Without risk life becomes empty, dull and lacking in quality. It’s not our job to remove all risk – we can’t anyway. Everything carries some risk. The trick is to learn to balance risk with reward, with benefits.
We do people no favours by trying to wrap them up in cotton wool to insulate them from all risk.
“Very thorough and high quality…” Abi, Student nurse
Lifetime access for only £30.00
Do you work in mental health services?
Are you a support worker, student nurse or just an interested person who’d like to know how to make more sense of mental health and disorder?
Do you find it hard to see how all the different disorders and peoples’ approaches to them fit together?
Do you have difficulty getting other professionals to see things as you do?
Would you like to be more effective in working with the people you care for?
Then this online video course is for you.
People learn best when they have questions and they remember best when they have a ‘schema’, a ‘picture on the box’ to help make sense of what they’re taught. That’s what this training is all about. Over two and a half hours of video instruction alongside a range of information and exercises in the accompanying workbook help you to make sense of the seemingly overwhelming field of mental health and disorder.
And all for much less than the cost of a good night out.
You can have all this for less than you’d pay for a take-away meal for two. But unlike a take-away, the benefits of this training will last your entire career.
Click the link below to get full access to the course videos and workbook.
I haven’t posted here for a while. I’ve been busy with other things but now I’m back and I’ll be making a few changes. It’s a new direction… a new road ahead.
I plan to focus more on short, punchy videos instead of the longer ones I’m used to. One or two minutes seems more social media friendly and perhaps easier to fit with peoples’ busy lifestyles.
I hope you enjoy the new style.
When assessing an individual’s mental capacity it is important that we confine ourselves to assessing that person’s ability to make this particular decision (or type of decision) at this time. This is what the Act means when it refers to ‘time and decision specific’ assessment.
At first glance this seems obvious and clearly reasonable. However on closer inspection it brings up a number of issues relating to ‘established practice’ that need to change. It also provides many workers from support workers to nurses, social workers and many others with a very real source of anxiety. Here’s why.
In the past capacity decisions tended to be made by certain professionals such as psychogeriatricians or psychologists. One typical approach would be to ask a doctor to come and assess a service-user’s capacity, not in relation to a specific issue but ‘globally’. This would be done using one of several techniques, the most common in UK being the Mini Mental State Examination (MMSE).
The MMSE is a reasonable tool to assess cognitive deficit and is helpful in diagnosing certain conditions such as dementia but it is not an assessment of capacity. Diagnosis is not the same as capacity. The fact that a person has a particular diagnosis does not tell us anything about their capacity to make particular decisions. The MMSE is not decision specific unless the care and treatment being offered relates to the service-user’s ability to count backwards from 100 in 7s or to name the current Prime Minister.
The MMSE does not inquire into preferences of diet, whether or not a person understand how to cross a road safely or what time they would like to go to bed. These are the sorts of questions that must actually be assessed on a day to day basis when we are making decisions about a person’s capacity.
The other major problem with ‘global’ assessments of capacity (apart from the fact that they do not asses capacity in the first place) is that they are not time specific. A psychogeriatrician’s assessment at the start of the month will have little bearing upon the service-user’s day to day decision-making capacity at the end of the month. So unless we can persuade the Dr to visit each service-user every mealtime to assess their capacity to choose between carrots and peas we have to use a different system.
Fortunately the Mental Capacity Act provides us with just such a system and, although unfamiliar to many it is very straightforward and in fact reflects what we’ve all been doing since early childhood anyway. You see assessing capacity is not difficult in itself so long as you understand it – and also understand what we are NOT expected to assess just as clearly as what we are expected to assess.
The Mental Capacity Act is clear….
“The decision maker is the person delivering the care or treatment”
This means that the support worker who decides that Albert needs a bath is responsible for assessing whether or not Albert has the capacity to consent to that bath. If he or she decides that Albert does not have the capacity to consent to that bath then the support worker is also responsible for deciding whether or not the bath would be in Albert’s best interests.
This may seem unfamiliar when it’s written down like that but actually that is precisely what has happened day in and day out in practice for decades in health and social care settings. Nobody calls the GP every time they think a resident in a care home might need their hair washed – they just decide. What the Mental Capacity Act does for us is it provides us with a way to show that our decisions make sense and gives us the legal backing to be free from prosecution for assault so long as we can justify our actions.
Part 5 of the Mental Capacity Act is subtitled ‘Protection from liability’ and deals with just this issue, ensuring that care workers can do what is necessary so long as they can show that the individual lacked capacity and that their actions were both proportionate and in their best interests. This is very empowering for care workers because it allows them the respect they deserve in making day to day decisions and provides them with legal protection at the same time.
Regular followers of my stuff might be forgiven for thinking that I’m opposed to psychiatry and the biological model. After all I regularly complain about the standard medical approach with its reliance upon medication to treat mental disorder – especially relating to antipsychotics for people diagnosed with disorders like schizophrenia and bipolar disorder. But that doesn’t mean I’m ‘antipsychiatry’ – just that I’m cautious. This is especially true where medications are concerned.
