BBC news piece and meeting AWP

You can see the news piece on:

http://www.bbc.co.uk/news/uk-england-bristol-18773710

Unfortunately the film clip has been removed (see previous post)

Note that neither organisations mention 'working together to carry on the provision' or 'finding a way to commission it'. Pontius Pilate meets Houdini and patients are 'collateral damage'. Both the University's and AWP's reputation have benefited from this clinic in the past at very little cost, now they are playing a game of chicken except that the disastrous outcome affects real people's lives not numbers in an end of year report.

The bit from AWP finding a solution is farcical- even experienced and caring clinicians like Dr Doran from Worcester (who was on the news item clip) need help from the clinic when stuck.

AWP's comment about what they are going to do would sit well in a Kafka novel. The mails sent to me indicate that AWP does not provide ANY real support in most of the cases. As Jade said in the interview - it is not only the medicines but also the fact that you are reviewed every six weeks by a consultant psychiatrist (and the same person - not a sequence of new people who have little understanding - my note).

So if my arithmetic is correct the intervention that has saved Jade's life and has made her able to lead a life again, would have cost about 4 hours of clinic time per year-not exactly a great deal - my calculation makes it £ 1000 to £ 2000 real expenditure depending on the estate costs. How little compared with heart surgery...

Let's imagine the same story for diabetes- hundreds of difficult to treat diabetes patients no longer have expert diabetological advice as a leading UK service run by a historical collaboration between the NHS and the University of Bristol will be closed as 'not commissioned'. Outpatient based general medical services will not see these patients as all GPs should be able to prescribe and support these patients beyond the steps outlined by NICE or their own PCTs.

It is also not surprising that AWP says that most of the people seen by the clinic don't have local mental health provision outside the clinic (as in the letter sent by them)- AWP is incapable of recognising profound distress, disability and constant suicidal thoughts as conditions in need of help. Most patients are either not looked after or told that 'nothing else' can be done.

One of you has already been dropped by secondary care in spite of being one of the few people who had an experienced and senior AWP case manager prior to his moving on.

Do write in with your story of interaction with the local NHS trust -people need to know about it. It can just be a few lines and anonymous.

Alternatively your story can be put in as a comment at the end of this post.

Try to go to the meeting on 26th July at 10 am at Callington road hospital next to Tesco.

If you cannot go send someone to represent you- let me know if you need help finding someone. Email to psychopharmcare@gmail.com ; Remember that AWP will not focus on the fact that many are either too ill to go or struggling to keep a job or a family going and therefore find it difficult to come. They will focus on the fantasy that this act (of vandalism) does not affect any people who SHOULD be in the centre of their focus. They still don't realise that their actions show that their website statements are callous hypocrisy.

Let's finish on a positive note. We have had over 1000 hits on the blog. I will need help with keeping this going as I am moving to a new job. Anyone interested- please let me know by email ; ).

Does any manager understand this service?

AWP took clinic out of BRI and no need to identify other suitable care- we already have it in psychopharmacology.

Here goes:

I have received an email this last week from Andy Sylvester at AWP regarding this service.  My understanding from Andy Sylvester's email is that it was a Bristol University led R&D programme and it was hosted at the BRI. AWP did try to help out by reaccommodating.  This is not a service that the PCT or AWP funds and we have not been involved in the decision to stop providing the service.

Since Andy's email I have spoken to Alison Middleton who was going to investigate this further and speak to Paula May.  This will also include identifying the patients that will be effected and how best to provide suitable care to support them.

I will keep you all updated as soon as Alison contacts me with more information.

 Kind Regards
Sally Whitley

Programme Manager Mental Health  (Interim) NHS Bristol
0117 900 2623
sally.whitley@nhs.net

A letter from a relative to Paul Miller acting CEO AWP

 

22^nd June 2012

Chief Executive of AWP

Paul Miller - Acting Chief Executive

Avon and Wiltshire Mental Health Partnership NHS Trust

Jenner House,

Langley Park,

Chippenham,

SN15 1GG

Dear Mr Miller

I am writing to complain about Avon and Wiltshire Mental Health Partnership Trust’s decision to close the Psychopharmacology Clinic.

My mother is a patient of the clinic and has suffered with Manic Depression for in excess of 20 years.

My mother has been directed to every imaginable NHS and private healthcare avenue in order to access support in managing her mental health, and as a family we have lost count years ago of the number of different strategies, drugs, therapies, ‘next steps’ and doctors she has seen in this time. None of which brought her, or our family, any perceivable state of calm or quality of existence until she was able to access the support of Dr Andrea Malizia through the Psychopharmacology Clinic.

