Monthly Archives: April 2016

Q – #AtoZChallenge on Mental Health

Welcome to the letter Q post in the #AtoZChallenge on mental health. This letter was hard at first, but I still came up with a few words. Here goes.

Quality of Care

Quality of care is important mainly to health insurers. That is, it’s not necessarily the real quality of care that’s importnat but how it’s documented in paperwork. As such, we often get patient satisfaction questionnaires. I think they’re worthless. So is the endless stream of paperwork staff have to complete to justify the care they provide. After all, the more staff have to deal with paperwork and patient satisfaction questionnaires, the less they can actually do the real work of care.

Quality of Life

Another loaded term which is used to assess people’s satisfaction with their lives. We get this scale called the Manchester Short Assessment of Qualty of Life questionnaire four times a year. I laugh at the randomness of questions. Like, inbetween questios about your satisfaction with friendships, your financial situation and such is the question whether you’ve been accused of a crime within the past year.

Seriously though, quality of life assessments have real impact on care and policies. For example, if a lot of people treated in a certain way for a certain condition have a very poor quality of life post-treatment, this treatment is unlikely to be used often in the future.

Quiet Room

The “quiet room” or “time-out” is an euphemism for seclusion or the isolation room. Many survivors of forced psychiatric treatment report very traumatic experiences with the “quiet room”. Others find it helpful when they’re severely disturbed, because they can scream there. I have mixed experiences. When I was still on a locked unit, it was often used as a threat to “give me back my responsibility for my behavior”. Seclusion cannot legally be used in this way in the Netherlands; its only purpose can be to avert danger. Now that I’m on an open unit, however, I find sometimes when I’m in crisis that it helps to have me in seclusion for a while.

P – #AtoZChallenge on Mental Health

Welcome to day 16 in the #AtoZChallenge on mental health. Todays’letter is P. There ae many obvious mental health terms starting with P, but also some you may not know.

Privileges

Privileges are what freedom of independence and movement someone has while in the mental hospital. In Believarexic, the book by J.J. Johnson I read a few months ago, the main character rightfully says that what are called privileges in the mental hospital are basic rights in the real world. For example, every adut in the real world is allowed to shower independently, whereas some people in mental hospitals need to do such basic tasks under staff supervision.

Of course, restrictions to someone’s freedom even in the mental hospital need to be motivated. If a person isn’t a danger to themself or others, they should really be allowed to go wherever they want unless this is a hindrance to their treatment. What I mean by this is of course even a person with full privileges should show up for their treatment appointments. Usually, even people with full privileges need to ask for permission from their clinician to leave the hospital overnight.

Psychiatrist

A psychiatrist is a medical doctor specializing in mental illnesses. NOwadays, they’re commonly seen as human pill dispensers, because prescribing medication is their primary task. However, in the Netherlands every psychiatrist is also a qualified psychotherapist. A psychiatrist is usualy a person’s head clinician. Head clinicians are the only ones who can open diagnosis-treatment combinations in the Netherlands. Diagnosis-treatment combination is insurance lingo for the patient’s diagnosis and the treatment that is suited to that diagnosis according to protocols. As such, a head clinician is the only one who can change a patient’s formal diagnosis. By the way, clinical psychologists and psychotherapists can also be head clinicians.

Psychologist

Psychologists do most of the talk therapy part of mental health treatment. There are three levels of psychologists employed by mental health agencies in the Netherlands. Basic psychologists are fresh out of college with a Master’s degree in psychology. We have a basic psychologist employed at my unit but I’m clueless as to what his duties are. Anyone can call themself a psychologist. Then there is the health care psychologist, which is in fact a protected title. Only someone who has completed two years of additional trainign after college and is licensed can call themself a health care psychologist. This is the most common type of psychologists employed by mental health agencies. They can do basic psychotherapy but cannot be head clinicians. Last are cliniical psychologists, who’ve got two more years of specialized training and many also have a Ph.D. These people can be head clinicians and do more specialized psychotherapy too. Clinical psychologists are often assigned to the more complex cases. My unit currently does not employ a clinical psychologist.

