I’m conducting an experiment

Introduction

The purpose of this experiment is to investigate the responses of local Mental Health services under certain controlled circumstances.  It is hoped that the data emerging from this experiment may confirm or refute the hypothesis that people who work in MH services demonstrate a high prevalence of behavioural traits that can be classified as ‘difficult-case-avoidant’.

 

Method

A range of local MH professionals comprising General Practitioners, Consultant Psychologists, Staff-Grade Psychiatrists, Art Therapists and Nurses specialising in the treatment and management of those with MH problems have been exposed over a period of several years to an annoyingly intelligent, articulate and treatment-resistant patient.  The patient (who shall be referred from here on in by the pseudonym ‘Aethelread’) has been passed from service to service and from individual to individual in a manner that conforms to the classic ‘failure-to-treat’ model first elaborated by Nutter et al in their seminal 1991 paper ‘Failure to Care in the Community: A Critique of Emerging Mental Health Treatment Models’.

One unlucky professional, a staff-grade general psychiatrist, has been left ‘holding the baby’, as he accepted a re-referral from a Nurse Specialist colleague without realising that all other referral options (including the desperate, last-resort, ‘maybe drawing a pretty picture will help you feel better’ option) had been exhausted.  He has deployed a number of strategies for encouraging Aethelread to disengage from MH services.  These include: being a bit of a twat; attempting to scare Aethelread by threatening sectioning; demonstrating himself to be the pharmaceutical companies’ bitch; attempting to demoralise Aethelread by informing him that he is not mentally ill; being a lot of a twat.  In accordance with standard experimental protocols, Aethelread has responded to all of these tactics in a manner intended to imitate the behaviour of a disappointed patient somewhat frustrated by being made to jump through various hoops like a performing dolphin who doesn’t even get rewarded with any fish.

As of 11:20 on Friday August 7th 2009, however, Aethelread has activated the ‘second stage’ of the experimental procedure.  In this stage, he will attempt a sudden and silent disengagement from MH services.  This has begun with a simple failure to attend a 6-monthly ‘review’ with the aforementioned staff-grade general psychiatrist.  Over the coming days, weeks and (potentially) months, Aethelread will continue to ignore any and all attempts to contact him, and will not attend any appointments, assuming any such appointments are offered.

 

Potential Results

Potential responses to this second stage have been classified as follows:

The ‘thank fuck for that’ response: the staff-grade general psychiatrist will update Aethelread’s notes to indicate that he has failed to attend an appointment, write a brief discharge letter to Aethelread’s GP, then forget about it all with a grateful sigh of relief;

The ‘better make it look like we’re going through the motions’ response: the staff-grade general psychiatrist will contact Aethelread by letter, noting his failure to attend the appointment, inviting him to respond within a set period, and informing him that if he fails to respond within this time period he will be discharged back to his GP;

The ‘actually doing our jobs’ response: the staff-grade general psychiatrist and others will make repeated and genuine attempts to contact Aethelread, in order to establish both his reasons for failing to attend the appointment, and to ascertain his current state of mental health;

The ‘Defcon One’ response: the staff-grade psychiatrist will arrange for an immediate section as a ‘precautionary measure’.

It is anticipated that the response offered by the staff-grade general psychiatrist will fall into one of these four categories.  Should a wholly unexpected response occur, the list of potential responses will be updated accordingly, with a full description offered at that time.

 

It is intended that interim reports will be presented in these pages from time to time, reflecting those occasions when there is significant activity to be reported.  A full summary of the experiment, together with a detailed description of all results and pertinent concluding remarks, will be published once the experiment has been completed.

—-

Yes, I know I should have gone.  Yes, I know I should have gone because it would be the best thing for me.  Yes, I know I should have at least cancelled, because just not turning up is a criminal waste of limited NHS resources.  Regrettably my state of abject panic this morning (have you heard there’s a plague on?  and that places like psychiatric hospitals are perfect breeding-grounds for the infection?) didn’t allow any other response.

