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The Scandal of Cleveland Street

If you want an education then hang out with the homeless. First lesson: (teacher) reputedly, the singer Paul Gadd lived in this block of flats. (pupil) Gary Glitter lived in this block? Did he know before porridge that there’s two flats in this block that are used as high-class brothels? Look how close it is to transport links. Stressed gentlemen can pass away a hour or two being pampered before embarking on the journey homewards thereby avoiding the worst part of the rush-hour while experiencing the highest form of mindfulness. (teacher) To get maximum benefit, three flats now should be brothels. No point letting a good flat in a prime location go to waste. Second lesson (outside the Princess Grace Hospital): (pupil) In the twenty minutes that we’ve been here, we may have come to the attention of police officers from the section that deals with Royal Protection. This hospital treats Royalty and not just from the UK. (teacher) That’s why they banned me from using the disabled toilets. Third lesson: (teacher) Do you know who John McVicar is? (pupil) Are you being daft? (teacher) John McVicar is was a lecturer at Leicester University and when I was in prison he was mentor…

Lesson Four: Three hours in a branch of a ubiquitous, worldwide, chain of cappuccino parlours listening to anecdotal evidence of the disastrous SWEP (severe weather emergency project) combined with a near forensic examination of the governmental and charity finances, that is; the public money supplied by the Office of the Deputy Prime Minister and via charitable donations behind this scheme to aid the homeless, and asking, who really gained? The agency that profited by supplying significant numbers of ill-prepared and poorly trained staff? The SWEP agency staff themselves? Who universally emigrated from Africa to gain economic betterment, achieving such, by working during the Christmas period. Or was it the highly qualified professionals whose expensive oversight signed off this scheme despite not being there on the ground to check if SWEP was being fruitful or not? One thing is for sure, whoever benefited it was not the intended persons, specifically, the homeless living on the streets of London during one of the mildest

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Bringing Up Baby

Has Norman Tibbet been reincarnated? The Little Fat Fellow had a home visit by the crisis resolution team and Fiona, a white South African lady whose medical discipline is unknown, persuaded him to take a job. Aside from the obvious question: is the NHS a job creation service for Africans? What does Fiona think she is doing telling a sufferer of severe and enduring mental illnesses to get a job? He’s been known to psychiatric services for twenty-four years. Did she overlook the fact he’s prescribed seventeen pills a day? Did she take no account of the complications of his anti-psychotics which have left him with both diabetes and chronic leukaemia? Fiona claims she knows patients who take medication and are able to hold down a job. Some would say ‘don’t trust Africans, they’ve let you down before and they are known for flights of fancy’. The Little Fat Fellow’s qualifications? He is articulate and intelligent. The Little Fat Fellow selected a Fund Manager as a position he would consider, but being pragmatic, he acknowledges that his experience and knowledge means he is more suited to a role as a Road Sweeper. Beep, Beep.

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Terror Bulletin (otherwise known as: a psychiatric report.)

I’ve been analysed. Again. This time by Aaron Frazer, a Trainee. That is: a Trainee Social Worker who wrote an Outcome of Assessment report based on the questions asked by Rohini, a Community Psychiatric Nurse. A five page document that could have been condensed to three pages without any content being lost. An irritating letter full of inaccuracies where Aaron can’t even spell my name correctly. Like almost everything in psychiatry, the answers you get depend on the way you ask the question and the assumptions you make in framing it. The word-processor will give you any solution you want, provided you change the inputs in the appropriate way. To consider Aaron’s report as a punctilious recording of our encounter, you have to convince yourself that at all times Aaron was ‘objective’ and you have to believe that there was a structure to the cross-examination.

