Older people denied access to MH Care

BBC News online 3oth March

Mental services 'shut to elderly'

Older people are often denied access to the full range of mental health services available to younger adults, a watchdog has found.

At four out of six mental health trusts examined in England decisions were based as much on age as clinical need, the Healthcare Commission found.

Out-of-hours, alcohol and crisis services, and psychological therapies were often unavailable to the over 65s.

A body representing trusts said new policies would benefit older patients.

Healthcare Commission chief executive Anna Walker called the findings "unacceptable".

The date on a birth certificate should not be the measure of whether or not someone receives the help they need

Kate Jopling of Help the Aged

The research showed that older people were often prevented from accessing care because of stretched services or a lack of age-appropriate care.

Some staff said patient groups considered to be of high risk to the public or where government targets were applicable were often prioritised, leaving older people's services lagging behind with little funding.

Ms Walker said: "Trusts are not always providing appropriate mental health services to the over 65s.

"It is truly unacceptable that out of hours and crisis services were often not available to older people.

"There needs to be a fundamental shift towards providing care based on a person's clinical need rather than their age.

"Considering a quarter of admissions to mental health inpatient services are over 65, this issue needs urgent attention."

'Scandalous'

Kate Jopling of Help the Aged said: "It's shocking to think that, despite the need, older people are routinely being denied treatment for mental health services.

"The date on a birth certificate should not be the measure of whether or not someone receives the help they need for a mental health problem."

And Gordon Lishman of Age Concern said the services that did exist for older people were often chronically under funded and are not of the same quality to those offered to adults of working age.

He said the situation was scandalous and urged the government to use laws to stamp out age discrimination.

Care Services Minister Phil Hope said any unfair discrimination against older people was unacceptable.

"We are taking action and we expect NHS trusts to make improvements."

Steve Shrubb, director of the mental health network which represents the majority of mental health trusts said: "We have some of the best mental health services in Europe yet it is clear that there are still improvements to be made to mental health services especially to ensure that older people get access to the correct care when they need it."

He said new policies, such as quality accounts, would put the needs of patients into sharper focus.

Meanwhile, a second study from the Commission of all 68 NHS specialist community mental health trusts in England, found that almost half of under 65s needing specialist mental healthcare still do not have an out-of-hours number if they are in a crisis.

Half of people with schizophrenia have not been offered recommended psychological therapies, it suggested.

http://news.bbc.co.uk/1/hi/health/7972617.stm

Reality is so passe....and you can change your reality (tv) to suit

Yes, it's official. Gotta keep you sunny side up.

I burnt mine on a sunbed but have a red jumpsuit and Biggles hat and as the future is so bright I am already wearing shades, no one will notice.

Forgive me if there is a teensy weensy bit of cynicism sneaking in. Old habits die hard but is okay cos I have my memorial magazine of Jade Goody's life as a form of inspiration. We could all learn alot from her.

So the new road to perdition/reformation involves

Smiling at everyone and smiling even if someone isn't there (You never know whose lurking about)....not forgetting to smile at yourself every time you look in a mirror, window or anything remotely reflective...see it as a kind of CBT.

Taking your medication with a spoonful of sugar and being grateful to the pharma companies for their generosity in creating this tabby for you...remember you really are that special.

Love your enemies more than your friends (or at least show appropriate amounts of adoration)...because they are the ones who you can rely on to be up there..or heading that way and hell why do all the work yourself? No! you don't need the top job (heads always roll at some point)...be far enough behind to make a sharp exist or change allegiance when necessary....not forgetting to smile at everyone whilst you do.

Wear a badge saying "Happy to help". Simple but effective.

Go on a reality tv show. It's important for people to know that you are a bit bonkers but not much so keep laughing in the face of adversity...and don't be afraid to get your bits out (the punters love that sort of thing and you can claim it as 'one of those wobbly times when the moment ran away with you' when it comes to writing your book). Do ensure you have a publicist ready and waiting when you leave. You want the world to share in your recovery.

Write a book...for sure you can stick in really devastating stuff but mix it with some 'revelational bits of how you made progress' (in between shenanigans with a couple of minor celebs, some wild parties followed by days roaming around dressed as a chicken in unknown places and waking up from a drunken stupor aboard the QE2, followed by an in depth debate around stigma with Prince Phillip)..top it off with an epiphany (in the form of words of wisdom from a fellow wandering star) and Bob's yer uncle.

I feel better already. Now for a chorus of "Always Look On The Bright Side of Life".

"He lives in a house. A very big house. In the country"

Lucky bastard!

As to am I because my dwellings are council estate, and until Mr NICEY NICE has rehabilitated me into the workforce (along with the employers and other employees..what's left of them... and not forgetting the NHS which is in the most direst need of all) then my home is safe...as in I will have a home to live in. Unlike thousands out there.