Bad Aethelread.  Go straight to gaol.  Do not pass Go.  Do not collect £200.

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This entry was posted in About me, Cheerful stuff, Psychiatry, Psychology, Self-destructive behaviour, The NHS. Bookmark the permalink.

18 Responses to I’m conducting an experiment

  1. PC says:

    “demonstrating himself to be the pharmaceutical companies’ bitch”

    What?

    People generally go to doctors to get treatment, and this usually consists (at least in part) of medication. It’s best to at least try the medication. There is science behind it. At worst, you spend a few days feeling worse whilst you figure out a med isn’t for you… but against the chance of feeling slightly better? Isn’t that worth it? I’ve just tried Lithium and ended up in hospital because I had such a bad reaction…. but it did offer the chance of getting better.

    Have you asked to see someone else/someone more senior? My psychiatrist recommends this if you aren’t getting on with you doctor.

    And as for the service you’re receiving? Sorry, you aren’t special. It’s not unique to you, or even the psychiatric services. I know someone who started having seizures out of the blue. The Neurologist messed her about and thought she was attention seeking. But she had a genetic condition, which could have been resolved with surgery if it had been caught… instead, it was left, and she’s now brain damaged. I know of cancer patients who have to chase appointments for life-saving treatments.

    It’s not just doctors or receptionists, it can be anyone you come across in the NHS.

    HOWEVER. Not everyone in the NHS is a c*nt.

    I spent this afternoon dividing my time between answering and making phonecalls, going to the hospital and going to the GP. Why? I have ultrasound results which need investigating… but it seems information has gone missing, not been forwarded on, and generally no-one knew what was going on.

    I could have said “screw it” – but carried on being passed around, until I reached a wonderful secretary who sorted it.

  2. NiroZ says:

    I can understand, after being told that your not that ill, that you would be greatly disinterested in the psychiatrist. But he wasn’t trying to make you the phama companies bitch. Unless every person who tries a drug is a pharma bitch. In which case, it’s a pointless term that carries undue negative acconitations.

    (Disclaimer: I’m drunk)

  3. disallusioned says:

    I can safely assure you that in my experience no one will notice you failed to attend. And things will continue as though you never even existed. Or at least thats what happened when I tried this.

  4. You should have gone but I understand why you didn’t. I think you’re probably spot on with the possible responses. I hope you get the doing their job one, even if you probably don’t. xx

  5. aethelreadtheunread says:

    Thanks for the comments.

    You all make excellent points. :o)

    Even, in some cases, when you are inebriated… ;o)

  6. Lucy McGough says:

    This could go a bit wrong. Do you have people to keep an eye on you in case you get ill?

    Or am I just worrying too much?

  7. aethelreadtheunread says:

    Hi Lucy, and thanks for the comment.

    Do you have people to keep an eye on you in case you get ill?

    No, i don’t, but prior to this i didn’t really have people to keep an eye on me, anyway. All i got from General Psychiatrist was a 6 monthly review (and no guarantee that they would continue), and the chances of that appt. coinciding with a time when i was actually ill were pretty slim. And, given that my coping strategy when i’m under the (mental) weather is to go into lock-down/ hibernation mode, even if it did happen to coincide with an appointment i just wouldn’t go. What i did on Friday is a good case in point. I wouldn’t describe myself as ill, exactly, but i’m well aware that my reasons for not going to the appt. were far from logical.

    Or am I just worrying too much?

    Well, i don’t know how much you’re worrying, so it’s kind of hard to answer the question. But you shouldn’t worry at all, really. I had a fairly major crisis just a few weeks ago, after all, and i got through that ok. I’m like a bad penny really, whatever happens i’ll never actually go away… ;o)

    Seriously, though – don’t worry. I’ll be fine. I always am. :o)

  8. PC says:

    Has there been any positive outcome from using the services of the NHS?

    I don’t see what you’re going to get out of not going, either:

    – They don’t get in contact. Which I guess shows their incompetence, and proves that ‘they don’t give a damn’ – meaning, why should you – right?