Psychotherapy

There are many forms of psychotherapy, both individual and in a group. Psychotherapy usually employs talking to help the patient recover, though some psychotherapies are partly non-verbal too. In many countries, the term psychotherapist can be used by anyone who so desires. Not so in the Netheraldns: psychotherapists are psychologists who’ve had I believe it’s four years of training in psychotherapy techniques. They are bound by the same laws as doctors and health care and clinical psychologists. A psychiatrist is registered separately as a physician and as a psychotherapist. As such, they can lose one license but keep the other. I once read about a psychiatrist who mostly practised psychotherapy and due to abuse of power lost his license, but only his physician license at first.

O – #AtoZChallenge on Mental Health

Welcome to the letter O post in the #AtoZChallenge on mental health. Here goes.

Observation

Observation is an essential part of a patient’s care in a mental hospital. In other countries, I’ve heard staff are supposed to check on patients every fifteen minutes or so. Not here. In the Netherlands, if a patient is in their room all day – and yes, most mental hospitals allow this -, no-one cares whether they’re in bed or engaged in some type of activity. Even if patients are in the day room, nurses are more often than not in the office doing their business. As such, I have experienced that nurses “observe” that I had a good day while I was in bed feeling too low to get out all day. Then of course when patients are acting out, nurses have to intervene and “observe” the patients’ misbehavior. This is a pretty sad reality.

One-on-One

One-on-one care is where a staff member is assigned to just one patient who needs a lot of care. This is sometimes also called hand-in-hand care. Few mental health units in the Netherlands offer true one-on-one care even to the sickest of patients. Usually, when a patient needs one-on-one support, they are in a seclusion room most of the time and are allowed out to get their one-on-one attention. I’ve heard about real one-on-one care in other countries. Wonder how they fund it.

Outpatient Treatment

Outpatient treatment is often defined as treatment for which the patient has to come to the mental hospital at fixed times during the week or month. However, home treatment, where the mental health provider comes to the patient’s home, is becoming more and more used especially for severely mentally ill people.

Often, care for mentally ill people starts with outpatient treatment. The last step in treatment, after the patient is discharged from the hospital, is also outpatient treatment. This is called stepped care: a person is only stepped up from outpatient to partial hospitalization or inpatent treatment if they need it and is stepped down to outpatient care as soon as possible.

N – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, day 14. Today’s letter is N. Another late post, because I slept through the day yesterday so wasn’t able to schedule it. Here goes.

Neuropsychiatry

Neuropsychiatry is the branch of psychiatry specializing in the effects recognized brain diseases have on people’s mental health and behavior. Of course, mental illnesses have a biological component too, but neuropsychiatry is particularly interested in conditions like epilepsy, Parkinson’s Disease and brain injury. Some psychiatric institutions have specialized neuropsychiatric units or outpatient clinics. Mine has both. The inpatient unit is mostly for people with brain injury. In my institution, a neurologist is in charge of directing the care on this unit.

Neurotransmitters

Neurotransmitters are chemicals that the brain cells use to communicate. They commonly have multiple functions, hence the side effects of psychiatric medications affecting neurotransmission. Well-known neurotransmitters are serotonin and dopamine.

Serotonin is thought to play an important role in mood. A deficiency in it can cause mood disorders, such as depression or bipolar disorder. Unfortunately, an excess of serotonin caused by antidepressant use can cause serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome is particularly associated with a type of old-school antidepressants called MAOIs.

Dopamine plays a role in different physical and mental functions. Dopamine is necessary for movement. Parkinson’s Disease is caused by a degeneration in the dopamine-producing cells in the brain. On the other hand, an excess of dopamine is linked to psychotic symptoms. First-generation antipsychotics (such as Haldol) block the brain receptors for dopamine. Like I said however, dopamine is necessary in movement. Hence, peoople on first-generation antipsychotics commonly experience tremors and muscle stiffness similar to Parkinson’s patients. This movement disorder associated with antipsychotic use is called Parkinsonism.

Nicotine

Many people with mental illness smoke. Among people with schizophrenia, as many as 90% do. It is well-known among smokers that cigarette-smoking relieves stress. This coul be psychological dependence though. However, research shows that nicotine actually helps decrease psychotic symptoms specifically. It is not just a matter of psychological dependence on nicotine that causes people with schizophrenia to experience fewer symptoms after smoking. As such, schizophrenics might unknowingly use nicotine as self-medication.

