatment Team

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I worked with the Emergency Team for a while. This was where people would come during daytime hours to be assessed and we, as nurses, would decide whether to admit someone or to refer them to another service i.e. home treatment team (HTT).

We had so many ‘fake’ patients asserting their mental illness rights, looking for admission so we could find them a home with a garden. Or they needed housing application forms completed, saying that they had a mental illness, which they hoped would put them near the top of the the already groaning housing list or benefit forms so they could access Disability Living Allowance.

Many reported being depressed but when asked to explain, some would say they’ve got a bad back and needed a ground floor flat as the stairs were difficult. Or excruciating headaches due to noisy, antisocial neighbours and it’s driving them mad so they need to move. As though getting a new home would somehow magic away their pain and depression. While I appreciate that decent housing is beneficial to everyone, admission to a mental health ward is not. Furthermore, housing lists are stretched to their limits and London now requires around 66,000 new homes a year to provide enough homes for current and future Londoners.

Given that our hospital served the local population which was approximately 52% non white-British, we had patients from nearly every country and many of them needed interpreters. When they mentioned housing or benefit forms, I always asked them via the interpreter “Do you know where you are right now?” and “Do you know this is a mental health emergency department?” And often told them “This is not a housing services.” or “This is not a benefit office.” before signposting them to the appropriate services

The thing is, we had thousands of patients with chronic mental illnesses who desperately needed our support and mental health intervention or treatment. Moreover, Mental Health is like the Cinderella service of the NHS and we don’t get lots of money so what little we do get is needed for ‘real’ patients.

Do you think I was harsh in turning patients away?

Obsessive compulsive disorder – OCD

The following might be some of the things you’ve heard about OCD:

  • Someone is ‘a little’ OCD
  • OCD is not that big a deal, people just need to relax and not worry so much
  • OCD is just being a germaphobe
  • OCD is a choice
  • OCD is about being obsessively tidy or clean
  • People with OCD wash their hands many times a day

However, it’s a lot more complicated than all the above.

Premierhealth.com
  • Obsessive compulsive disorder (OCD) is a common mental health condition in which a person has obsessive thoughts and compulsive behaviours.
  • It affects men, women and children, and can develop at any age. Some people develop the condition early, often around puberty, but it typically develops during early adulthood
  • OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.
  • OCD is a serious mental health condition that causes individuals to experience a variety of symptoms that typically fall into one of two categories: ‘obsessions’ (thoughts or images)) and/or ‘compulsions’ (behaviours), which do intertwine

Obsessions

  • are unwanted, persistent and uncontrollable thoughts, images, or impulses
  • they can sometimes be persistent worries, fears or doubts or a combination of all these
  • the person doesn’t want to have these ideas; he or she finds them disturbing and usually knows that they don’t make sense
  • interfere with the sufferers ability to function day to day as they are incredibly difficult to ignore
  • come with uncomfortable feelings, such as shame, fear, disgust, doubt, or a feeling that things have to be done “just so”

The sufferer will go to extreme lengths to block and resist their obsessions – invariably they return within a short period of time, often lasting hours if not days, which can leave the person both mentally and physically exhausted and drained. One way people try to block or neutralize obsessions is with compulsions.

Compulsions

  • are repetitive/ritualised behaviors or thoughts that a person engages in to neutralize, counteract, or make their obsessions go away
  • can also include avoiding situations that trigger obsessions
  • are time consuming and get in the way of the normal activities of daily living
Independent.co.uk

People with OCD realise that acting on the compulsion is only a temporary solution, but without a better way to cope, they rely on that compulsion as a temporary escape.

Compulsions serve to avoid or reduce distress. In some cases, a person may believe they must perform compulsive acts in order to prevent something terrible from happening i.e. a person might touch things only after they’ve all been bleached -they believe they must perform this act in order to prevent disease or a person might feel the need to constantly check that the doors are lock – they believe they must do this to stop someone in their family from being harmed.

Normal or abnormal?

Obsessive and compulsive traits on their own are not a mental illness — we all have normal, everyday obsessions, things that maybe we obsess over. I like my kitchen cupboards to be neat and tidy but my sister takes it to the extreme and goes mad if all the labels aren’t facing the right way. She’ll get angry, then sulk for a minute with whoever the perpetrator was, then carry on as normal. However, this doesn’t mean that she has OCD either.

Helpguide.org

The main difference between normal and abnormal obsessions is that people with OCD report obsessions which are more intense, frequent and difficult to control. They can’t just “snap out of it.”

The real struggle with a person’s OCD is a manifestation of anxiety that creates an actual disturbance in one’s day to day life. Their thoughts are linked with intense anxiety driving them to engage in compulsive behavior — their only way out. See the wheel.