Aaron from his Social Worker point-of-view wrote, ‘The patient’s social and personal history was not explored within this assessment, primarily because it is well documented in his clinical history. Below is a discharge summary (sic) from August 2012’. My first concern, I was not in hospital during August 2012 nor was I discharged in August 2012. It’s a minor point but if you cannot get the small details right then what hope do you have of getting the bigger picture. Second concern, this Mental Health Trust’s computer records only go back to a point in 2010 despite my being known to services for decades. And thirdly, using previous ‘filler’ is just an exercise in ‘cut ‘n paste’ to pad out the document and adds complexity while coming across as an afterthought.

‘The patient presented at the appointment appropriately dressed and with no evident signs of neglect or poor personal care.’ My fingernails were filthy, my hair was unbrushed with a tendency to make me look like a hedgehog, my jumper was soiled by food stains and I ponged. So, no signs of poor personal care. I do wonder how many derelicts they see on the Harrow Road on a daily basis before ‘poor personal care’ becomes noticeable? Of course, if Aaron thinks I am from the labouring classes then that is what one would expect, if on the other hand, I had worn a dark-blue pinstripe suit to reflect my former working-life what would the output be?

This type of document merely acts as an irritant and adds little, if anything, to my care. Irritation is derived from the errors and the lack of judgement contained within. Basic errors such as getting ‘subjective’ and ‘objective’ garbled. A lack of sensibility around my entering an intense emotional state brought on by a series of inadvertent intrusions on personal grief. And of course, at all times, the patient is viewed as an unreliable witness. As an unreliable recorder Aaron attests ‘The patient stated that he required the local authority to provide (a) cleaner to do a deep clean of his property.’ No, I did not say this or make a case for such. It was Aaron who entered the notion of a single visit to my property by local authority cleaners to perform a ‘deep clean’ and despite professional resistance in the consulting room I objected. Oh, I know that my flat is in a terrible state and gathered from being in the mental health system for eons, by now, I have a good idea what works for me and what doesn’t.

My psychoanalyst said, ‘The report comes across as a disciplinary hearing.’ Anyone can see this system of work is plain wrong, so why a supposedly competent Trainee Social Worker would chose to work in this way is anyone’s guess. The serious point being – Aaron Frazer is destined for a career of writing reports in this style – and consequently he runs the risk of repeatedly wasting tax-payers’ money. The more ridiculous parts of his letter will be incorporated into my novel. If he wishes to claim authorship Aaron will be welcome.

PS For the benefit of mental health professionals who have difficulty understanding the meaning of the word ‘report’ Aaron’s letter is a ‘report’ because it contains recommendations.
PPS What are my formal qualifications? The report claims that I left school with no formal qualifications and this, in the face of my relaying that I am qualified to write care plans. Were you listening Aaron?

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The Kings of Pain

Have you heard the story of the young woman who was coping with life? She had a conversation with ‘the mental health professionals’ and is now being cared for as a self-harmer.

Another supervision session with my analyst. The mood is more intense than a simple good-natured chat. He questions the purpose of my visiting Woodfield Road, W9, an establishment with people where there is no therapeutic relationship. Maybe they look upon their role as just an administrative relationship, however, since I was asked questions on my childhood trauma of being in a burning building by persons completely unaware of the history, it has to be assumed they consider they are offering a version of therapy. Therapy with a line of questioning that can bring repressed trauma back to the surface then fails to dissipate the feelings before the patient is cut adrift.

That’s the thing about seeing an analyst, the pair of you analyse past events, and today it is the flaws of NHS psychiatric care. If, or potentially, trauma has been brought to the surface, before leaving the consulting room a process of decompression should always be observed. Did Rohini and Aaron observe a process of decompression? No. After a quizzing on trauma by placing me back in a burning building ‘the mental health professionals’ upped the ante by going headstrong into a risk assessment of suicidal intent. All risk assessments themselves carry an element of risk. The risk being the patient may come out the other side worse off than when they went in by exacerbating a heighten emotional state. Legally, a risk assessment is carried out with the consent of the patient. No consent, no risk assessment. Rohini, the Community Psychiatric Nurse could not resist the temptation of performing a risk assessment near the end of yesterday’s appointment, presumably because it formed part of her training, for certain, it forms part of the on-the-job training of Aaron, the trainee social worker. It is not with the benefit of hindsight that I can say these things, I am such an old hand of using psychiatric services I express these misgivings of insensitivity in the consulting room, but. . .