Are we to become a nomadic state? Does that sound like neurosis talk? If so, well so be it because I am trying to work out where exactly the people who lose their homes are living or going to live?

Will we see a big rise in the sales of tents? Or sleeping bodies found curled up in the remnants of dumped cars after the joy riders have had their thrill and moved on?

Perhaps the 'wartime Blighty spirit' will kick in and people will take in the 'redundant' homeless.

Perhaps I need to be more grateful than I am (regarding present state of having place to live in). For sure if I wasn't paranoid to hell about stangers (sometimes people I know) staying here, I would see the value in 'putting the homeless up'.

I reckon we all like to live in hope that the present financial nightmare is just a blip and the mega borrowing of our Government will carry us through..until such time as. That is if the pound is worth anything at all come July!!! And then well maybe we can start do so something about the environment!!!

I sense is a very good time to be a tourist..then again likely to be quite wealthy anyway and be thinking they have hit the jackpot coming to Britain to do some retail therapy.

And fekk knows why I really wrote that. Perhaps because I read the latest 'rehabilitation' spin from NICE as a form of insanity.

When it takes over a year to get anything remotely near to the right care support for my Dad, I wouldn't trust these organisations to find an easy access place to store their paper clips!

Having met with my MP today, I think he is of the view that things are a mess. Seems I am not the only service user in Bedfordshire that has gone to him with concerns over systematic failures. He has decided to write to the Strategic Health Authority....Another arm of the system but I suspect local Trust will not be best pleased about that and start a new arse covering exercise.

And that progress that was being made with Dad. Well, the carer's are turning up...sometimes around 9.30 pm, making a sarny and buggering off pronto and the meals on wheels is fine and dandy when it arrives (only they are starting to forget his address..wonder where his meals are actually ending up).

He collapsed yesterday, whilst friend and I were there, and I rang the GP. This being 3 weeks after the CMHT said they were going to organise a GP home visit! The GP saw him today and told him he has 'postural hyper-tension' (dizzyness on elevating his body). He has been advised to hold on to something when he gets up.

Hence, why I felt need to go to MP today...because I want organisations with a 'DUTY OF CARE' to carry that out...something they find beyond their capacity to deliver, on a regular basis.

Whether MP input will make any difference... I don't know but surely only so much arse covering can go on before action is taken. I assume that because it isn't just me (the mad woman with the garden fork against the steam-roller), the MH Trust and SHA can't use the cop out clause "It is an isolated case".

I still think you should trust no one (well the very few known and worthy) and then you won't be disappointed!

P.S. Big thanks given to MH Advocate, without whom I wouldn't have got to meeting today. Was in awful state this morning and they rallied me through.

Murder or a case of negligence by MH Services?

Ikechukwu Tennyson-Obih was sentenced (24 March) to life imprisonment for murdering PC Henry in Luton on 11 June 2007.

If you believe what the prosecution said, and the subsequent sentence that was given, then Mr Tennyson-Obih was of sound mind when he killed the policeman.

He had been diagnosed as suffering from scizophrenia in 2005. From what the media are saying that was due to alcohol and cannabis abuse.

What is missing from media reports is whether or not MH services were being provided to Mr Tennyson-Obih, after his diagnosis, and if any monitoring of his condition was taking place.

From a non emotive perspective, I do not know whether he was of sound mind when he committed the crime but think it is likely that he was suffering from his illness, possibly aggrevated by use of illicit drugs and booze.

Marjorie Wallace (Not always the most compassionate person to speak out on behalf of the mentally ill) has been quoted as saying that most mentally ill people do not kill others and based on research carried out by SANE, 1 in 3 killings, committed by people who are mentally ill, were preventable. This, has (hopefully) put some balance back in the media circus but does little to get any real justice for the mentally ill, whilst the public now have another pound of flesh to pacify their neurosis around lunacy.

Afterthought, if Mr Tennyson-Obih is of 'sound mind' (the prosecution's and jury's view....not mine) does that mean he will NOT be treated for scizophrenia whilst he is in prison?

If this is scaremongering then I am scared!!!

Couple of news stories arrived today:

From Times Online March 24, 2009

Hundreds of deaths linked to schizophrenia drug clozapine
David Rose

Fifty people die each year and hundreds more suffer serious side-effects as the result of taking powerful tranquillisers prescribed by the NHS, The Times has learnt.