    – They do get in contact. But I doubt this will restore your faith in them either.

    Neither are going to precipitate an outcome conducive to treatment.

    I think you might have benefited from going to the appointment and describing your recent psychotic episode. It possibly would have kick started another round of meds.

  9. werehorse says:

    My guess would be the second option – you’ll get a letter and be offered another appointment, if you don’t respond to that your case will be closed. It will be an automatic administrative thing that the psychiatrist will have nothing to do with.

    I’m not convinced that actually doing their jobs would require them to make a lot of effort to chase you up. Would that happen or be expected to happen in other areas of medicine?

    I do feel though that you should have a CPN or similar.

  10. J.Wibble says:

    Can you ask to see a different psychiatrist? Might be worth a try, I’ve seen some psychiatrists who are really good and some who are dire. The number who are dire seem to outweigh the good ones, but it’s worth a shot. Not contacting them at all won’t help you, and I can understand your reasons (G-d knows I’ve been there myself) but it might be worth insisting you get a different psychiatrist because your current one isn’t helping. Apologies if you’ve already tried this.

    As for pushing pharmaceutical interventions, some psychs are very pro-medication and if that’s not working for you they can use all sorts of tactics to convince you it’s your fault. That doesn’t mean it is – maybe meds aren’t what you need, or maybe they are but they haven’t tried you on the right ones yet. I didn’t get the right meds until my psych pretty much threw her hands up in the air, gave me a list of meds and got me to pick one. I thankfully picked the right one and am much better off for it. The fact that it took me a year to convince them that it wasn’t my fault the meds I was on weren’t working aside, it was eventually worth the monumental effort.

    werehorse – It’s true that making an effort to chase up patients probably wouldn’t be a major feature of other branches of medicine, but this is because in physical medicine it is expected that the patient is rational and capable of consenting to or refusing treatment. The same assumptions should not be made in psychiatry, as the reason you are being treated in the first place is because your mind isn’t working properly and thus your ability to make rational decisions is likely to be adversely affected.

    Often patients aren’t chased up, and often if you want them to see you when you need them you virtually have to get down on your knees and beg. I actually did this, literally, in an A+E department on one occasion, and it was incredibly degrading and humiliating but it was only after I did it that the nurse agreed to contact the out-of-hours Crisis Team.

    The MH services do have people whose job it is to put a lot of effort into chasing up people who disappear without contact (and thus are presumed to be quite ill), it’s just rather hit-and-miss as to whether the team in your area, or even whichever team is on duty at the time, is willing to do it. I’m not saying this absolves all responsibility from the patient for their care, just that in fact there are people who are paid to do this and thus it definitely is their job to do so.

  11. aethelreadtheunread says:

    Thanks for the extra comments.

    PC – Has there been any positive outcome from using the services of the NHS?

    Depends in what field. In every area other than MH – yes, absolutely. In the realm of MH… not so much.

    Neither are going to precipitate an outcome conducive to treatment.

    Indeed. Guess it’s just as well i don’t want the ‘treatment’ that’s on offer then, eh?

    I think you might have benefited from going to the appointment and describing your recent psychotic episode. It possibly would have kick started another round of meds.

    I suspect you’re right. But since i don’t want another round of meds, and would in fact refuse them if they were offered, there doesn’t seem much point in pursuing that, does there?

    (Btw, i’m not sure how long you’ve been reading this blog, so don’t know how much you know about my med history. (For the record, i’m pathetically grateful and pleased that you and everyone else read it at all, i’m not meaning to suggest that have to read the whole bloody thing before you can express an opinion – absolutely, you don’t have to.) As a brief summary, they either (a) don’t work for me (my depression is officially ‘treatment-resistant’) or (b) have been recommended in such bizarre circumstances (such as when my psychiatrist told me i wasn’t experiencing psychosis, but wanted me to take antipsychotics for those non-psychotic symptoms just the same) that i have lost all faith in the meds, and the people who prescribe them.)

    werehorse – My guess would be the second option – you’ll get a letter and be offered another appointment, if you don’t respond to that your case will be closed.