Nurse

Obviously, mental hospitals employ nurses as support staff. Their primary tasks are to observe and facilitate the patients’ day-to-day functioning. Obviously, administering medications is a common task. However, nurses also use psychosocial interventions.

Community psychiatric nurses (CPNs) are employed by outpatient clinics to help support patients in the community. They often do some form of psychosocial counseling and are also often employed as case managers. As such, they do some tasks formerly done by social workers.

M – #AtoZChallenge on Mental Health

Welcome to the letter M post in my #AtoZChallenge on mental health. We’re finally halfway through the challenge. It’s proving pretty hard for me. Particularly, I’m finding it hard to comment on others’ posts regulalry. Sorry about that. This letter was an easy one.

Medication

Medications are usually believed to be an essential part of treatment for severely mentally ill people. The most common psychiatric medications used are antipsychotics, antidepressants, mood stabilizers and benzodiazepines. I will discuss benzodiazepines separately.

Practically everyone on a long-term inpatient unit takes an antipsychotic. It seems every psychiatrist has their favorite medication of first chooice, though a large number of patients take clozapine. This is not the antipsychotic of first choice, since it can cause potentially fatal side effects, but many people on long-term units are treatment-resistant. Other well-known antipsychotics are aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).

Commonly-used antidepressants include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). These belong to the newer class of antidepressants, called SSRIs. Venlafaxine (Efexor) is an example of an even newer class, called SNRIs. It isn’t as commonly used though. (Efexor in partiuclar was heavily promoted by big pharma in like 2008 but it seems it’s not the wonder drug originally thought.) When people have treatment-resistant depression, they may get older antidepressants (tricyclics of MAOIs) or an antipsychotic (particularly Abilify) may be added. Mood stabilizers are primarily for people with bipolar disorder. Lithium is th most well-knwon mood stabilizer, but anticonvulsants (originally intended for people with epilepsy) are becoming more and more commonly used.

Mindfulness

Mindfulness is one of the recently hyped-up treatments for mental health problems. There are mindfulness workbooks for everything from depression to bulimia to obsessive-compulsive disorder. Mindfulness can be a great part of psychotherapy, but of course it isn’t for everyone.

Movement Therapy

Movement therapy utilizes exercise, yoga or other movement-based techniques in the treatment of mental illness. Exercise can alleviate depression and anxiety. Relaxation techniques are also used in movement therapy. Often, a movement therapy session consists of first doing an exercise and then talking it through with the therapist. Movement therapy can be done both in group and individual settings. I have experience with both and it’s been a help in channeling my irritability..

Music Therapy

Like movement therapy, music therapy is a form of non-verbal therapy for mental illness. I have never had music therapy, because it wasn’t offered at my old institution, and I get the impression that most people here use it to learn to play an instrument. For some though, merely listening to music can be healing and may be part of music therapy.

L – #AtoZChallenge on Mental Health

Hi and welcome to the letter L post in the #AtoZChallenge on mental health. I did not have the energy to schedule this post in advance, because I was extremely tired over th =e past few days. Sorry for that. Here goes.

Lethargy

This is quite a suitable word for today. Lethargy means being overly tired and also often being unresponsive, not very alert. Lethargy can be both a side effect of sychiatric medication and a symptom of psychotic disorders, although in that case it usually presents differently.

Loneliness

Loneliness and aloneness are pretty common among psychiatric patients. Some people’s mental illness causes them to self-isolate, while other people suffer from being isolated from others. To combat loneliness, many support organizations for people with mental illness have buddy programs that pair a client with a volunteer.

Long-Term Care

Many people with severe mental illness need care throughout their lives. Outpatient care, even if it’s for life, is covered through health insurance or community assistance. There are strict limitations on outpatient care and people need to be re-assessed regularly. In the Netherlands, the Long-Term Care Act only covers long-term inpatient treatment for the mentally ill and institutionalization or supported housing for people with other severe disabilities. People with mental illness who lived in supported housing when the Long-Term Care Act went into effect in 2015, have five years of transitional rights to supported housing care, after which they need to get re-assessed. They may then get approved for care through the Long-Term Care Act, which is essentially for life. People with other disabilities who lived in institutions or supported hosuign by 2015, got approved for the Long-Term Care Act automatically.