Signs and symptoms of OCD

Issues that commonly concern people with OCD and result in compulsive behaviour include:

Everyday Health
  • Cleanliness/order – obsessive hand-washing or household cleaning to reduce an exaggerated fear of contamination; obsession with order, with an overwhelming need to perform tasks or place objects, such as books or cutlery, in a particular place and/or pattern (with intense distress or distractions if this order or arrangement is disturbed)
  • Counting/hoarding – repeatedly counting items/objects, such as socks/clothes or pavement blocks when they are walking; hoarding items such as junk mail and old newspapers
  • Safety/checking – obsessive fears about harm occurring to either themselves or others which can result in compulsive behaviours such as repeatedly checking whether the stove/kettle/iron has been turned off or that windows and doors are locked
  • Religious/moral issues – feeling a compulsion to pray a certain number of times a day or to such an extent that it interferes with their work and/or relationships
Irishtimes.com

Most people with OCD know that their thoughts and compulsions are irrational. They know that just because they think something is going to happen doesn’t mean it will, and they know that acting on their compulsions won’t stop or prevent something, but they can’t risk it. This is what makes OCD so distressing for sufferers.

Treatment normally involves counseling, such as cognitive behavioral therapy (CBT), and sometimes antidepressants. CBT for OCD involves increasing exposure to what causes the problems while not allowing the repetitive behavior to occur.

An important thing to remember is that the occasional intrusive thought, even a disturbing and horrific one, is normal for every individual, even those without OCD. But if you need help, please contact you GP. OCD and mental illness can be successfully treated.

I hope this will answer some of your questions about OCD but please feel free to ask for more details or to make any comment.

Incompetent nurses on mental health wards

My nurse training

I spent three arduous years at university, half of which was spent as a student on placements within various mental health settings, to become a mental health nurse. But it took me another four years of working as a mental health nurse, along with more part-time studies, to feel confident about my knowledge and skills and to become a good nurse.

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I was so proud when I was offered my first nursing post on my favourite ward and looked forward to working with the team. Generally, within our Trust, on each ward for twenty patients, we had two qualified Registered Mental Health (RMN’s) nurses on shift and two Nursing Assistants (NA’s) on each of the three shift i.e. morning, afternoon and night shifts. One RMN acts as shift co-ordinator and they allocate patients to each member of the team. Normally, one would allocate patients with the least clinical needs to the NA’s and the patients with higher risk and needs would be allocated to the qualified staff.

We also had State Enrolled Nurses SEN’s – qualified second level nurses, who had undertaken a course of preparation of at least 18 months. This title and their training course were phased out in the ’90s. By 2000, SEN’s worked in the clinical setting as part of a team usually lead by a Registered Nurse (RN’s). SEN’s were less well trained than a Registered Nurse, who had undertaken courses of three years. SEN’s wouldn’t often take charge of a ward and there were other restrictions as to what they could do.

Couldn’t care less attitude

We had three of these lovely SEN’s on our ward, I liked them as individuals and I respected their 10-20 years of experience. I learnt much from these SEN’s – more about ‘how not to be a nurse’ unfortunately. We had Marie who was from the eastern side of the world. She had a nervous tic where she blinked rapidly and wriggled her nose in time to her rapid-fire speech. You would forgive patients for not liking Marie as she was brusque and barked out orders to patients and staff like a drill sergeant.

One day I popped my head in to see Connie, an elderly lady who had schizophrenia and found her sitting on her bed crying. I asked why and, in her lovely Irish lilt, she sighed “Oh, I don’t want to get anyone in trouble. I’m okay, honestly.” Knowing she wasn’t okay, I encouraged her to tell me what was wrong. She whispered “Marie’s just been in to wash me and put cream on my bottom but I’m even sorer now, she rubbed me so hard with a rough towel. But no matter, please. I’ll be fine.”

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“You don’t look very fine to me Connie. Come on my lovely. Let me see what we can do to make you more comfortable.” She lay on her bed and lifted her hospital gown, legs akimbo, the poor thing. She was mortified. Actually, so was I when I saw that her bottom, her genital area, the top of her thighs and under her large breasts were all red-raw and seeping green liquid. I pulled her gown down and told her I was off to see the ward doctor and wouldn’t be too long.

Doctor Dalani, a kind but very young junior doctor was good at his job and, he loved working in Psychiatry. I caught him just as he was going for lunch and explained the problem. I giggled when his face turned puce but I pretended I hadn’t seen him retch. He came with me to assess Connie’s sores; he lifted her gown, took one look and fled from the room. I don’t think he was aware that he’d held his breath all the while he was in Connie’s room. Back in his office, he prescribed antibiotic cream and a course of antibiotics.

