I have just finished reading a book by one of my favourite authors, Sarah Moss.
This one -- her most recent -- is called "The Tidal Zone" and is a really interesting, thought-provoking read. The basic story line involves a fifteen-year-old girl who almost dies from an unexplained anaphylactic incident whilst at school. The book is told in the first person (from the girl's father's point of view) and follows how the girl's family copes after this incident.
However, this basic story line is in fact a container for a whole host of other things -- and it is these things that the book is really about. Moss covers the NHS (how it operates in today's chronically underfunded and chronically overcrowded world), the nature of family, how one's previous experience shapes one's reaction to future experiences, how the the practicalities of everyday life impact on a relationship, the role of breadwinner versus homemaker... The list goes on.
This description makes "The Tidal Zone" sound like a very serious book -- and in some ways it is, or at least some of the topics that Moss writes about in it are serious. Yet the writing style is light and lively and Moss is genuinely funny, drawing out the humour in the banalities of everyday life.
If you're looking for a book that is superbly written and easy to read but also intelligent and insightful, I would recommend "The Tidal Zone".
Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts
11 March, 2017
07 February, 2017
Getting older
My husband and I are struggling with elderly parents at the moment. We all have an inkling, I suppose, that our parents getting older can be a difficult time, but it's not until you're in the midst of it that you fully appreciate all that this entails.
At the moment we live in fear of the phone ringing, because one of our parents has fallen a couple of times recently. They have a bracelet around their wrist which allows them to contact a private company that can call an ambulance if they are unwell or have fallen -- otherwise how would anyone know, with them living alone? That's positive, of course, but it's not straightforward.
The foremost problem is that, once called, it takes ages for the ambulance to come -- over four hours, last time. So, you are left with an elderly person lying on the floor in the cold unable to get themselves up. Once the ambulance arrives, the staff are absolutely great, but it's the wait that's the problem.
An added problem is that the company that calls the ambulance doesn't have a call back number, so while they will ring to tell you that your relative has fallen and an ambulance has been called, there is no way of ascertaining when the ambulance has arrived or how long it might be. If you live at a distance from your parent, this leaves you with a huge dilemma -- do you embark on a journey of several hours to reach them or will the ambulance get there first? Last time, not wanting to call 999 when they were clearly so busy, we had to resort to scrabbling around on the Web for possible non-emergency numbers to ring in a bid to get hold of any information.
Social care is another problem. Social services will only visit the elderly on a regular basis if they are incapable of looking after themselves and are in need of personal care, i.e. help with getting out of bed, washing and dressing. If an elderly person is capable of doing these things, then they are judged to be able, but of course there are other things that they may need help with. For example, they become reliant on meals-on-wheels services and hired domestic help if they are not up to cooking or cleaning.
It can also be difficult to persuade elderly relatives to do things that would actually be helpful to their situation. We have suggested joining befriending networks of other elderly people and even hiring someone to help with transport to events, appointments, etc., but with no luck so far.
What we have really learnt from all of this is how important it is to plan ahead. We all need to acknowledge the fact that we will get old (however unwelcome the notion) and think in advance about how we will deal with this and the help that we may need to organise.
At the moment we live in fear of the phone ringing, because one of our parents has fallen a couple of times recently. They have a bracelet around their wrist which allows them to contact a private company that can call an ambulance if they are unwell or have fallen -- otherwise how would anyone know, with them living alone? That's positive, of course, but it's not straightforward.
The foremost problem is that, once called, it takes ages for the ambulance to come -- over four hours, last time. So, you are left with an elderly person lying on the floor in the cold unable to get themselves up. Once the ambulance arrives, the staff are absolutely great, but it's the wait that's the problem.
An added problem is that the company that calls the ambulance doesn't have a call back number, so while they will ring to tell you that your relative has fallen and an ambulance has been called, there is no way of ascertaining when the ambulance has arrived or how long it might be. If you live at a distance from your parent, this leaves you with a huge dilemma -- do you embark on a journey of several hours to reach them or will the ambulance get there first? Last time, not wanting to call 999 when they were clearly so busy, we had to resort to scrabbling around on the Web for possible non-emergency numbers to ring in a bid to get hold of any information.
Social care is another problem. Social services will only visit the elderly on a regular basis if they are incapable of looking after themselves and are in need of personal care, i.e. help with getting out of bed, washing and dressing. If an elderly person is capable of doing these things, then they are judged to be able, but of course there are other things that they may need help with. For example, they become reliant on meals-on-wheels services and hired domestic help if they are not up to cooking or cleaning.
It can also be difficult to persuade elderly relatives to do things that would actually be helpful to their situation. We have suggested joining befriending networks of other elderly people and even hiring someone to help with transport to events, appointments, etc., but with no luck so far.
What we have really learnt from all of this is how important it is to plan ahead. We all need to acknowledge the fact that we will get old (however unwelcome the notion) and think in advance about how we will deal with this and the help that we may need to organise.
18 October, 2014
The complexity of mental illness
There has been a strong political focus recently on mental health, with pledges to reduce waiting times for those in need of interventions and to put mental illness on a par with physical illness. There is also a movement to change people’s perception of mental illness, thus reducing stigma and enabling people to talk about and understand mental illness in the same way that they do physical illness. These moves have sprung from people having to wait many weeks before receiving treatment for mental disorders, with this, on occasion, resulting in suicide as patients despair of ever receiving help.
