Monthly Archives: April 2016

H – #AtoZChallenge on Mental Health

Welcome to the letter H post in the #AtoZChallenge on mental health. I’m very tired but still managing to schedule my posts in advance. I hope the week-end brings some relaxation. Anyway, here goes.

Handover

The nurses’ discussion of patients at the end of one shift and the beginning of another. At least, they’re supposed to discuss patients but may discuss whatever’s on their minds. Handover, like evening and afternoon breaks for nurses, tends to last much longer than it’s supposed to.

Homelessness

A significant number of patients on long-term inpatient units don’t have a home outside of the institution. Some have actually been homeless before they were admitted to the hospital, while others, like myself, gave up their housing. I didn’t have a home for over 2 1/2 years between giving up my student accommodation in 2010 and getting the small town apartment with my husband in 2012. Unfortunately, if your official residence is the institution and you want to rent a home later on, the housing corporations may make a problem out of it. It wasn’t too bad when I got the apartment – they just needed my psychologist’s approval to move -, but I’ve heard of people being kicked off the housing list for being institutionalized.

Hormones

Hormones are often thought to play a role in mental health, especialy if the problems start in puberty, during or after pregnancy or during menopause. Postnatal depression or anxiety is fairly common, although skeptics believe it’s a fictional disease. Unfortunately, when people get ill and hormones are being blamed, they may miss out on potentially sanity-saving treatments. The reverse is, of course, also true: people getting treated with psychotropic medications when really their hormones are acting up.

Hygiene

Hygiene is often a big issue for mentally ill people. Of those in long-term inpatient units, most, including myself, need reminders or even bribing to get showered, use deodorant or brush their teeth. With some people, staff leave this responsibility with the patient, but with others, they’re very asseritve in their attempts to get the patient to take proper care of themself.

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G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.

Gender

There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.

Genetics

When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.

Geriatrics

Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.

GP

Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

F – #AtoZChallenge on Mental Health

Welcome to my letter F poost in the #AtoZChallenge on mental health. I hope you are enjoying and learning from the challenge so far. For this post, I have a few new words for you.

Food

No, I don’t mean to discuss how mental illness impacts one’s relationship with food, though it can often change ot “It’s complicated”. I want to discuss institution food. Yes, it is as bad as you thought it’d be. We used to be able to pick something that wasn’t too bad off the menu, but now that we get the food in bulk, the nurses decide what everyone will eat. It’s so bad that if you’re a vegetarian new to the unit, you may need to wait a week or two before you get your veggie burger. I don’t know whether the same is true if you have a food intolerance.

Force

I’ve discussed words that relate to this one, such as control and dependence. Force can only be used on people who are invooluntarily committed to the hospital or in emergency situations. For example, if someone is attacking a nurse, they don’t need to wait to get the patient sectioned before using solitary confinement or rapid tranquilization. Though force cannot be used unless a patient has been involuntarily committed or there’s an emergency, coercion can be used pretty much whenever the staff see fit. In 2008, when I was on the locked unit, I was threatened with a section or forced discharge if I didn’t consent to solitary confinement.

Forensic Unit

Until the early 1990s, the only forensic psychiatric units that existed in the Netherladns were either state hospitals or specific prison units. A person can’t be sent to a state hospital on a forensic section unless they’ve committed a violent or sexual crime. In fact, until a few years ago, people who had merely threatened violence could only be sent to a state hospital for four years at most.

Now, many regular mental institutions have forensic units. These are used as a step down from a state hospital for people who are ready for resocialization or for people convicted of less serious crimes. Forensic psychiatric units also serve people who are at risk of coming into contact with the criminal justice system.

E – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter E. This is one of the harder letters. However, I still was able to come up with several words for discussion.

Eating Disorders

Eating disorders, which include anorexia, bulimia, binge eating disorder and unspecified eating disorders, are among hte deadliest mental illnesses. This is not just because of the physical effects eating disorders have on their sufferers, but also because people with eating disorders are particularly likely to be suicidal. For clarity’s sake: you can’t tell whether someone has an eating disorder by looking at them, because people of any size can have eating disorders. The core of eating disorders is also often not about what or how much one eats, but about one’s thoughts regarding oneself and one’s eating habits.

Emotions

Emotions are an essential part of human experience. They are often affected by mental illness. An emotion is different from a mood, in that emotions last for a short while whereas moods describe one’s overall affective state over a longer period of time.

Equality

Disabled people, including mentally ill people (yes, mental illness is a disability!), make up the largest minority in the United States and probably elsewhere too. The fight for equality for people with mental illness was started in the 1970s with the antipsychiatry mvement. However, you don’t have to believe that mental illness is a social construct to want equality for mentally ill people nowadays.