My mother continues to struggle each day of her life with depression which impacts upon every aspect of her existence. Her appointments with Dr Malizia are effectively what she lives for, a glimmer of hope within the darkness of her depression; each a small milestone for her to aim for. Each time she has an appointment, with Dr Malizia I hear her express to him “I’m safe when I come here to see you”. The clinic is her life line, in literal terms; access to some effective support which gives her the strength to keep trying new strategies presented by someone she trusts, someone whose expertise has allowed her to regain some vague minimal sense of what ‘normality’ might feel like.

My mothers treatment is far from complete, her last two appointments have seen changes to her medication and a chance to build upon what is glimmer of ‘my mum’ seen through the suffocating cloud of her depression. Her GP, although extremely supportive, has told us that she has no experience of treatment using the specialist medications prescribed through the Psychopharmacology Clinic. Without access to this specialist support and type of treatment, we doubt that my mother would be able to cope with life at all; ending her life as a result of her depression has always been a very real consideration for her that she does her best to fight against, a solution to escaping the despair she has to live with.

Please consider this letter a freedom of information request as to the consultation process undertaken by Avon and Wiltshire Mental Health Partnership Trust before taking the decision to close the Psychopharmacology Clinic. I find it abhorrent that, as a patient of the clinic, my mother had no knowledge of discussions around its closure prior to a decision being taken. The trust has a legal responsibility to undertake consultation and to complete an impact assessment before taking such a decision, and a lack of these processes would constitute illegal practice.

I would also like to request some clarification of exactly how this closure supports the aims of the trust publicized on the website. The trust claims; “Our aim is to enable and empower people to reach their potential and to live fulfilling lives through providing recovery and reablement focused services that yield positive outcomes for our service users and their carers.”

Finally, I ask you to consider how, as a trust, you would be able to justify a loss of life as a result of this closure. This appears a dramatic statement to make but, when you are close to someone who lives with severe mental health difficulties you begin to understand that, to that someone, taking your own life can seem like a practical solution to your problems.  To take away the one avenue of support that is preventing someone from taking this step, equates to switching off a life support machine – would you be able to justify doing this to a patient who had chance of recovery?

I look forward to your reply.

Yours sincerely

BBC Points West piece on psychopharmacology clinic

http://www.bbc.co.uk/iplayer/episode/b01knnxl/BBC_Points_West_09_07_2012/

From 12.30 minutes to 15.30 minutes

Aired on BBC1 on Monday 9th July

Freedom of Information response from University of Bristol

Thank you for your recent Freedom of Information request.

The University of Bristol has historically conducted its research in psychopharmacology through the provision of consultants to carry out clinical work with Avon & Wiltshire Mental Health Partnership NHS Trust (AWP), having association with and providing the administrative function for this work. Following a recent University wide redundancy exercise, the consultant who was responsible for leading the research in this area at the University was selected for redundancy.

The University has not made any decision to formally close down studies in psychopharmacology, though is aware that the departure of a clinically-active member of staff will impact on the services offered by AWP.

The University is not responsible for providing clinical services and research into psychopharmacology will continue at the University.

If you are not satisfied with the University's response to your request you may ask the University to review the response by writing to:

Director of Legal Services
Secretary's Office
University of Bristol
Senate House
Tyndall Avenue
Bristol BS8 1TH
Email: freedom-information@bristol.ac.uk

enclosing a copy of your original request and explaining your complaint.
Please include an address for correspondence. The full complaints procedure is set out at http://www.bris.ac.uk/foi/publicinfo/review.html

If you are still not satisfied with the outcome of the internal review you may also contact the Information Commissioner at:

Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
www.ico.gov.uk

Best wishes

Matt Morrison

Information Rights Officer
University of Bristol
Matthew.Morrison@bristol.ac.uk
0117 3317751 (ex.17751)

This e-mail is for the above named recipient(s) only. It may contain proprietary material, confidential information and/or be subject to legal privilege. It should not be disclosed to or used, retained or copied by, any other party. If you are not an intended recipient then please delete this e-mail and all copies and promptly inform the sender. Thank you.

Please note that in order to protect the security and working of University network and computer systems, it may be necessary to intercept, monitor, record, copy, audit, inspect and/or disclose to authorised University and law enforcement personnel any files, messages and any or all uses of the systems. The University may also be required to disclose this email as a result of a freedom of information or data protection request, or in connection with litigation.