In the original draft of the Long-Term Care Act, people with psychiatric disorders were ineligible for long-term, institutional care. Eventually, they are now eligible only if they’ve been in inpatient mental health treatment for at least three years. I wonder what this means if I fail at living with my husband, since I have been an institution patient for over three years but didn’t apply for LOng-Term Care Act funding right away.

K – #AtoZChallenge on Mental Health

Welcome to the letter K post in the #AtoZChallenge on mental health. I have only one word for you that is truly related to long-termmental health care and a few that are only perceived to be related. Here goes.

Keys

There is a joke that the differences between the patients and staff on a mental unit are, among others, that the patients get better and leave and that the staff have the keys. There are of course the locked units, where the staff have the keys to open the door of the ward. Even on open units, some rooms and cupboards are locked. This goes of course for the medicine room and cupboard, but also on some units the kitchen cupboards are locked so that patients can’t get food outside of meal times. My side of the unit is the only one where kitchen cupboards are open during the day. I was very surprised to find out that, not only are the cupboards locked on the other side of our unit, but on other units, the entire kitchen gets locked sometimes. This means people can’t even have tea when they want to.

Killers

Like I said before, some people get to the mental hospital on a forensic section. I don’t honestly know of most patients with a forensic status what crime they were convicted of. As such, it is totally prejudiced to assume some are killers – except that some people within the general population are killers too. People with psychotic disorders, which are the most common type of disorders in long-term mental health, don’t tend to kill random people even if they are violent. For clarity’s sake: most people with mental illness are not violent and the evidence is mixed on whether people with mental illnesses are more likely to become killers than those who don’t have a diagnosis. Some mental disorders do predispose people to criminal behavior, such as psychopathy or its milder variant antisocial personality disorder. Other disorders do not.

Kleptomania

It is a common belief that theft is particularly common in institutions, both mental and otherwise. I don’t know whether this is true. I for one have *knock on wood* not had anything stolen from me.

Kleptomania though is a compulsion to steal. It is not the same as someone stealing believing (delusionally) that an item is theirs or wanting the money to buy drugs or anything. Kleptomania is about stealing for stealth’s sake. Kleptomaniacs may even steal worthless items. Kleptomania does not usually lead peope to become institution patients. After all, theft is not serious enough a crime to get someone on a forensic section. Kleptomania is an impulse control disorder. Other such disorders, such as pyromania and intermittent explosive disorder, do potentially lead to serious enough crimes.

J – #AtoZChallenge on Mental Health

Welcome to the letter J post in my #AtoZChallenge on mental health. This is one of the hardest letters – I mistyped it in the theme reveal. I’ve come up with just two words and they’re not very related.

Jobs

Mentally ill people are particularly likely to be unemployed. Like I said when discussing experience, some institutions create special jobs for people with mental illness to work as recovery or experience workers. These are paid jobs not suited for people in long-term inpatient care, although they are very suitable for people who have overcome a long-term institution life. People still in long-term care can become part of a recovery group. This is often seen as volunteer work and earns you around €10,- for two hours a week of attendance.

People who are long-term institution patients of course have to do something during the day. Some of these activities are simple industrial or administrative duties. At my old institution, these were purely seen as day activities and didn’t earn you any momey. At my current institution, patients doing this work earn like €1,- an hour. That’s still only a small percentage of what people in regular employment earn, of course – minimum wage islike €10,-. People doing this type of work often still call it their “job”. People doing creative day activities usually don’t.

Juvenile

Children can get mentally ill too, of course. I recently read that as many as 30% of children in the UK have a diagnosed psychiatric disorder. Now I assume this includes autism and ADHD, which are not always seen as a mental illness. However, among older children and adolescents is also a significant number of sufferers of depression, anxiety and eating disorders. Even among younger children, mental illness can happen. I even heard of psychiatrists specializing in infant and toddler mental health.

Most mental health agencies serve people of all ages, but there are also separate children’s mental health agencies, especially for inpatient treatment. Even those agencies that serve all ages have separate units and treatment teams for children and adolescents. In the Netherlands, after all, child mental health care is regulated by the Youth Act rather than the various laws regulating adult mental health care.