The list of side effects (otherwise known as undesirable consequences) that accompany psychotropic drugs can be a major problem but the same is (and has always been) true of all medications from AZT to aspirin. If a particular person suffers side effects from a particular drug then there’s a case for trying a different drug or even a different dose but that, in itself, isn’t really a case for scrapping all antipsychotic medication. All we can really say is that we need to be cautious about medication and avoid the ‘hammer to crack a nut’ approaches of the past.
Medications are biological tools. They are chemical preparations designed to make chemical changes in the physical body. This is because of an assumption that mental disorders are caused by physical (specifically chemical) problems. But is this always true?
Combat veterans are known to develop psychotic disorders as a result of their experiences spending time in active service. It seems ridiculous to assume that all these men and women (who had passed psychological evaluation before entering the battlefield) suffer from organic brain disorders. Yet their symptoms are similar, if not identical to those experienced by many of their civilian counterparts who are diagnosed with major psychotic disorders and treated with chemicals.
Combat veterans suffer a form of psychosis that is caused not by biology but by stress.
For these people I think that there is an excellent case for using medication to treat their distress and to provide a degree of respite from their symptoms but that’s not the same as cure. That’s one thing I do disagree with traditional psychiatry about. I believe that recovery is attainable for many more people than the drug companies would have us believe. Happily though, so do many modern psychiatrists. People like me who advocate recovery aren’t so much joining the mainstream as the mainstream is catching up. That’s a nice feeling.
There are, of course many people who argue vehemently that psychiatry is flawed and that medication should never be ‘used on’ mentally ill people. However, sincere though I’m sure these people are, they may well fall into the same trap as the overly zealous arguments in favour of using too much medication. They may be too general.
Just as not all cases of psychosis seem likely to be chemical, so not all cases need necessarily be purely stress related. Whether the argument is in favour of medication or against it there is a real problem with polarisation and over-generalisation in mental health care. The disadvantage of these ‘black or white’ arguments is that they assume that everyone is the same and that everyone needs the same sort of intervention.
This sort of one-sidedness can feel easy and comfortable for those doing the arguing but there’s a price to be paid for superficial reasoning. The price is poor treatment because of flawed assumptions that compare chalk and cheese and assume that they are the same thing.
And that price is not generally paid by the individuals doing the arguing. It’s paid by the mental health service-user whose options for recovery are limited not by lack of knowledge but by stubborn refusal on both sides of the argument to look beyond their own, pet theories.
If I seem a little hard-nosed about this it’s for good reason. I was trained in the traditional way where medication and unquestioning acceptance of the biological hypothesis were everything. I was at the extreme ‘medical’ end of the continuum.
Then I was lucky enough to be selected by the NHS for further training at the Post Graduate level. I spent two years part time being exposed to the other side of the argument and, like many of my peers, became just as rabid in my defence of social and psychological perspectives instead. I was for a while the typical antipsychiatrist (or more accurately ‘antipsychiatric nurse’). And that felt good.
Today I’ve moved on a little from either of those two positions. Now I am able to see past the partisan posturing of either side and I try to walk the middle line. It seems to me that balance is everything. Isn’t that usually the case in the real world?
I no longer see much of a place for extremism in mental health care – especially when those who pay the price are not the ones making the arguments.
Please don’t misunderstand me though. I am far from an apologist for the biomedical status quo. I believe that medicine may well have something very positive to offer in relation to symptom management but in most cases that’s about all. I think that true recovery is generally achievable in other ways. But that’s for a later video.
To arrange training for your staff please complete the contact form below…
Today we consider the very first principle of Stoicism as defined by Epictetus in his handbook, The Enchiridion. What can we control and what can’t we control?
This means understanding the difference between problems and facts.
Stoics choose not to waste energy or emotional effort on facts that they cannot change – it’s pointless. Instead they work on things they can change, control or influence. That means they work on (and worry about) surprisingly little.
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Stoic philosophy isn’t the dry, humourless approach to life that many think it is. ‘Stoic joy’ comes from the ability to manage and control our emotions, the ability to choose our feelings without being blown this way or that by the winds of fortune.
Much of modern mental health practice comes from the wisdom of the ancient Stoics. Some of our most successful modern therapies are derived almost exactly from the Stoics whose philosophy leads inevitably toward happiness, contentment, self control and yes, joy.
This video series introduces the basic elements of Stoicism to a modern audience. It’s the antidote to the instant gratification, consumer culture that is the root of so much misery today.
To book training for your staff please complete the contact form below
We all have good days and bad days. That’s part of being human. We call it normal mood fluctuation. Sometimes we feel great. Other times… not so much.
It’s important to understand what this normal mood fluctuation is about. And what it’s not. Feeling fed up or ‘a bit sad’ is NOT a depressive illness. If your mood has been low for a few days, or even less because of a personal tragedy, or even without a tragedy, that’s not depression.
Depression lasts weeks and months.
Depression is an illness with physiological symptoms.
Depressed people have trouble with sleep… With appetite… With concentration… With movement… It’s much more than just a low mood.
So when you feel a bit sad don’t assume you need antidepressants and run off to the the doctor to get some. It’s OK to have good days and bad days That’s part of the human condition It’s part of being who we are.
And when you meet someone who really is depressed, understand that they’re experiencing something far more profound than being ‘a bit sad’. They’re not about to pull themselves together, howeer much you tell them to. If they could have done that they would have done so already.
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