Assertive Community Treatment…..

Well, week one of placement is finished and done. Lots and lots of interesting things have happened. Assertive outreach must be one of the most interesting mental health services to work in. Partly because the client group includes the most difficult to engage. That’s why the model was implemented in the UK. To break the cycle of admission – discharge – disengagement – readmission. So called ‘revolving door’ psychiatric patients. The idea is that assertive outreach manages to engage people and keep them engaged as fully as possible and for as long as possible. And that they spot when people are disengaging and take steps to reverse the process. A large part of the work involves monitoring medication compliance. Literally watching people take their medication seven days a week. And checking under the tongue afterwards. A few missed doses and the team start getting a bit concerned. Sounds quite paternalistic. And it is.

There’s an approved mental health professional (AMPH) within the team. She does all the mental health act assessments when things start to go awry. This week a young woman has been deteriorating rapidly and is due to be assessed over the weekend. I’ve been assured that I’ll get to be involved in at least a couple of assessments. They’re pretty frequent. Often people are admitted on a section 3 as a result. There’s usually a fair few clients in hospital at any one time. Everybody is admitted to the same ward under the same consultant psychiatrist. The consultant, the assertive outreach community team and the ward staff work closely together. A member of assertive outreach attends the weekly ward round. A member of ward staff attends the assertive outreach weekly team meeting. The consultant attends both.

One of the really interesting things is the new supervised community treatment orders. A few clients are on them. One of them is successfully avoiding contact with the team and has missed a depot injection. She can be recalled to hospital within the section (17a) and forcibly given the injection. If she’s still well, she’ll be allowed to leave pretty much straight away. If she seems to have deteriorated, she could be kept for up to 72 hours for a proper assessment. After that, she could be kept on the section 17a and discharged home, asked to stay informally or have the community treatment order revoked and be placed back on a section 3 and held for up to 6 months for treatment. The trouble is, nobody’s a hundred percent sure quite how to go about the recall process….

There are lots of little stories and if I get time, I’ll blog a specific situation later. I have to go and do a little portfolio work right now. And find some chocolate. And maybe a brandy. In a nutshell, I’m loving it. It’s all good

Tartan wellies and ward rounds…

Yesterday, I started placement. I’m with ACTON (Assertive Community Treatment Outreach Network). Being a bit careful, I did dress a bit tidy for my first day. Didn’t really want to be the scruffiest one in the room. To be honest, I ended up being one of the smartest and made a mental note to dress down a notch today.

So today I wore my tartan wellies. I did have black trousers on rather than jeans. And a smart-ish top that (sort of) matched. It was fine. Except I ended up spending most of the afternoon in ward round and pretty much everyone else had very very smart clothes on. Oh well. Because it’s assertive outreach, service-users get really unwell and some are in and out of hospital. If you’re not familiar with ward rounds, basically one patient after another is seen by the consultant psychiatrist and the team of people responsible for ensuring their wellbeing. The boots thing was quite amusing really. In between patients, the consultant commented on my tartan shoes. I explained that even as a poor destitute student, there are some things you just have to have. I also explained that they were boots not shoes. I think he was impressed. He kept looking at them anyway. Personally, I think he was jealous.

Ward round was fantastic. I asked a question early on. The consultant was thinking aloud about whether to prescribe lorazepam or diazepam and opted for lorazepam and I was curious as to the logic behind this decision. Not only did he answer this question fully but, from that point on, he explained everything to me. The medication interactions, side effects, the evidence base for why he was making the decisions he made. It was really interesting. We even had a bit of a debate about community treatment orders. I did learn something really interesting. Apparently, Oxford university is undertaking a randomised controlled trial to establish the relative outcome benefits of extended section 17 leave and supervised community treatment (section 17a) and our locality has been selected for involvement in the trial. So suitable patients will now be put forward and consequently randomised to one or the other. The results of that will be really interesting. I love research. I know that’s really sad.

I also love my tartan wellies. Good old Tkmaxx

Rabbit Stew

Bess has gone to the magic bunny man and lady who will pack her up and send her home in a few days with a brand new hubby in tow. We dropped her off this morning, me and em, and stayed for the first half hour or so of the bonding process. The magic bunny lady and man’s garden is all set up for bunny bonding. The main section is sectioned off into small squares surrounded by waist-high fencing (your waist not a bunny’s). First we put Bess into one of the runs and Mr magic bunny man fetched lots of bunnies one by one and deposited them into surrounding runs. She spent a few minutes sniffing each before trying to attack them through the bars. Basically that means ‘not for me, thanks’ so Mr magic bunny man slid a sheet of plastic between them so they couldn’t see each other any more.

Mr and Mrs magic bunny people asked us if we minded trying her with Stewie. Stewie is on the ‘unrehomable’ list on account that he’s so aggressive to humans. They’ve actually applied behavioural techniques and he’s no problem with them any more. Generally speaking, he grunts at people before charging and trying to eat them. They promised to teach us how to handle him if he did end up coming home with us at any point. I didn’t even know rabbits could have behavioural problems

Anyway, they seemed to get along. For ages, Bess took no notice of him at all. That’s apparently a really really good sign. It signifies acceptance. Before we left, they were sniffing each other for a bit then Stewie was hopping all over the place on his side of the fence. They said he’s never been so happy. We have to call tomorrow for an update.  It could all change but Mr and Mrs magic bunny people thought it was hopeful.