The ‘but’ being; the accumulative effect of encounters like yesterdays have taken their toll. My behaviour has altered and there appears to be nothing in the arsenal of the NHS to correct the damage inflicted by the NHS, for no-one ever admits fault, one error is piled upon another error, until such time the patient is so damaged that he is neurotic to point of not functioning or even self-harming. My analyst compared my experiences with the NHS to a song by the Kings of Leon: terribly repetitive and no grip.

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Circles and my deep-seated psychiatric problems

Was my appointment with Woodfield Road, W9 a grotesque parody? On first impressions it was not good. An hour before the appointment I did a recce. The workmen were in and entry was troublesome. I retired to a café.

We started promptly at eleven. I was shown into interview room number 6 by two ABT workers. A man and a woman. The woman’s name-badge was the wrong-way-round, a common phenomenon for public sector workers and the man was badgeless. The interview starts, I interrupt by asking who’s who?, and introductions are made. The pic ‘n mix approach of W9 produced: Rohini, a Community Psychiatric Nurse and she is my first CPN since I entered psychiatric services eons ago and Aaron, a trainee social worker. This probably explains why he has no name-badge as trainee he may not have issued the requisite plastic. Aaron took notes. Rohini restarted by saying “she would not ask all the same old questions again” and in the course of the next hour she proceeds to ask all the same old questions. When I pointed out to Rohini her inconsistency she suffered a convenient attack of mutism.

If we accept the preparation before the interview was haphazard – they appear to consist of Rohini spending half-an-hour reading my computer records (which are erroneous) interspersed with talking to people who were involved in my care from over four years ago. The request for my paper records to be retrieved from storage was not processed.

Aaron the trainee took notes – I articulated my care needs and supplied cogent reasons – the majority of my speech went unrecorded and then Aaron – who, at all times, must be remembered is a trainee, supplied a solution. A solution that has failed in the past. There was some resistance from the ABT workers when I attempted to express why Aaron’s solution was a non-starter. I can’t say the meeting went well for I made the mistake of entering in the instance of ‘Unity Mitford’. My equilibrium was unsettled. It was not that Rohini and Aaron had no idea of the circumstances of the life and death of Unity Mitford that upset me, rather, it was a coarse and brunt interjection of Rohini’s which made me rattled: she demanded an instant answer; an instant answer that she could understand. By this stage Rohini was rushing through the standard (and to me, deeply offensive) questions on risk. She was determined to finish the assessment within sixty minutes. I would say to the pair – if you cause your patient to become rattled – then that is a sign of failure in your approach. The old rule of thumb used to be: you would not speak to a consultant psychiatrist like that, so, why speak to a patient of a consultant psychiatrist like that? I told Aaron off for passing notes in class. Looks like the mantra of ‘nothing about me without me’ is a million miles away in the approach of Woodfield Road, W9. On past experience I will probably never, ever meet these people again. If the appointment proves to a success it will depend on the verdict contained within the report the ABT workers write for Tuesday 27th May 2014.

Postscript:
As a precaution to today’s meeting at Woodfield Road, W9, independently, I arranged a supervision session with a psychoanalyst. Like a mental health profession who needs supervision for being around damaged people I need supervision being around mental health professionals.

On arrival my analyst said: “When I looked at your file before this meeting, a meeting which I was looking forward to, I noticed…” – and it was quite an insight! Why, oh why, oh why, can’t the NHS be this smooth?

However its comparing apples with oranges – would the pair of ABT workers hold down jobs in John Lewis Oxford Street? On today’s performance they would have to raise their game.