Later that day, with said cream, pills and non-latex gloves I popped into Connie’s room, bathed her skin with a soft cloth and warm water, dried it and applied the cream as softly as was possible. Connie said her thighs were painful at night as they rubbed against each other so I told her how I’d slept with a large pillow between my thighs in the past and I got her one from our store cupboard. I was disappointed because Marie could have and should have done all this. When I went to explain what I’d done and said that a new care plan should be put in place, Marie yapped at me, “She’s my patient. Don’t touch!”

Inefficient and just plain dumb

It was lunchtime and I could hear a commotion on the ward; chairs scraping and raised voices so I looked out from the office. Two members of staff, two third-year students and several patients were all standing, anxiously staring at each other, mouths wide open but saying nothing. Jenny, an older and very large patient, appeared from around the dining area corner. Stil in her nightdress, she was staggering towards the ladies, in the corridor, and clutching her throat. She was choking!

“Get the emergency trolley and call the Crash Team” I shouted at staff as I ran to Jenny. I tried to bend her over, to no avail and using the heel of my hand, I thumped hard between her shoulder blades, in an attempt to dislodge the food – nothing.

familysafety.com

The students were yelling at the other two members of staff, “do something. Where’s the trolley? What’s the number for the crash team?” Fortunately, Judith, a large Caribbean nursing assistant came from nowhere, taking control, “You get the trolley. You call Crash, 2222!” Then she tried to help me hold onto Jenny, who was slipping from my grasp, going blue and wheezing. Jenny had, unfortunately, wet herself, then – she was unconscious.

Jenny slid to the floor and I went with her, finding myself kneeling in a pool of urine. I continued to thump hard between her shoulder blades and I started to panic – there was no emergency trolly, no oxygen…….. “Get everyone away from here!” I demanded, “or get a curtain,” because other patients shouldn’t be watching this. I felt angry at the lack of support from the other two staff and the senior students and their inability to follow simple instructions. Moreover, I felt scared as Judith and I stared at Jenny’s limp body and felt her pulse weaken.

The door to the ward burst open! Help had arrived. The on-call-doctor asked if she’d lost output. I foolishly replied, “Yes – she peed herself.” Then, I realised, that wasn’t what he meant. I was moved out of the way, by two senior nurses who beamed “Well done.” and ” You did well.” I was shaking like a leaf. “Take five minutes to yourself – and breathe!” One said warmly and I watched as Jenny was put on a trolley and taken to the general hospital. She survived after they were able to dislodge a large piece of unchewed beef.

Immediately after the event, I rounded up the staff and students to de-brief. I asked how everyone was and also, what we could have done differently. “You could have been a bit calmer. You shouldn’t have shouted at us. You could have………….. You should have…….

I told them that what I’d actually meant was We could have:

  • intervened sooner; perhaps as she got up from the dining room chair
  • attempted to dislodge the food immediately and
  • called out for help, instead of all just standing there
  • moved patients away
  • put a screen up
  • got the emergency trolley and oxygen sooner
  • offered to help me

I was furious with the nurse in charge, an SEN who had been on this ward for eight years but still didn’t know what to do in an emergency. This wasn’t the first incident either. I spoke to our ward manager the next day and said, as much as I like Narish (an SEN), I couldn’t work with someone so incompetent and that he needed extra training. That day, he was moved to another ward!

English as a second language

I was by now acting ward manager on a ward for the elderly when I came across Mala, who was of Indian origin and spoke near-perfect English. She was an SEN of many years and appeared competent. She was always smiley, keen and efficient so I liked working with her on shift. However, I was auditing her patients’ files one morning and spotted lots of grammatical errors and spelling mistakes, one which could be misconstrued and another, well, that one was just funny.

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Once, during a team meeting, Mala not only fell asleep but, she was snoring so loudly, we couldn’t hear each other speak. She was nudged several times by staff either side of her but on each occasion, she fell back into her coma. At the end of the meeting, I asked Mala to come into my office for a quick chat. Immediately defensive, she slouched on a chair with her arms folded and her chin in the air. I said I’d like to talk to her about a few things and started by asking if she was okay? “Of course I am okay. Why are you asking me? Do you have a problem with me?”

“Tell me what happened in the team meeting Mala.” I began. Her nostrils flared, she pulled herself up and snorted “Nothing, I was just resting my eyes.”

“You were sleeping Mala and it’s not appropriate in a team meeting or at any other point during a shift. Is everything okay with you?”

“I was just resting my eyes. Why are you picking on me? You don’t like me, do you?”

“Mala, let’s stick to the point. You were asleep and snoring.”

“No. Why are you writing things down? Why you don’t like me?

