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Boxed-in: the treatment of those with physical health and mental health conditions

There needs to be an overhaul of the way patients with complex care needs are treated, writes RUTH HUNT

WE ARE a long way off from achieving parity of esteem between psychiatric patients and general patients in terms of availability of treatment, waiting times and the quality of treatment.

With different funding streams, priorities and targets, it means rather than looking at an individual holistically, they are separated into boxes. 

We already know the pressure this places on those who work in health and social care provision, but what about the patients and staff on the ground?

The reality is for those who have a psychiatric condition along with a physical disability or chronic illness and are admitted to either a general or psychiatric ward, the lack of knowledge from staff has contributed to a litany of incidents, putting the health of the patient at risk. 

One such case involved a man with schizophrenia who was arrested on a psychiatric ward for being aggressive, which was out of character for him when well or unwell. 

It transpired he had undiagnosed diabetes and the “aggression” was a hypoglycaemic episode. He ended up in a coma and died.

Another case involved a teenager with bipolar who absconded from hospital and fell from a height. 

He was taken by ambulance to the general hospital. They took an X-ray but when they couldn’t see anything, they cleared him to return to the psychiatric hospital. 

Back on the ward the staff got annoyed with him lying on his bed, so forcibly attempted to get him on his feet. Luckily his family had arranged an emergency appointment at the nearest spinal unit, where he had a scan. 

He had broken his second lumbar vertebra and was immediately admitted on to the spinal ward.

Along with such incidents, access on psychiatric wards is a common problem. Grab rails have been removed due to ligature risk, but that poses a major problem for those with physical disabilities. 

Pressure-relieving mattresses and other specialist products often have to brought in by family members.

Alison Cameron, 53, knows these accounts are all too familiar. Some months ago, she was in acute pain and referred to the pain clinic of the general hospital. 

Rather than listening to her symptoms, it was assumed — because of her mental health diagnosis — the pain was psychosomatic. 

Due to her persistence, an MRI scan was reluctantly ordered “to reassure her it was nothing.” 

The scan revealed a large growth in her uterus, which required a full hysterectomy.

The treatment she received, as a survivor of rape, was gruelling and triggered her post-traumatic stress disorder (PTSD). 

Following the surgery, the impact both physically and mentally led to severe anxiety, which progressed to her not taking care of herself. 

The increasingly suicidal thoughts which followed resulted in her being admitted to a psychiatric ward. 

She was worried how the psychiatric hospital and staff would manage treating both her physical health and her mental health problems. 

It wasn’t long before she found out: “I had an attack of severe pain, but the ward was ill-equipped to source even the most basic pain relief.  

“Not only that but staff seemed resentful that this pain had started on a bank holiday.”

Cameron felt the knowledge and ability to care varied among the staff: “Those who came from a general nursing background had a far greater understanding and in terms of my care could see how a life-changing physical diagnosis impacted on my mental health. 

“However, such staff aren’t the norm, most have tunnel vision regarding the interaction between physical and mental health.

“That led to the familiar feeling of having to split myself into separate compartments in order to fit into a fundamentally fragmented system. 

“At times, I felt invisible on the ward. When the staff did their ‘checks’ (which consisted of staff using a sheet on a clipboard to tick off patients) I was asked how I was. 

“It was clear I was in distress, but the nurse moved on without any interaction with me, other than him ticking a box. 

“I am used to feeling negated in the mental health system but now in such a vulnerable position it was particularly dehumanising.”

A spokesperson for the Royal College of Psychiatrists said: “The potentially life-threatening consequences of people not having their mental health assessed when receiving physical treatment, and vice-versa, shows why all front-line staff must be trained to identify and understand mental illness and why people with known mental illnesses should be able to access regular physical health checks.  
 
“While progress has been made, we are still some way off achieving parity of esteem between mentally ill patients and patients with physical conditions. 

“We know that the life expectancy of mental health service users is more than 16 years lower than the rest of the population. 

“Training all front-line staff to spot mental illness and ensuring mental health service users have better support for their physical health will further equalise physical and mental health care.”
 
With Cameron being a former governor for a mental health trust, she has some ideas for what could improve the situation for those with physical and/or learning disabilities and mental health problems.

Her first issue is that there needs to be a greater emphasis in nurse training about diagnostic overshadowing — where mental health staff assume every symptom is due to a diagnosed metal health condition, leading to physical health symptoms being missed and left untreated.

“Staff also need to be trained to treat those with a learning disability,” Cameron said. 

“I have witnessed particularly poor treatment for patients who have autism, for example. Wards are rarely fully accessible, and this also needs addressing.”  

A second point of concern relates to the power imbalance between physician and patient. 

As Cameron pointed out: “There is insufficient respect for the knowledge those of us have of living with an often complex combinations of conditions. 

“There needs to be a move from the parent/child relationship towards a relationship where clinical and lived expertise are considered of equal worth.”

Unless these points are properly addressed the system will remain reliant on putting people in separate boxes. 

“The care in each specific box may be excellent,” Cameron conceded, “but it is the gaps between them, where the dangers lie.”

Ruth F Hunt is an author and freelance journalist.

Alison Cameron is an activist and writer, you can find some of her work in the book The Patient Revolution: How We Can Heal the Healthcare System, edited by David Gilbert (Jessica Kingsley Publishers).

Whatever you’re going through you can call Samaritans free of charge on 116 123, any time day or night. Or you can email jo@samaritans.org.

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