Professional clinical and educational views addressed to Royal College of Psychiatrists

To whom it may concern:

I am greatly concerned about the decision to close the Bristol Psychopharmacology Unit.

My learning disability patients do not directly access the clinic but I have sought the expertise of the clinicians who have run the clinic over the years. The problems addressed are the complex prescribing issues, and I am sure knowledge emanating from this unit has prevented costly assessments and admissions around Bristol (often a hidden benefit).

I hope urgent discussions about the planned closure can take place.

Yours sincerely

Dr Helen Sharrard

Consultant Psychiatrist in Learning Disability, S Glos

From the perspective of the School of psychiatry this loss will impact significantly on the training of psychiatrists & will significantly reduce an important research resource, used by many trainees over a long period. It will also mean that the concentrated expertise in dealing with difficult to manage cases will be lost in the region & we may need to refer more often to the Maudsley and other specialist centres, a great distance from the SW. Trainees may also need to gain specialist experience through placement out of the Deanery as a result.

I hope it is possible for this unit to be retained in some capacity for the future.

Yours,

Rob Macpherson, Head of School of Psychiatry, Severn Deanery.

Sounds familiar? Medication that works will be stopped...

This has been forwarded (anonymised and with permission)- this is an issue that will affect many people attending the clinic. In no other specialty would this be allowed when medicines have helped. The cost for these two is a maximum of  £ 2500 per year assuming that there are no discounts or parallel imports. What is the cost of being unable to work and not paying tax? And of being on benefits? What is the cost of despair and suicide?

Dear Dr Malizia,

Firstly let me say how horrified I am to hear of your redundancy and of the forthcoming closure of the Psychopharmacology clinic, which I'm sure has been responsible both for saving lives and restoring quality of life to many, including myself.

I received your letter asking if I wanted a review, but on a purely practical note I am unlikely to get myself out to Southmead; it may sound pathetic but it's a step too far for me, it's too far out of my 'norm', my little world.

I have a problem in that the clinic is currently prescribing me both 10 mg of Aripiprazole and 50 mg of Agomelatine daily, and I understand  that my GP will be unable to prescribe this, although I was hoping the situation might have changed with the Agomelatine?

I assume this means I will have to drop the medication, given that I am unable to get myself out to Southmead for a review, and given that the clinic is closing in Sept anyway.

So how should I best go about it? I have 5 weeks medication left; should I just half the current dosage until I run out? Is that the best way to do it?

Again, my commiserations on your redundancy. Thank you so much for all the help and care you have given me in the past, and best wishes for your future.

Bristol Mental Health: is support and treatment for suicidal and depressed people who struggle on to fulfill their duties going to be available only in the private sector?

Having used clinic 7 over many years and been refused any help by (AWP) Community Mental Health in 2003, I have very little confidence in there being adequate service provision in the future, if "clinic 7" goes. I was offered 24 weeks CAT therapy by (AWP) in 2011, after many grim years. This was ended abruptly with substantial pressure to move into the private sector. Sorting out and paying for a new therapistis a big ask in depression and contravenes the most basic NHS principles when suicide lives on your shoulder, tantamount to unethical actually.

With the community teams moving to a new base, it is already noticeable how dramatically less accessible they are. Any suggestion that Community Mental Health will step in should be refuted immediately and is already a joke.

Clinic 7 accepted my GPs referral and has offered support for many years, without threatening deadlines. Clinic 7 doesn't evict you after a preset time or when a patient still is in a bad or even worse place. Remarkably. Dr Malizia keeps trying and I need his confidence that a solution can be found. Dr Malizia has an ongoing input on a regular basis trying to help me cope with this depressive episode, I have minimal expectation of adequate alternatives being offered come September. His experience and expertise does of course have a price but his input has kept me working and paying taxes, so I am sure it is cost effective at a societal level.

No-one I work with has any idea of my health issues; the latter primarily resulting from bereavement which left me bringing up small children on my own.

.

Abandoning Clinic 7 patients will cost so much more elsewhere and in the health service, very quickly I suspect.