I – #AtoZChallenge on Mental Health

Welcome to the letter I post of my #AtoZChallenge on mental health. This was a hard letter again, but I stil have a few words for you. Here goes.

Intramuscular Injections

Antipsychotics can be taken by mouth, but many can also be injected in a patient’s muscle. That way, they need to be administered only once every week or two rather than taken daily, because in a muscle, they’re absorbed slowly and steadily. Intramuscular injections, also caled “depot medication”, are often used on patients who refuse oral medication.

Involuntary commitment

Like I said in my letter D post when discussing danger, patients who are a danger to themselves or others can be committed to a psychiatric hopsital involuntarily. In the Netherlands, there are several ways a patient can be committed involuntarily. In acute situations when a patient is a grave danger to themselves or others, they can be taken into care with the mayor’s approva. Usually, this takes the form of a simple phone call by a psychiatrist to the mayor (or their substitute), who will almost automatically give the go-ahead. A judge will see the patient committed this way within a few days and approve or deny the involuntary commitment. An acute section lasts three weeks and can be prolonged with another three weeks once.

If a situation is less of an acute problem or after at most six weeks on an acute section, a patient can be brought to a judge for a longer section. A patient does not need to be an immediate and grave danger to themselves or others; merely being a danger suffices.

There are two newer forms of commitment too. First, there’s the observation section, which lasts three weeks and is meant for people who haven’t yet been diagnosed with a mental illness and aren’t a grave, acute danger either. A patient on an observation section can’t be subjected to force. A patient who realizes they might become a danger at some point, can file for self-commitment, indicating they will be admitted to a hospital and treated if certain criteria have been met, whether they want to at this time or not.

A patient can’t at this point be forced into outpatient treatment unless through a provesional section, threatening involuntary inpatient treatment if they don’t comply with their treatment plan while in the community. The government is trying to change the law so that patients can in fact be forced into any form of mental health treatment.

A Day in the Life of My New, Healthy Self

I started in a whole health journaling challenge on April 1. Unfortunately, due to fatigue and depressed moods setting in this week, I’ve not been able to do much of it. I finished the third journaling exercise, which has me envisioning a day as my new, healthy self. It was quite inspiring. Here is what I wrote.

I get up in the morning at 7 or 8AM. I shower, get dressed and have a healthy breakfast of yoghurt with muesli or a breakfast smoothie. I take my medication and brush my teeth. I may go to day activities to do snoezelen, swimming or go for a walk. Day activities will help me find companionship. I go on the elliptical trainer in the morning while listening to upbeat music.

For lunch, I have some bread. I may have another smoothie or some fruit. In the afternoon, I journal and go on the Internet for blogging and reading blogs and Facebook. When I live with my husband or if I have WiFi while in the institution, I watch some old TV online. I may go for a walk. Most importantly, I don’t sleep in the afternoon.

I meditate or pray in the afternoon too and read my Bible. I do some yoga in the afternoon as well. Either this will be the sun salutation I learned from my activity staff or I will hopefully learn some new series of poses.</P

In the evening, I eat a healthy meal. While still in the institution, I try to eat a bit of everything served. (I obviusly do the same when my husband cooks, but he usually cooks meals I like.)

I don’t sleep in the evening either. Instead, I go online, read a magazine or book. I go to bed at 10PM. I brush my teeth again before bedtime.

As you can see, I’m not 100% sure whether I’ll achieve this new, healthy state of mine while still in the institution or once I live with my husband. INitially, after writing this entry, I was completely motivated to start right then and there. I wrote my entry in the afternoon, so I decided to try a bit of everything served for supper that day. I have been doing well in this department – the only thing I skipped this week were mashed potatoes. I also did well in having healthy breakfasts each day. I also went on the elliptical a few times, though not in the mornings.

However, I’ve not been doing well in the sleeping department. I slept during the day almost each day and some nights have been pretty much sleepless. I also still need to get into the habit of brushing my teeth twice a day. My spiritual self-care is a mixed bag: I did yoga and meditation a few times but didn’t read the Bible or pray.

My biggest hurdle so far is to get into a healthy circadian rhythm. I think getting myself out of bed may give me energy rather than the other way around, but I’m not 100% convinced. I need to try this at least.

Small Victories Sunday Linkup