Experience

I was inspired to share about experience when someone commented on
another post in the challenge that few mental health professionals have been on the other side of the desk. In the Netherlands, many mental health agencies employ “experience workers”, which are people with a (history of) mental illness who have had additional training in using their experience in the support of other people with a mental illness. Most assertive commnity treatment teams, which are intensive outpatient treatment teams for people with severe mental illness, employ such experience workers. The education of experience workers used to be mostly informal, but now there is even a full college track in social work with mental health experience.

D – #AtoZChallenge on Mental Health

Welcome to my letter D post in the #AtoZChallenge on mental health. Today, I have quite a few words to share with you again.

Danger

In the Dutch mental health act, people can be involuntarly committed to a mental hospital if they’re a danger to themselves or others. Danger can refer to many things, including self-harm or aggression, but also to “social disintegration” or “eliciting other people’s aggression with one’s behavior”. In other words, if you’re plain irritating, you’re a “danger” to yourself.

Dependence

With the current rehabilitation model of psychiatric care, we’re not supposed to become dependent anymore. That is, we can clean our rooms and do other household chores, but often only when told to. I have often experienced the same sense of dependence no matter whether practical independence was encouraged or not.

Depression

One of the more common mental illnesses within the general population. It is not as common among long-term mental hospital inpatients, although some will claim they feel “depressed”. That usually refers to minor, everday depression. I was once screened for depression because a mental nurse insisted I get screened after teling him how low I felt. Being borderline, I often feel slightly depressed but my emotions also shift rapidly.

Diagnosis

What the mental health professionals say is wrong with you. You need a primary diagnosis, which dictates practically everything about your treatment. If you happen to have more than one mental disorder, too bad.

Discharge

When you’re let out of the mental hospital or, in outpatient treatment, when treatment is discontinued. Discharge is usually a mutual agreement between the patient and their treatment provider. An exception is involuntary commitment, when someone can be discharged when their section runs out. People can also be forcibly discharged if they have improved so much that they no longer need the mental hospital, have broken the hospital rules multiple times, or refuse every treatment offered.

Drugs

This can refer to either the drugs handed out like smarties by mental health professionals or to the street drugs patients get in the hospital parking lot. Seriously, drug dealers wait right outside of a mental hospital and patients with privileges will get their (and other people’s) drugs. Outside of my unit is a billboard that says drug use is prohibited, but I’ve smelled people smoke marijuana and who knows what else right next to the billboard.

C – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter C. Today, I have quite a few words to discuss with you.

Care Plan

When I first entered the world of care, I didn’t have a care plan. They were just starting this up at the blindness rehabilitation center and I was among the last who didn’t have one. I hated it, because I thought a care plan meant I’d actually get better care. That’s the idea. It doesn’t work that way in real care.

Care plans in mental health are part of treatment plans but not the same. They list the patient’s goals for a particular time period, the help a patient will get and the risks if the patient doesn’t get that help. Care plans are framed in a very rigid format. As such, they cannot accommodate all the varied problem areas a mental patient might experience. The care plan also needs to conform to one’s care package, which is the amount of funding allocated to a patient’s care. Then again, care plans are also used to justify funding. If this isn’t a circular argument, I don’t know what is.

Caseload

A treatment or care provider’s caseload is the number of patients assigned to them. In intensive outpatinet care, one professional might have a caseload of ten patients. Usually, their caseload is much larger. Caseloads are related to how much care a person is allocated again. For instance, as a person in my care package category, I’m only allocated 50 minutes of “treatment” a week. This includes psychotherapy or counseling, social work, medication management, etc.

Comorbidity

This is the co-existence of two or more mental illnesses in one person. Many people in long-term psychiatric care have more than one diagnosis. Interestingly, a “dual diagnosis” refers specifically to a mental illness and an addiction co-existing.

Control

I once read a list of things typical to institution life, and at the end, the list went: control, control, control. Even though the philosophy of mental institutions has changed over the past several decades to “allow” patients more independence and to rehabilitate us, this has become its own framework of control. I have had many battles with nurses who said that, because this is a treatment unit, I should be able to do daily activities independently, despite the fact that I can’t do most of these.

B – #AtoZChallenge on Mental Health

Welcome to my letter B post in the #AtoZChallenge on mental health. This is a much harder letter than A was, but I still found some interesting terms in mental health starting with the letter B.

Behavior

Behavior is defined on Wikipedia as “the range of actions or mannerisms by individuals in conjunciton with themselves or their enviornment”. Well, it does not include just individuals, but also animals, artificial entities, etc., but the full definition is way too complex to go into here. The bottom line is that behavior includes all actions a person (or animal, artificial entity, etc.) conducts in interaction with themselves or their environment. Everyone exhibits behavior, sometimes not even consciously.