“I have to keep notes Mala.” Let’s move on to your notes and care plans. I noticed lots of errors; this one here,” I pointed out to her. “What does it say?”

“It says ‘patient slept all night,'” she stated.

“No Mala, it says ‘patient slipped all night'”

“Well, you know what it means. I am a good nurse. You just don’t like me.”

We were all aware that this particular patient had a habit of falling over -and as patient notes are potentially legal documents – Mala’s ‘slipping’ all night could be taken quite literally in a court of law.

Mala, let’s look at this one – what does it say?”

“It says ‘patient obese from having too much ‘coke'” she faltered.

It says “too much ‘cock’ Mala.” She had the good grace to blush and she gulped “Oh, I did not know. Sorry, I will change.”

AmericanNursesAssociation.com

On I went, error by error, and much to Mala’s consternation, I suggested that she attend the English course provided by the Trust. She was not happy and continued with “You just picking on me. Why you don’t like me. Tell me.”

“Mala, I’m not picking on you. I’m doing my job. Would you like it if, as a manager, I didn’t do my job properly?”

“You being racist. You don’t like my English. I will put a complaint,” she huffed.

“Okay, Mala. Let me print out the Bullying and Harassment Policy and the Race Discrimination Policy for you. Why don’t you take them both away with you, read them and highlight anywhere that you feel I’ve been inappropriate, picking on you or being racist. When you’ve finished, come back to me and I’ll help you write your complaint in the correct grammatical and spelling format. I’ll let you have two weeks. How does this sound?”

Mala glared at me but took the policies anyway before I asked her to sign the notes I’d just typed. She refused, fuming and stormed off. They would be signed when, after two weeks, I asked her into my office. “How did you get on reading the policies Mala? Would you like me to print out a complaint form?”

“I can’t be bothered. I….. No. Just leave it at that,” she blustered.

“Okay Mala, but I still want you to attend the English course so, I’d like you to apply within the month. I also would like you to sign the notes I typed during our last meeting.”

While I appreciate that SEN’s had less formal training than we did as RMN’s, these three had many more years of experience on the wards. and it just beggars belief that they’d been allowed to get away with such incompetence for so long. Still, that’s another post.

How would you have responded to any one of these three SEN’s? I’d be interested to know your thoughts.

My journey through psychotic depression part V

I began this particular series in recognition of World Mental Health Day on 10th October, when I decided to tell you my story – publicly – for the first time. It’s taken a while and it’s been hard – I didn’t realise how difficult it would be to write it all down and to see it in print. However, I think I really needed to let go of it and I wanted it in writing, in the hope that it will encourage others to open up and raise awareness of how mental ill health can happen to any of us at, any time.

If you see anything of yourself or your own experiences in this post, perhaps you’ll feel relieved that you are not alone and seek help. Maybe you’ll even recognise some of the symptoms in a friend or family member? Hopefully, you’ll gain insight into different mental health problems and understand how difficult life is for people who experience mental ill-health?

Please click here for Part I Part II, Part III and Part IV if you wish to read the backstory.

Ah yes. New Year’s Eve. Our almost sixteen year old son was just about out the door with his long-term girlfriend when he said “Dad, why are you wearing my new shirt?” Tony replied “It’s New Years and we’re going out. I like it. Why, what’s up Geez?” Eye roll here – “Dad, it’s my new shirt and I wanted to wear it tomorrow for my brother’s birthday party,” and Tony almost exploded, calling him all the names under the sun, effin’ and C-ing, telling him he was a selfish little sh*t, and said “I paid for it, we got it for your Christmas, I’m effin’ wearing it.”

“All you had to do was ask.” my son huffed.

Mercola.com

“Who you effin’ talkin to? Eh? And I ain’t got to ask no one nothing mate. It’s my house and I’ll do what I effin’ want.” (He’d conveniently forgotten that I bought and continued to pay for the house, during one of his long absences). My son had never raised his voice to either of us but I could tell by his stance and quivering lips that he was a. angry because his father was shouting at him and b. upset about the shirt, the fact he was being yelled at and being called ‘mate’ by his father.

Tony rarely raised his voice to the boys and the boys were never witness to any of the beatings I got – as they spent a lot of weekends with their grandparents, whom they adored. However, both boys are black belts in Karate and I was terrified that one day, like today, our eldest son might lash out at this father. But I think we both knew; not to go there – his father would hit back and would fight to the end, just to prove a point. We’d all seen Tony headbutt his really mild-mannered friend to the ground one day, cracking his head open. So we knew what he was capable. of.