Data from the medicine watchdogs own reporting scheme suggests that clozapine, a drug taken by schizophrenia patients, has been linked to 950 deaths since being licensed in 1990 equivalent to nearly one fatality a week.
Recent figures record the deaths of 55 people taking the medication in four months, from October to January, despite the drug being prescribed to relatively few people.
The anti-psychotic drug is used as a treatment of last resort for schizophrenia patients but appears to increase the chances of having a heart attack or stroke, or of suffering other long-term health problems that are not adequately monitored by current checks, campaigners say. More than 11,600 adverse reactions linked to clozapine have been reported in 19 years, according to the Yellow Card reporting scheme of the Medicines and Healthcare products Regulatory Agency (MHRA), which is designed to flag up potentially harmful side-effects for licensed drugs.
Related Links

Schizophrenia is the modern leprosy
Children given unlicensed anti-psychotic drugs

Mind, the mental health charity, which analysed the figures, said that the number of deaths associated with the drug was chilling. The MHRA promised to look into the charitys concerns.

The warning comes as the National Institute for Health and Clinical Excellence (NICE) is due to publish guidelines tomorrow on the treatment of schizophrenia, which affects about one in every 100 people in Britain. The watchdog will recommend that oral anti-psychotic medications should be offered to people with newly diagnosed schizophrenia, although patients should take clozapine only after trying at least two other drugs.

The drug, also known by the brand names Clozaril, Denzapine and Zaponex, was prescribed on 7,000 occasions last year many of which will have been repeat prescriptions to help to control delusions and hallucinations.

People who take clozapine must be given regular blood monitoring for the risk of a potentially fatal blood disorder known as agranulocytosis, but at present there is no mandatory requirement to monitor their health in other ways.

NICE will recommend tomorrow that GPs and other primary healthcare professionals should monitor the physical health of people with schizophrenia at least once a year, with a focus on their risks of heart disease.

Alison Cobb, senior policy officer at Mind, said that the drug could be effective for some patients and acknowledged that people with schizophrenia had a higher risk of death than the general population. There are health risks and side-effects associated with all anti-psychotic medications but it is chilling to see this number of deaths associated with clozapine and the month-on-month increases, she said. The figures refer to heart disease, strokes, cancer and other long-term health problems that cannot be explained simply by suicides or an increased overall risk of death.
We want to see the use of clozapine properly reviewed and for people taking it to be offered the full range of health checks and alternative treatment options that might mitigate any harmful effects.

A study published in the British Journal of Psychiatry last month concluded that use of clozapine in patients with severe mental illness was associated with a significantly increased risk of death compared with the general population. However, the author of the study, David Taylor, the chief pharmacist at Maudsley Hospital, South London, defended the use of the drug, which he said had transformed the lives of thousands of people around the world.

Most of the deaths reported could not be said to be a result of clozapine treatment; none could be definitively linked to its use, he said. Clozapine, it is widely agreed, is under-used in this country and in practice its use is delayed for much longer than NICE currently recommend.

The safety of clozapine has been continuously monitored since its launch in 1990, he added. In fact, no other drug has been as closely monitored. Close and intensive physical monitoring should be mandatory for all people with severe mental illness, regardless of treatment.

In a statement, the MHRA added: We are aware of the particular concerns of Mind in relation to clozapine and have already indicated to them that we will look further into the concerns they have raised and consider whether the trends in reporting through the Yellow Card scheme raise any new issues that merit update to the product information or indeed require reminders to prescribers about the need for close monitoring of patients to optimise safe use."

Simon Hough was diagnosed with schizophrenia 14 years ago and still manages his condition with medication. Fellow patients warned him off clozapine, after those taking it compared the effects to like coming off cocaine or heroin.

They described feeling really low and lethargic, and the side-effects such as weight gain and dry mouth were so much worse than other drugs, he said. One guy I knew was average weight, about 10 or 11 stone, and he just ballooned up to about 18 or 19 stone when he started taking the drug. Thats got to have some impact on your long-term health.

Mr Hough, 42, who now works for Making Space, a mental health charity in Northwich, Cheshire, took part in the CUtLASS study, a large-scale trial comparing the effects of modern antipsychotic drugs with those of older treatments.
I was offered clozapine but after all that Id heard about it I preferred to be in the group that took quetiapine [an alternative drug] instead.


Psychiatrist over-prescribed lithium


3/23/2009 8:30 AM
By Justin Anderson -Cabell Bureau


http://www.wvrecord.com/news/217993-psychiatrist-over-prescribed-lithium-man-says

HUNTINGTON - A Huntington man is suing his former psychiatrist for allegedly over-prescribing lithium that caused end stage renal disease.

Troy L. Robinson filed a lawsuit against Deleno H. Webb III and Area Psychiatric and Psychotherapy Group in Cabell Circuit Court on Feb. 17.

Robinson says he was a patient of Webb's from Feb. 12, 1997, to April 23, 2008. Robinson sought Webb's services because he had feelings of depression and anxiety.

The complaint says Webb diagnosed Robinson with bi-polar disorder and began prescribing him lithium -- Eskalith -- in September 1998. The dosage was 450 milligrams twice a day.