In mental health care, however, “behavior” has a different meaning. It refers not to everything a person does, but to specific actions that are supposed to say something about their mental health. “Behavior” then becomes a sign of mental illness. Worse yet, when a mental nurse says something is “behavioral”, they usually mean it’s willful. “That’s behavior”, is a mental nurse-ism for “you are willfully acting inappropriately”.

Biomedical Model

This is the model which sees illness as a direct result of dysfunction in the body. The biomedical model, when applied to mental illness, sees mental illness as purely a chemical imbalance or a brain disease. Proponents of the biomedical model use only medications or other biological interventions (eg. brain surgery) to treat mental illness. There are hardly any doctors who subscribe exclusively to the biomedical model, especially in mental illness.

Bipolar Disorder

Also known as manic-depressive disorder, this disorder is characterized by alternating episodes of major depression and mania. Mania is a state of elation where a person is overly active, reckless and impulsive and/or irritable. Some people in a manic phase spend thousnads of dollars they don’t have on things they don’t need. Bipolar disorder is not about mood swings. Rather, the depressive or manic phases last for at least a week for mania and two weeks for depression, often longer. Some people in manic states experience psychosis too. Then we get the well-known delusion of gandeur. Please note that being convinced you are Napoleon does not make you bipolar per se. Bipolar mania, as I said, also includes increased activity, impulsivity and irritability.

Borderline Personality Disorder

I have this diagnosis and it’s really one of the most misunderstood mental illnesses by mental health professionals. The lay perception (and perception by some professionals) of BPD is one of a woman who threatens suicide when a friend doesn’t answer the phone within five seconds. She has one boyfriend after another, with whom she picks fights then five minutes later makes love. She doesn’t show up for therapy appointments, but demands her therapist make time for her whenever she does show up, then when they refuse she runs in front of a slow-moving car saying she’s going to kill herself. That last one was a true example from my psychology textbook, seirously.

Surprise: this is not what BPD is like in most cases. Firstly, BPD occurs almost as often in men as in women but is underdiagnosed in men and overdiagnosed in women. Secondly, BPD is characterized by emotion regulation difficulties, which means a person’s emotions can shift rapidly. People with BPD often do engage in self-injurious or suicidal behavior. They also have an intense fear of abandonment, which leads some to fall in and out of love very rapidly. Borderlines do outwardly look like they are manipulative bitches sometimes, but inwardly, they suffer tremendously from their rapidly shifting emotions. They do not demand excessive attention per se (like people with histrionic personality disorder do) Learn more about what it’s like to suffer from BPD.

On long-term mental units, you don’t see many people with BPD, because standards of care dictate they can only be admitted very briefly for crisis intervention. Us borderlines are supposed to get dependent otherwise. Well, I can tell you, I know people with other diagnoses who are much more dependent than I am.

A – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health. I discussed many topics related to mental health already last October for #Write31Days. As I menitoned in my theme reveal post for the #AtoZChallenge, I’m going to give short descriptions of several words for each letter (sometimes though I have only one). For today, my letter A post, I have quite a lot of words. Here goes.

Acute unit


Also called “admission unit” in the Netherlands, here is where people go if they’re in crisis. The acute unit is for short-term treatment only: up to three months. Even so, some people stay there much longer. Like, I spent sixteen months on an acute ward because the rehabilitation unit didn’t want me.

Addiction

Though addictions are typically treated in separate units or even by separate agencies than mental illnesses, many people with a mental health diagnosis also have an addiction.

Admission

The process of getting admitted to a psychiatric unit. If people are admitted to an acute unit, this is usually through the crisis service or psychiatric liaison in the emergency department. On treatment units, such as for eating disorders or personality disorders, people usually get admitted through their outpatient treatment team. An admission interview typically consists of a brief assessment of one’s symptoms and some standard questions (eg. does the patient know where they are and what date it is). Details of the patient’s initial treatment may also be discussed.

Aggression

Aggression is quite common among mentally ill people, especially those in inpatient care. This may not be a politically correct statement but it’s true. Most times, this consists of verbal aggression, but nurses and patients sometimes get attacked physically too.

Alcohol

Alcoholism is not as common among mentally ill people in inpatient treatment – they often take their addictions out on other drugs. However, still you get the occasional alcoholic on an inpatient mental health unit. Most instituttions don’t serve alcohol in the cafeteria, though near my institution is the railroad store where they do sell alcohol.

Attention-Seeking

Us mentals are supposed to crave attention more than do people without mental illness, hence the common belief that a mental illness is “attention-seeking” behavior. Well, let me tell you: mentally ill people often keep their symptoms hidden for a long time and most don’t crave attention more than do mentally healthy people.

Attitude

A similar myth about mental illness is that it’s an attitude problem. It’s not. I wrote a post on mental illness and attitude last October. The idea that mental illness is an attitude problem is very damanging to people with mental illness, who often have a lot of shame as is. There is a group of people wiht an attitude problem here and they’re the people who think they can judge another person’s attitude like this.