In that moment, I was afraid. As a mum, I didn’t like seeing my son angry, humiliated or upset, particularly as he was on his way out to a party with his girlfriend. I shot them both a warning look and ushered them out swiftly, with a big smile and and hugs. I whispered “Off you go Sunshine, I’ll speak to Daddy.”

I turned and there was Tony; in my face, his eyes popping, fists clenched and the veins in his neck pulsating with rage? He started to pace the hallway and I realised that, luckily I was dressed. Seeing the opportunity, I grabbed my bag from the kitchen worktop, dashed out of the front door and raced to my car.

I popped round to my best friend’s house, all bubbly and full of cheer to say hi for New Year. I couldn’t tell her – and certainly not tonight, probably not ever really, I was too ashamed. I sat with a glass of champers and, swallowing hard to get rid of the giant boulder in my throat, we clinked glasses. I smiled in all the right places and joined in the banter ’til about eleven o’clock and then went home.

I felt sure Tony would have gone out without me by now, to meet the girls he worked with and their partners, all people that I knew. However, there he was on the sofa, with a pal, drinking beers and smoking dope. “Alright darlin’, I’ve changed my shirt, we going now?” he grinned stupidly. Heart hammering, I looked at him incredulously and said “No, I’m not.”

Thesun.ie

“Come on you dopey cow,………” I shook my head. You could hear a pin drop……. Then ……. “No? Alright. You sure? Okay, we’re going, ain’t we George?” he nodded towards his pal. As they were leaving I reminded him it was his son’s birthday party the next day, so not to get too drunk please. “No worries darlin’, see ya,” and off they almost skipped, like a couple of silly teenagers. I poured a solitary glass of champagne and watched t.v. until I saw the New Year in, then went to bed, miserable.

Sleep evaded me, and I near jumped out of my skin when I heard Tony lumbering up the stairs, sometime after three-thirty. Pretend you’re asleep, I told myself, over and………. too late – the bedroom door almost came of its hinges as he burst in and lunged at me, catching my ear. I later realised it was torn as he’d ripped out an earring in his haste.

Then his fists; I felt the punches to the sides of my head, I felt my hair being ripped out at the roots. I felt sick and my mouth seemed as though it was full of cotton wool. I couldn’t shout, I wanted to scream but my voice wouldn’t work! Instead, I yelped and sobbed pitifully like an abandoned puppy.

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Through it all, I wondered if the boys were home and I actually prayed that they weren’t. I’d have hated them to see me being dragged around akin to an old ragdoll. I felt deeply humiliated. Why wasn’t I fighting back? Why wasn’t I stronger? I didn’t defend myself, instead I curled into a pathetic little ball; my pathetic thoughts hitting me as hard as the blows.

Not satisfied, he yanked at my hair, time and again, and kicked out at my ribs and my back until I fell to the floor. He looked like a giant, standing up on there on the bed. He threw a pillow down at me, got undressed and got into our bed. I lay there, crushed and alone until, thirty seconds later I, heard him snoring.

My mind in turmoil, I tiptoed from the bedroom and went to the bathroom to see the damage. Fortunately, apart from my ear, there was no telltale marks or scratches on my face. I managed to get the loose hair into clumps, ball it up and flush it down the toilet. At this point, I checked the boys’ rooms. I didn’t expect either of them to be there and they weren’t, as I already knew our youngest was with their grandparents and the eldest at his girlfriends.

Birthdayinspire.com

It was gone four now and I knew I wouldn’t be able to sleep, so I snuck downstairs to start making the birthday cake and do some baking. I had plenty to keep my mind occupied but by sevenish, I was flagging; I’d have a couple of hours sleep as most of the big jobs were done and people weren’t due til after two. I snuck back into our bed – he didn’t like me sleeping anywhere else – and dozed off. I woke at the sound of the front doorbell, the clock said ten past ten, and thinking it was the boys, I jumped out of bed.

I raced round our room picking up fistfuls of hair and, for some odd reason, I tiptoed along our landing. Just in time to hear Tony telling George “Yeah, sh*t man. I gave her a bit of a slap last night. Listen mate, give me ten and I’ll be ready,” and I flew down those stairs to confront them both, chuckling in the kitchen. “A bit of a slap,” I spat at them both, “Really? It was a bit more than a slap” and I threw the hairballs at him, “and – if you’re going out, you’d best be back here by one, with a smile on your face and ready to help me set up for the party,” I stormed into the living room and turned the stereo up full blast – I couldn’t bear to listen to him, or his pal. Tony got dressed and a tad shame-faced, he slunk out the door.

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He did come back, merry and full of smiles, laughing with all the guests; ten kids and up to forty adult family and friends. I’d always enjoyed this particular party on New Year’s Day and our son’s birthday; everyone ate too much, probably drank too much and danced ’til after midnight. By this time I was invariably shattered.