    That’s my guess, too.

    It will be an automatic administrative thing that the psychiatrist will have nothing to do with.

    Well, no, actually. If the psych wanted to, after all, he could overule the automatic response. (Not that i think he will. Or, in fact, want him too.)

    I’m not convinced that actually doing their jobs would require them to make a lot of effort to chase you up. Would that happen or be expected to happen in other areas of medicine?

    I pretty much agree with what J Wibble has to say about this, but with the proviso that i don’t think there should be an agressive follow-up in my case. It isn’t warranted.

    I do feel though that you should have a CPN or similar.

    I disagree. BY which i mean, of course, that i’m not interested in whether or not i should have a CPN, but i do know damn well that i don’t want one.. My life is my own – i don’t want well-meaning but ineffectual people crawling all over it.

    J.Wibble – Can you ask to see a different psychiatrist?

    TBH, i don’t know. I’ve never looked into whether it’s possible or not. But it isn’t worth it. What i want from a psychiatrist (all i want, in fact) is a diagnosis with no treatment. Psychiatrists, on the other hand, want to provide treatment with no diagnosis. We’re fundamentally at cross-purposes, so there aren’t especially good grounds for believing that seeing an alternative psych would help. Better to leave the appointment slots for people who actually want the help they may be offerred, i think.

    Thanks again for all the comments, and sorry if i’ve been rude or mean or just plain nasty in my replies. I’m not intending to be horrible, it’s just that this is something i have fixed and entrenched views on. Sorry. :o)

  12. Josie says:

    Hi Aethelread,

    i stumbled on your blog today via Mental Nurse, where a quote from this post made me snort with laughter :)

    I’m interested to come across you because your experiences have some similarities to mine – treatment-resistant depression, anxiety, panic attacks, some paranoid/psychotic stuff, and most importantly – the batshit NHS MH services!! I’ve had the delight of being a service user for 5-6 years now and have worked by way around more teams, medications and therapists than seems imaginable.

    The cynicism of your experiment made me laugh. And i love your writing style too.

  13. PC says:

    I’ve spent quite a few hours going over your old enteries, although I haven’t got through them all, I do hope you don’t mind me commenting without (essentially) “knowing all the facts.”

    I read that you’ve been classed as treatment resistant, but I simply do not believe that your psychiatrist has tried enough meds – or enough med combinations.

    “such as when my psychiatrist told me i wasn’t experiencing psychosis, but wanted me to take antipsychotics for those non-psychotic symptoms just the same”

    Actually, the symptoms of depression and psychosis overlap. I know people who’ve had no luck with antidepressants, but success with either an atypical antipsychotic (APP), or an APP + an antidepressant. I believe some of the ‘on label’ uses of APP are depression now.

    “What i want from a psychiatrist (all i want, in fact) is a diagnosis with no treatment. Psychiatrists, on the other hand, want to provide treatment with no diagnosis.”

    How is a diagnosis going to help if you don’t want treatment? Isn’t the purpose of a diagnosis to help people know what’s wrong, and treat accordingly?

    I know I sound like I’m nagging, but I really think you should try and see another psychiatrist. Hey, if they’re crap, you’ve not lost anything.

    I asked about your experience with the MH services as I didn’t know if you’d had any benefit from talking therapies or the like?

    It’s just that I’d hate to think of you suffering alone – and I’m not a great believer in depression spontaneously resolving…

  14. aethelreadtheunread says:

    Thanks for the comments.

    Josie – thanks for saying such nice things. :o) I’ve had a quick look at your blog (and bookmarked it for a more detailed look later on) and it seems to be really good.

    PC – I do hope you don’t mind me commenting without (essentially) “knowing all the facts.”