All of this is very laudable. It will be wonderful if we can reduce the stigma and get people talking about, rather that shying away from, mental health issues. However, I have experience of mental illness from a rather different angle, an angle that people may be less familiar with. One of my close relatives has suffered from schizophrenia—one of the most serious mental illnesses— for the whole of their adult life. The symptoms of schizophrenia include delusions (of persecution, for example), auditory hallucinations (hearing voices), and disordered thought patterns. The delusions, in severe cases, become overwhelming and replace the sufferer’s ‘normal’, rational view of the world. It is not uncommon that people who suffer from schizophrenia also suffer from a complete lack of insight into their condition—their delusions appear so real to them that they are incapable of recognising that they are ill, a condition known as anosognosia. My relative falls into this camp.
For someone who recognises that they are ill and actively seeks help, there is a good chance of curing that person (or at least of controlling the symptoms of their illness). But for someone who cannot recognise that they are ill, the outlook is much less bright. From my experience, try as you might, it is impossible to persuade someone with anosognosia that they need help. And suggesting to them that they are ill (or even failing to express agreement with their delusional beliefs) makes them extremely angry and, sometimes, violent. The situation becomes intractable.
What, then, happens in situations like these? Well, the simple answer is that nothing can be done, until the person exhibits behaviour that makes them a danger to themselves or others, at which point they can be detained under the Mental Health Act and forcibly treated. In these cases, pressure on the nearest relative becomes intense. (The ‘nearest relative’ is a legal term, defined in the Act, and it is not possible to stand down from the position of nearest relative.) The nearest relative is ‘consulted’ at every stage of the detention because, legally, someone cannot be detained under the Act without the consent of their nearest relative. But this process makes a mockery of the concept of ‘consent’ since, although the nearest relative has the right to object to the detention and, for example, discharge their relative from hospital, the responsible clinician can simply intervene if s/he believes this to be necessary (typically, if they consider the detainee to be a danger to themselves or others, which they have to be anyway in order to have been detained in the first place!).
As the nearest relative I found myself in an impossible situation. My relative was clearly desperately ill and in need of help, but refused to accept this. My relationship with my relative was pretty much non-existent, as a result of the years that I had spent struggling to cope with their schizophrenia. My relative demanded that I object to their detention under the Mental Health Act, which clearly I wasn’t prepared to do. The authorities persisted in demanding information from me about my relative’s condition and symptoms, information which I couldn’t provide because of my lack of a relationship with my relative. And, in all of this, no support whatsoever was provided to me, as the nearest relative.
So, my point is this: while it is entirely proper that we should provide help to people with mental health issues when they seek it, mental illness is so much more complex than this. There are a whole host of people who are ill but who do/will not seek help. What should we be doing for these people? And, perhaps even more importantly, what should we be doing for those individuals who are caught in the crossfire—usually relatives—for whom there is currently zero support or provision?
All of this is very laudable. It will be wonderful if we can reduce the stigma and get people talking about, rather that shying away from, mental health issues. However, I have experience of mental illness from a rather different angle, an angle that people may be less familiar with. One of my close relatives has suffered from schizophrenia—one of the most serious mental illnesses— for the whole of their adult life. The symptoms of schizophrenia include delusions (of persecution, for example), auditory hallucinations (hearing voices), and disordered thought patterns. The delusions, in severe cases, become overwhelming and replace the sufferer’s ‘normal’, rational view of the world. It is not uncommon that people who suffer from schizophrenia also suffer from a complete lack of insight into their condition—their delusions appear so real to them that they are incapable of recognising that they are ill, a condition known as anosognosia. My relative falls into this camp.
For someone who recognises that they are ill and actively seeks help, there is a good chance of curing that person (or at least of controlling the symptoms of their illness). But for someone who cannot recognise that they are ill, the outlook is much less bright. From my experience, try as you might, it is impossible to persuade someone with anosognosia that they need help. And suggesting to them that they are ill (or even failing to express agreement with their delusional beliefs) makes them extremely angry and, sometimes, violent. The situation becomes intractable.
What, then, happens in situations like these? Well, the simple answer is that nothing can be done, until the person exhibits behaviour that makes them a danger to themselves or others, at which point they can be detained under the Mental Health Act and forcibly treated. In these cases, pressure on the nearest relative becomes intense. (The ‘nearest relative’ is a legal term, defined in the Act, and it is not possible to stand down from the position of nearest relative.) The nearest relative is ‘consulted’ at every stage of the detention because, legally, someone cannot be detained under the Act without the consent of their nearest relative. But this process makes a mockery of the concept of ‘consent’ since, although the nearest relative has the right to object to the detention and, for example, discharge their relative from hospital, the responsible clinician can simply intervene if s/he believes this to be necessary (typically, if they consider the detainee to be a danger to themselves or others, which they have to be anyway in order to have been detained in the first place!).
As the nearest relative I found myself in an impossible situation. My relative was clearly desperately ill and in need of help, but refused to accept this. My relationship with my relative was pretty much non-existent, as a result of the years that I had spent struggling to cope with their schizophrenia. My relative demanded that I object to their detention under the Mental Health Act, which clearly I wasn’t prepared to do. The authorities persisted in demanding information from me about my relative’s condition and symptoms, information which I couldn’t provide because of my lack of a relationship with my relative. And, in all of this, no support whatsoever was provided to me, as the nearest relative.
So, my point is this: while it is entirely proper that we should provide help to people with mental health issues when they seek it, mental illness is so much more complex than this. There are a whole host of people who are ill but who do/will not seek help. What should we be doing for these people? And, perhaps even more importantly, what should we be doing for those individuals who are caught in the crossfire—usually relatives—for whom there is currently zero support or provision?
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