The boys had gone to bed and most of the tidying up had been done by mum and the others. I thought I’d throw myself on the sofa, drink my coffee and reflect on the day. Just at that Tony, still smiling and happy, said “I’m of to bed darlin’, you coming?” You could have knocked me down with the proverbial feather. “No, not yet,” I offered quietly. I was scared.

The veiled threat was in his face but, knowing the boys were at home, Tony didn’t do anything other than growl in my face “There’s something wrong with you. You’re effin’ frigid,” and without coming up for air, he continued “all effin’ smiles and nice to everyone else, but not me. You effin’ C, ” and he stormed off to bed.

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The next day, after the boys went out to see friends, you could cut the atmosphere with a knife. I said to Tony “The next time you hit me – and there will be a next time – you are out that door. I. have. had. enough.”

He attempted a conciliatory smile. But he knew. He could sense the change in me. I’d been preparing myself, mentally and emotionally. I just wasn’t ready – this time…………….

I really thought I’d be finished writing about my journey by now, but still it goes on. Please bear with me – until the next time.

12 Celebrities who suffer from anxiety

Herviewfromhome.com

Anxiety is a normal, if unpleasant, part of life, and it can affect us all at different times and in different ways. It can persist whether or not the cause is clear to the sufferer.

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. It’s natural to worry during stressful times, but some people feel anxious day after day, even with little to worry about. Their feelings of anxiety are more constant and can often affect their daily life.

For people with an anxiety disorder, feelings like stress, panic and worry are longer-lasting, more extreme and far harder to control. Symptoms may also include feeling restless or agitated, panic attacks, having trouble concentrating or sleeping, sweating, shortness of breath, dizziness and heart palpitations, MQ Mental Health, 2019.

Let’s take a look at some female celebrities who have told of their anxiety and/or panic attacks:

Prevention.com
  1. Oprah Winfrey said in a 2013 interview that anxiety nearly caused her to have a nervous breakdown. 
  2. Kourtney Kardashian wrote on her blog “When my anxiety is extreme, it feels like my body is constantly burning calories all day long,”
  3. Lady Gaga says “I’ve suffered through depression and anxiety my entire life; I still suffer with it every single day.”
  4. Ariana Grande said that following the bombing at her Manchester Arena concert in May 2017, she experienced symptoms of post-traumatic stress disorder (PTSD).
  5. Whoopi Goldberg is afraid of flying and this condition is a form of anxiety known as a phobia, a fear of a particular object or situation.
  6. Adele suffers from anxiety attacks

It may be especially hard for men to disclose mental health problems, as boys are more often taught from young to be strong, not to be a cry-baby and not to talk about feelings. However, as of late, lots of male celebrities have expressed problems with anxiety and what’s great is they’re using their own platforms to bring awareness to mental health issues and encourage other men to get help:

Today.com
  1. Prince Harry has shared how panic attacks plagued him after his mother’s death. 
  2. Michael Phelps said that throughout his career, he struggled with depression and anxiety at various times.
  3. Zayn Malik of One Direction said he cancelled one of his concerts due to extreme anxiety.
  4. Leonardo Dicaprio says that his anxiety stems from the small things, things that really shouldn’t make you anxious.
  5. Hugh Grant said “absurd stage fright attacks” would hit him in the middle of filming without warning. The episodes began while he was filming Notting Hill in 1999, after which, he took a five-year break from acting.
  6. Ryan Reynolds said he spent many nights earlier in his career awake paralyzed by anxiety.

The above are just some of the celebs who suffer from anxiety, there’s lots more who experience different mental health disorders.

When celebrities and people in the public eye open up about their anxiety and disclose their mental health issues, it can help break down some of the barriers surrounding mental health and reduce the stigma. According to Psychology Today, “High profile people who disclose their experiences with mental illness bring a positive light to health and wellness.”

However, Each Mind Matters said that according to research, sharing your own story may have a larger impact on the attitudes of the people in your daily life than a celebrity’s public disclosure.

What helps you when you’ve experienced anxiety? Do you have any tips you could share?

 

 

Mental ill-health in the UK armed forces

According to inews’ Nigel Morris (1), “More than 60,000 armed forces veterans in the UK have broken the law, are homeless or are suffering mental health problems, a study has disclosed.”

The scale of their struggle to adjust to civilian life brought accusations that ministers were failing men and women who had risked their lives for their country. According to the analysis, some 50,000 are coping with mental health conditions, 10,000 are in prison, on parole or on probation and 6,000 have no permanent address.