On learning that the BT of ABT stands for Brief Treatment my analyst declared: “You can’t give brief treatment to a man whose father burnt to death. It’s a contradiction in terms.” I resisted this type of analyst in the past but I can’t resist it anymore.

And on the disclosure that I attempted to introduce the Neural Diathesis-Stress Model to the assessment – a pointless task as it appeared to go over the heads of the ABT workers – and currently I score a 62 per cent chance of going psychotic – not a particularly high score on past performance but higher than Joe Public – my analyst despaired. In his opinion: it would be hard to tell who the CPN was and who was the patient.

As a patient you are entitled to be assertive on unsatisfactory answers. I think they were a bit shocked when I told Aaron off. A lot of hysteria was about from Aaron who offered to terminate the interview.

Overall, my psychoanalyst is not impressed. He asserts there is an actual fault in the procedure – and to use John Lewis as an illustration – normally the staff remain courteous at all times and a reasonable solution to a problem can be reached in a relatively short time. But then, when has a mental health professional ever admitted fault? Apples and Oranges.

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Last Minute Adjustment – Little Wing

When I’m sad she comes to me, a thousand smiles she gives to me.

A call to Woodfield Road, W9 revealed this info: my 2 ABT Workers will be picked on the day in that morning’s “clinical meeting” from who’s available from a makeshift list of four disciplines – nurses, occupational therapists, psychiatrists and social workers; my assessment will be “up to 60 minutes long”; and my paper medical records have been requested from an off-site storage depot.

It brought back memories of my old Community Mental Health Team and the futility of calling between 9 am and 11 am when “the team” went for their morning “meeting”. Officially it was a 9 to 5 organisation although in the afternoon the social workers frequently clocked off at 4 pm and on Fridays “after lunch”.

Not to mention the receptionists who at lunchtime took the long way home. Telling no lies made me a happy man. (Abreaction therapy via Sodium Amytal and its close neighbour Sodium Pentothal)

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Bald Headed Woman

My appointment with Woodfield Road, W9 is already looking like a grotesque parody. A messy letter with a confusing array of typefaces has arrived. “Following a referral from your GP we would like to offer you an appointment to be seen at the Assessment and Brief Treatment Team.” The brief of the Brief Treatment Team is to provide snap answers.

My last experience of the Assessment and Brief Treatment Team, was a 13 minute home visit by rude social worker (Mr Leon G), who recorded in my medical notes that he performed an assessment, however, this “assessment” was later disputed by Joy, the lady who accompanied rude social worker before, during and after the encounter, due to his failure to complete any paperwork in her presence and Joy contested, therefore no assessment had been performed. This, in addition to the failure by rude social worker to introduce himself, by saying: who he was, what he was and why he was seeing me.

On the issue of paperwork, “We enclose a Crisis Card with our emergency duty number, as well as a Patient Details form, please complete as much of this form as possible and bring it with you.” Er, no Crisis Card and, er, no Patient Details form were enclosed. I say, What a Shower!

A pair of ABT Workers will see me on Thursday 22nd May. My expectations are so low that it would be hard to disappoint me, which is not to say, their behaviour will not irritate. During the cross-examination I expect the Workers to be impertinent, I expect irrelevant questions, I expect as I respond to questions about myself to be interrupted, I expect the staff not to understand my answers, I expect to face a level of ignorance due to a lack of general knowledge (Note to self – do not refer to Unity Mitford or any of the Mitford sisters or even Terry Thomas), I expect to face a level of ignorance due to a lack of professional knowledge and I expect the whole encounter to be degrading.

Has the system conspired to turn my life into a series unfortunate events? It’s almost, as if within psychiatric services, a depreciation index exists. Ah, I have this option: “If there is anything you would like to discuss before (coming to Woodfield Road) then please ring us,” yes, I may phone to ask, “How do you intend to improve the quality of my life?”

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