By November 2001, Robinson's lithium level was recorded in the therapeutic range and the creatinine was elevated at 1.7, but he claims Webb did not changes the dosage. In October 2004, Robinson claims his lithium level had grown to 2.4 and the amount of creatinine in his blood had risen to 3.3, a level described in the complaint as "dangerous.

"Despite these dangerous blood levels, Dr. Webb continued to prescribe lithium to this patient until it was discontinued in January of 2007," the complaint says.

On March 16, 2007, Robinson was diagnosed with end stage renal disease as a result of lithium toxicity, the complaint says. Nevertheless, Robinson continued to see Webb until April 2008.

Robinson claims Webb was negligent in his prescribing lithium and that Webb did not warn him of the possible dangerous side effects of the drug.

Robinson says he's sustained physical and emotional injuries, medical costs, loss of earning capacity and earnings, loss of household services, pain and suffering and other damages. He claims the company, Area Psychiatric and Psychotherapy Group was negligent in hiring and retaining Webb.

The plaintiff seeks various compensatory and punitive damages as well as pre- and post-judgment interest and legal fees.

Timothy L. Eves is representing Robinson. Cabell Circuit Court Judge David Pancake has been assigned the case

NICE Issue Guidlines on Work and Long Term Incapacity

The National Institute for Health and Clinical Excellence (NICE) has today (25 March 2009) issued guidance on managing long-term sickness absence and incapacity for work.

It is estimated that in Britain the annual costs of sickness absence and worklessness* associated with ill health is over £100 billion. This new NICE guidance aims to complement existing initiatives; helping reduce the number of employees moving to long-term sickness absence and promote return to work.

The recommendations in the guidance are aimed at all those who have a role in managing long-term sickness absence and incapacity. This includes all employers, employees, managers, workplace representatives, trade unions and professionals, as well as the health service.

The full guidelines are available via the NICE website. www.NICE.org.uk

On the website there is also a section relating to the rehabilitation of people who suffer with scizophrenia.

I'm all for it, in as much as people who are fit for work and can be 'rehabilitated' should be helped by different arms of the system. However, am ever cautious, not just because I don't trust the system but the timing seems to be at odds with what is going on in the job market...then again 'long term planning' could lead to a fully integrated and happy society in the long term.

Optimism is my new middle name. Ha!

Concerns around Mixamatoxins and Vet Appointments

Part of me wishes I had never taken all the meds I took before because am not looking forward to going on to Lithium with an innocent warm glow of positive anticipation.

Doing best to keep my Doubting Thomas at bay but having spoken to friend who has now been given a mood stabiliser, on top of their anti depressant, benzo and strong pain killers for physical problem am wondering where the layers of medication ever end.

I shouldn't really do comparisons ....for one... because everyone has varying tolerance levels and for two... I am only going on to one mood stabilizer although that is on top of benzos...which is making me para.

That the mix of these toxins is going to mong me out.I take biggest responsibility for this as have put up a damn good argument for staying on benzos (that being basic quality of life, in the absence of).

If only there was an off switch and I could go with the flow without wondering what the flow is, where it comes from, where it will take me and where I put my water wings.

There are some little rays of hope, filtering through. As in friend is managing to cut their benzo down by half each day but says they feel they are losing their mind and sense of self. Hard for me to know if that is benzo withdrawal or the combinations of the different meds ending in a cacophony of fekked up ness.

Also have done a bit of a surf of the net and Lithium is seen as the only true mood stabilizer. The King of Queens. Or is that the Queen amongst the Jokers?

Is all pretty iffy as in I won't know until I try it but the thought of feeling worse than how I do is mega concern.

When I was on the phone to Dad yesterday he said "I don't think it could get worse than this". My response was, "I often think that way but reckon it could be worse" (heaven forbid).

Which leads me back out of contemplation and into the getting on with life thing. Took Suki to vets yesterday for annual check and jabs. Big fun...NOT! The pair of us weren't really up to it. Thankfully friend was on hand with words of wisdom..such as "She seems to be handling the car journey, how about you?" (whilst Suki is doing cat equivalent of whining).

Vet was thorough, which means they were doing their job properly and Suki's anxiety levels were going through ceiling. The thermometer up the jacksie was the last straw and Suki was contorting herself (in ways I have never seen), hissing, screeching, scratching and trying to bite. My empathy was with her.

Everyone survived, although vet has nasty scratch on hand which they were kindly dismissive about and I have a freshly washed towel which I need to return along with urine sample tomorrow.

There is a possibility that Suki has diabetes or kidney problem...hence trip back with sample. This could lead to blood tests....oh dear! If that is the case will try and leave a few weeks between visits. As I think too much stress in one go won't do Suki any favours and I am not exactly 'gung ho' myself.

If life were a merry go round, I would be getting off now...and trying to find the porta loo.