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Mental Health First Aid England (2) reported that in 2015/16, 3.2% of UK armed forces personnel were assessed with a mental health disorder – over 6,000 people. Many more go undiagnosed and untreated. The most common ways these stressors impact on members of the armed forces are depression, anxiety, adjustment disorders, post-traumatic stress disorder, and alcohol misuse.

Just like the rest of the population, stigma and lack of awareness around our mental health compared to our physical health is often a barrier to armed forces personnel getting the treatment they need to recover.

MHFA training courses teach people to spot the symptoms of mental health issues, offer initial help and guide a person towards support. It won’t teach you to be a therapist, but it will teach you to listen, reassure and respond, even in a crisis – and even potentially stop a crisis from happening.

Developed in collaboration with the UK’s leading military support charities, Armed Forces MHFA is tailored to the unique culture and mental health needs of the military community. For everyone in the armed forces community – serving and ex-serving personnel, their families and support organisations – our training gives you the skills to:

  • Stop a preventable health issue from escalating by spotting and addressing it early
  • Know how and where to access treatment if it’s needed, for a faster recovery
  • Help keep yourself, the people you support, your colleagues and your family healthy
  • Minimise the impact of mental ill-health on work and life

Perhaps you would be interested in MHFA Armed Forces training? Take a look at their website.

Verywell.mind.com

NHS mental health care for veterans (3) report “Mental illness is common and can affect anyone (including serving and ex-members of the Armed Forces and their families). Whilst some people cope by getting support from their family and friends, or by getting help with other issues in their lives, others need clinical care and treatment, which could be from the NHS, support groups or charities.”

Within the NHS, there is a range of mental health services that provide different types of care and treatment. This includes dedicated mental health services for service personnel approaching discharge from the British Armed Forces and veterans. By veteran, the NHS says “we mean anyone who has served for at least one day in Her Majesty’s Armed Forces (regular or reserve).

These dedicated services are called the NHS Veterans’ Mental Health Transition, Intervention and Liaison Service (TILS) and the NHS Veterans’ Mental Health Complex Treatment Service (CTS). Both of these services are provided by specialists in mental health who have an expert understanding of the Armed Forces.

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But those who deliver mental health support say demand for assistance is rising and charities say more flexible and efficient support is what personnel and veterans need. Veterans charity, Combat Stress, claims it receives nearly 2,000 new referrals every year, Laura Makin-Isherwood, 2019 (4). However, in May 2019, it was said that Prince Charles was set to launch a £10m appeal to help fund their work.

That same month, the Defence Secretary, Penny Mordaunt announced up to £9m will be allocated to mental health and wellbeing activities for ex-service personnel, and support will be given to veteran-led groups looking for funding.

Veteran Mental Health – What’s next?

“The NHS has recently rolled out a new scheme, the ‘National Heroes Service’, part of the NHS Long Term Plan. It has been designed to improve the primary care of those who served and their families. Through the scheme, GPs are sent comprehensive resource packages helping them to identify veterans and ensure that hospitals and staff recognise their military background. Subsequently, if specialist care is needed the patient can then be directed to specific referral pathways.” Ed Parker, 2019 (5)

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While GP services should always be the first point of contact for a veteran seeking mental health support, there are specialist veteran services that have been set up in order to address veteran’s needs. These services have a better understanding of the mitigating circumstances the individual may have faced because of their military service, and ensure greater engagement and empathy with the patient.

Although steps have been taken to simplify the veteran care pathway through care coordination, more can be done to enable veterans to gain easy access to the support they need. As a group of charities with the same beneficiary at stake, we must continue to strive for collaborative, ethical, informed outcomes that enable veterans to live independent of both State and Third Sector support.

  1. Nigel Morris, https://inews.co.uk/news/uk/armed-forces-veterans-homeless-crime-prison-mental-health-254034
  2. MHFA Armed Forces
  3. NHS mental health care for veterans.
  4. Laura Makin-Isherwood, Forces.net
  5. Ed Parker, Walking with the wounded.org

Anxiety in men

An article by Madeline R. Vann, MPH caught my eye and I’d like to share some of it with you. Madeline wrote: “Anxiety disorder in men is real and treatable through therapy and medication.”

In her article, New Jersey-based freelance journalist Scott Neumyer, at 35, said he can look back and recognize signs of anxiety from as early as his childhood.

Irishtimes.com

But perhaps because men find anxiety easier to overlook than women do, he didn’t have to face his anxiety head-on until a crescendo event when he was 25. Neumyer was attending a Bruce Springsteen concert with a colleague when his first panic attack drove him into a bathroom. He can catalogue the many times after that first panic attack when anxiety symptoms made social and work relationships difficult, and when he began to fear going out in public.