We’ve been looking up bunny behaviour management. It looks painful to be honest. It involves at least one kevlar glove. Emma’s bookmarked the them on the internet, ready to order a couple of pairs on Bess’s say so.

Secretly, I really hope she does choose Stewie – I think if they get on fine with him, we will too.

Bye bye Archie

Archie died

Happy new year xxx

  

The chocolate gateuax was my very food item. Thanks Burnetts for bringing it. Emma says thanks to Sam for the multicoloured jelly. That was her personal favourite. I really liked the mulled wine aswell. 2 bottles of red wine. Brown sugar. Cinnamon sticks and cloves. Oranges. Lemons. Apples. And a bit of apple cider. Really easy to make. I very much liked it. Especially as it was a lovely warm contrast to the cold evening.

Libby was very sweet and sociable. Lauren was funny and cuddly. I think (and hope) Ian is playing charades here?!

   

Megan spontaneously draped herself around Leah. That was very sweet. I’m not sure if Ellie’s praying that the game of cranium will soon be over?

 

Lorraine posing for a new facebook profile pic. I really don’t know what Jeanette’s doing. Probably the same. Enisa having a cuddle off Libby.

  

I think Ian is trying to ascertain Sam’s emotional state with Emma’s expressions glove. Perhaps?

 

Megan and Leah having a pillow fight. Leah’s heart isn’t in it. Good really really seeings as she’s twice as old, twice as big and three times as strong Me and Leah ended the night with ABBA on singstar.

 

 Not a bad night. Not a bad night at all. Happy new year everyone xxx

Ian had a special birthday :-)

On 30th December, Ian was 40 years young. Me and Emma decorated the front of the house. It was very very very cold. I couldn’t feel my fingers. At least we didn’t have far to go

 

We went to Frankie and Benny’s to celebrate. I really really liked it. My meal was lovely. But the cocktail I had for pudding – Benny’s choca mocha – was delicious. Very like a pudding. It even had chocolate sauce swirled in the glass before the amaretto and whatever else was added. Emma didn’t like it.

The cake picture didn’t turn out very well. It had this picture on. I was really pleased that ASDA have a chcolate option on the photo cake now. Much nicer that the plain sponge.

 

Above, my mum in the purple and emma, enis and the hands of Pete Burnett on the right!

Below, Emma and Jeanette on the beer. I think maybe Emma is actually posing with Jeanette’s beer. And Lorraine with her hands over her face!

   

  

Above: Emma and parents on the left; Jeanette and a random stranger on the right

Below: Me with Leah and cousin Jaidon who is beginning to seem very grown up lately. Emma fooling around with a Burnett of the Peter variety. She does that.

 

I hope Ian enjoyed the evening. Out of all the Christmas/birthday get-togethers in the last three weeks – and there have been a few, I think it may have been my favourite. Happy Birthday again x

We did it all again on boxing day by the way…

Ian cooked. Roast lamb. It was lovely. And very big. And lovely. We opened prezzies. Leah was funny. This blue one was in the corner for hours before she noticed it. I think she liked it. She also got the wii off her mum and dad. It would have been a bit mean giving her a wii fit else. Funny. But mean. We played silly games the rest of the day. It was lovely. Thanks for having us xxx

Christmas Photos

Christmas morning at home.  Emma set the camera on timer. She likes that kind of thing. Off to Melton for Christmas dinner. Then back home to tackle prezzies under the snowman (we realised some time ago that you can’t have a tree with three cats and a couple of house rabbits). Some of the favourites were:

• this from the lovely paperchase: it’s shower gel but I’ll probably never open it
• this fob watch for placement and hopefully, one day, for a real job. I hope I don’t accidently stick it in the washing machine like I did with the last one!
• this which I actually but Emma but got to keep half of (not the best half but there you go!)
• and these which I’ve wanted for ages. I had one. But I wanted them all.

I liked lots of other things too. But I’d be here all day.

Emma spent the evening spinning a plate (a £3.50 kit) in new pyjamas. And a fleece. Because it was very very cold!

Now for the analytical serious bit.

My conclusions that Christmas is silly have been reinforced quite powerfully this year. On the way to Emma’s parents, we saw flowers by the side of the road, laid there in memory of a group of teenagers killed recently in a car crash. We got chatting as we drove. About the people living in the houses that we passed. About children who wouldn’t be getting presents. Who might not leave their room. Who might’ve pretended to be asleep the night before. About children like baby P. The last generation in a line of seriously broken and bruised and twisted families. Maybe because of our employment experiences, among other things, we’re both well aware that, although you don’t know who or where they are, you know these children exist and you know they’re suffering. And not just children. Adults, like the families of those teenagers, grieving. Others being abused in relationships. Some putting themselves into awful situations to pay for drugs. Often to block awful memories or constant disappointment and failure. Christmas is cruel to those who are suffering. The pain is magnified a thousandfold.

I said Christmas is silly but really, if I’m totally honest, I meant perverse. I think it’s obscene. Any pointed fingers point back at me aswell. The Queen’s speech about selflessness was hideously ironic bearing in mind that an awful lot of people listening had just eaten their own bodyweight in Christmas dinner and opened a stash of presents, half of which will never be looked at again.

I don’t really think it has anything to do with the birth of Jesus anyway. Christmas was a ploy to get the Pagans on board. Just like Easter. Keep the Pagan festivals just make it about Jesus instead. And yet I join in year after year.

WWJD I wonder?