    Not at all. I’m impressed and flattered that you’ve done any ‘further reading’ at all.) :o)

    I read that you’ve been classed as treatment resistant, but I simply do not believe that your psychiatrist has tried enough meds – or enough med combinations.

    Now, you see, what you’ve said there has slightly annoyed me, although i know that wasn’t what you were intending. My psychiatrist hasn’t tried any meds, i have. It seems like a really petty point, but it points out, perhaps, one of the ways i’m different to some other MH patients – i think of psychiatrists (and all the rest) as my assistants. If my psych wants to prescribe something, i take that as a recommendation, nothing more. I take the final decision when it comes to my treatment, not the psychiatrist.

    This may seem short-sighted – i freely admit, i’m no expert on meds – but it is my body and my mind, and so it’s me who has the final say on what goes in it. And when it comes to psychiatric medications – well, i know enough to know that no-one has yet demonstrated how they work, and that with antipsychotics in particular the widely-held suspicion is that they quieten down psychosis by acting, essentially, as wide-ranging and exceptionally powerful tranquilisers. I also know a certain amount about the side-effects of antipsychs, and i’ve taken the decision that they are a last resort – i will take them if i believe i have literally no other way of clinging on to my mind, but not until then.

    Actually, the symptoms of depression and psychosis overlap.

    Well, in the sense that some people who experience depression will also experience psychosis, that’s undoubtedly true. But the symptoms of depression and psychosis are (as far as i can tell from my own experience) pretty much opposite to each other. In depression thought come slowly, if at all; in psychosis they come far too fast (and far too powerfully).

    I know people who’ve had no luck with antidepressants, but success with either an atypical antipsychotic (APP), or an APP + an antidepressant. I believe some of the ‘on label’ uses of APP are depression now.

    I know i will not be the first person to speculate that the interest pharmaceutical companies have in promoting antipsychs for depression may be related to the fact that many of the most widely-prescribed antidepressants will shortly be coming out of patent, and those same companies have few ‘novel’ ADs to replace them. I’m afraid i’m always profoundly suspicious of cases of medication-drift like this.

    How is a diagnosis going to help if you don’t want treatment?

    I haven’t said that a diagnosis will help, just that i want one. I guess my reason is that a diagnosis would validate the reality of what i deal with, both to myself and to other people. I admit it’s not a very good reason.

    Isn’t the purpose of a diagnosis to help people know what’s wrong, and treat accordingly?

    Ordinarily, yes, but this pre-supposes that (a) the treatment works and (b) does not produce side-effects worse than the symptoms of the illness. As far as i’m concerned, the jury is very much out on (a), and as for (b) – well my symptoms have not yet progressed to the stage where i think meds are necessary.

    I know I sound like I’m nagging

    You don’t, really, and sorry if the way i’ve replied has made you think that i feel that you are. I know your suggestions are intended to be helpful. :o)

    I really think you should try and see another psychiatrist. Hey, if they’re crap, you’ve not lost anything.

    But i have, though. I’ve lost all the effort and emotional upset and galloping anxiety that a psych appt will cause. And it will be for nothing, since i’ve already decided not to take the drugs. I do want a diagnosis, but not that much. (And, as i said to J Wibble earlier, the slot would be better off going to someone who may want the help they’ll be offered.)

    I didn’t know if you’d had any benefit from talking therapies or the like?

    This post ( https://aethelreadtheunread.wordpress.com/2008/11/29/psychotherapy-a-retrospective/ ) is probably the best one to go to for that, although i’m afraid it’s rather long and rambling. A very brief summary would be to say that i have found some of my experiences with talking therapies somewhat helpful.

    It’s just that I’d hate to think of you suffering alone

    Thank you, that’s kind of you.

    I’m not a great believer in depression spontaneously resolving

    Spontaneous remission of depression is very common. It’s well-documented in scientific studies, and i also have personal experience. I’m actually moderately certain that quite a lot of positive outcomes from the various treatment options owe quite a lot to the fact that depression will get better on its own, provided you wait it out.

    Sorry for wittering on for so long. :o)

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