Someone close to Neumyer had been through anxiety treatment so he knew that seeing a doctor was the first step. He tried anxiety medication and went through several types before settling on Zoloft (Sertraline). But he also knew that medication alone wasn’t going to solve the problem, so he sought out therapy.

“Cognitive behavioral therapy has been the most effective for me,” he says, adding that he also read as many books as he could about living with an anxiety disorder. “Along with the panic and anxiety usually comes some form of agoraphobia, a fear of doing certain things and going certain places.

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I personally got to the stage where I hated going to watch my sons swimming because of the seating – all those steps looking down over the pool? The same with the cinema, those dreaded stairs – and in the dark! I also disliked the tube stations in London and the further down I had to go, the more I panicked, so in the end I had to get taxis (if I couldn’t park at whichever venue).

My two (now adult ) sons have experienced anxiety and panic attacks in the past. They’re both black belts in Karate, they’re club swimmers and play football each week. My eldest is a Research fellow, currently working in the States, researching neuromuscular disorders and my the youngest is a Physiotherapist. So, although they both claim to be geeky in a science-type way, they’re not weedy or wussie; nor do they come across as lads who would have panic attacks. Some family and friends have been shocked, like “Wow, I didn’t think he would have mental health problems.” So, really what I’m saying guys is, it doesn’t mean you’re a weak person, anyone can experience anxiety; it doesn’t care where you’re from, what class you belong to or what job you do.

Here are some other anxiety statistics from No Panic in the UK

  • Mental health problems are one of the main causes of the overall disease burden worldwide.
  • Mental health and behavioural problems (e.g. depression, anxiety and drug use) are reported to be the primary drivers of disability worldwide, causing over 40 million years of disability in 20 to 29-year-olds.
  • Major depression is thought to be the second leading cause of disability worldwide and a major contributor to the burden of suicide and ischemic heart disease.

Most common problems

  • A UK survey published in 2016 showed that 5.9 in 100 people suffer with a generalised anxiety disorder
  • Mixed anxiety & depression is the most common mental disorder in Britain, with 7.8% of people meeting criteria for diagnosis.
  • 4-10% of people in England will experience depression in their lifetime.
  • Common mental health problems such as depression and anxiety are distributed according to a gradient of economic disadvantage across society. The poorer and more disadvantaged are disproportionately affected by common mental health problems and their adverse consequences.
  • Mixed anxiety and depression has been estimated to cause one fifth of days lost from work in Britain.
  • One adult in six had a common mental disorder.
  • In 2013, there were 8.2 million cases of anxiety in the UK.
  • In England women are almost twice as likely to be diagnosed with anxiety disorders as men.

Men and women

  • In England, women are more likely than men to have a common mental health problem and are almost twice as likely to be diagnosed with anxiety disorders.
  • In 2013, 6,233 suicides were recorded in the UK for people aged 15 and older. Of these, 78% were male and 22% were female.
  • 10% of mothers and 6% of fathers in the UK have mental health problems at any given time.
  • One in five (19.1%) women had CMD symptoms, compared with one in eight men (12.2%)
Counsellingondemand.com

Madeline quoted “Scientists still aren’t sure whether anxiety disorders are more common in women than men because of biological differences, such as estrogen and other hormones, or because women may express distress differently than men do”, says Mark Pollack, MD, psychiatrist and chairman of the department of psychiatry at Rush University Medical Center in Chicago.

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe, NHS. Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal. But some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

The following information from the NHS is about a specific condition called generalised anxiety disorder (GAD). GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

Symptoms of generalised anxiety disorder (GAD)

GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include:

  • feeling restless or worried
  • having trouble concentrating or sleeping
  • dizziness or heart palpitations

Although feelings of anxiety at certain times are completely normal, see a GP if anxiety is affecting your daily life or causing you distress. Your GP will ask about your symptoms and your worries, fears and emotions to find out if you could have GAD.

What causes generalised anxiety disorder (GAD)?

The exact cause of GAD is not fully understood, although it’s likely that a combination of several factors plays a role. Research has suggested that these may include:

  • overactivity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • the genes you inherit from your parents – you’re estimated to be 5 times more likely to develop GAD if you have a close relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • having a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol abuse
  • But many people develop GAD for no apparent reason.

Who is affected?

  • GAD is a common condition, estimated to affect up to 5% of the UK population.
  • Slightly more women are affected than men, and the condition is more common in people from the ages of 35 to 59.

How generalised anxiety disorder is treated

GAD can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

With treatment, many people are able to control their anxiety levels. But some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Psychcentral.com

Self help for generalised anxiety disorder (GAD)

There are also many things you can do yourself to help reduce your anxiety, such as: 

  • going on a self-help course
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink
  • trying 1 of the mental health apps and tools in the NHS Apps Library

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