How I feel now- from a clinic attender who is unwell

Saturday 16th June

"Upon waking in the morning, I am always aware of my body feeling electrified, like I have ants crawling on my sweat sodden body.  My mind is uncontrolable from minute one, ruminating over and over the same visual "stories".  Thoughts of suicide in numerous ways; hanging, train tracks, cutting my wrists - anything that will release me from this terrible mindset.  I will swiftly rise from bed and find myself wishing that "GOD" or someone will do something about this.  I am completely preoccupied with the reason as to why is this happening to me and why is it so bad, why am I not responding to medication.  Daily life is so very difficult, my new behaviours are so far removed from normal it is ridiculously challenging.  A walk to the shop is filled with panic attacks, a visit from a friend is pondered over and often I will try and cancel - I don't want people seeing me in this horrendous state.  My whole family are at a loss as to what to do - all they can do is watch from the sidelines unable to comprehend what on earth is going on for me.  To say I am suicidal is an understatement.  I keep saying this - "I don't know how much more I can take".  My thoughts are attrocious, angry, scared, terrified, sad, lonely, death, dreams of a final funeral.  Continually finding two reasons I don't commit suicide and they are selfless.  I don't want someone to have to go through the horror of finding me, and It would destroy so many in my family.  I am embroiled in a seemingly pointless battle, both with my own mind and with the doctors that make up my own community mental health team.  I want something very swift to happen to me; an effective antidepressant? ECT?  SURGERY?  Anything to stop this.  I have tried every intervention I think known to man; Mindfulness, meditation, CBT, EMDR, Vitamins, Minerals, Activities, Walking, running, weight training, riding bike, sleeping (when my mind lets me) to name but a few because I am forgetting some.  I had problems before this recent situation but two and a half years ago my mind suddenly turned into a scene from a horror movie.  If I am not put straight then I am afraid I will find a way of dying that means no-one will find my body.  Only another sufferer of this condition would truly understand my plight, or maybe in addition a very well versed and practiced doctor.  It is shocking to think that the mind could be so very powerful and turn in on oneself in such a negative way.  As a result of being ill I have lost everything, my Wife, my children, my home, my friends.  I am struggling to stay on the bottom rungs of the social ladder and it hurts so much and is so very hard to interact with other humans I often wonder why I still try."

You can respond to Benn with comments below

Personal experience of the illness of depression and of the Psychopharmacology Clinic in Bristol

My Experience of Depression

The Distress of Depression

It would appear to me that depression is very variable in terms of its intensity and effect upon the sufferer.  The two extremes ranging from feeling low and sad through to utter despair where only suicide would bring an end to the suffering.

I have experienced depression to varying degrees for much of my adult life, although I do recall at school being bullied psychologically as I sought to adhere and live out my Christian beliefs; my response was to withdraw into myself.  The net result was that I left school at the earliest opportunity with very limited academic qualifications.  It was only later in life through extensive self study that I ultimately gained a Masters degree in economics from the University of ….  When I felt well enough I have found academic study to be a “balm” to my troubled mind, at other times I have been too depressed even to read.  With this qualification I was able to pursue a career as an academic.  During much of this time I was free of the most severe symptoms of my illness.  This continued for over a decade interspersed with periods of depression and as a result I resorted to alcohol in order to soothe my troubled mind.  This period also included times of extreme lethargy.  Despite setbacks I was successful in my career and was promoted to Principal Lecturer in .. at a very early age.  However, my depressive illness increased and I was very debilitated by it, to the point where I would just sit and stare into space unable to do the simplest of tasks.  I was also very ‘slowed up’ both physically and mentally.  By this time I was receiving hospital treatment but I was unresponsive to anti-depressants.  My doctor advised me to give up work at college which was a great sadness for me, although it was a relief to not longer have to battle to keep going when I felt so ill.

By this time I felt very ill and I had various physical symptoms such as stomach pains and flu like symptoms and I was convinced that I had cancer.  My doctor referred my to a specialist physician who after thorough investigation ruled out a physical cause for my feeling so ill. The distress of low mood has been linked with periods of intense anxiety.  At such times this was so great that I was obsessed with ending my life to escape this distressed experience which included repetitive painful thoughts and anxiety attacks. These thoughts of suicide in my worst times have escalated to planning how I would actually do it.  What actually stopped me doing this were the dual thoughts that it would be wrong to do as a Christian to the extent that I would lose my eternal inheritance and secondly I would be unsuccessful and end up just damaging myself. Never the less there are many times when  if I could have had an injection that would just put me to sleep, such as that administered to a dog, I would have done it.

My self esteem is low and of late it has felt even lower together with a lack of confidence and forgetfulness which has resulted in my checking everything I do which I find very tiresome.  As to the future I would love to improve my health to the point where I could return to my career, as I write, this still seems a long way off.  One problem is that I have been off work for so long that I have de-skilled particularly with computing which has now become such a feature in the academic world; I would also need to be able to concentrate for longer times that at present.

Treatment

The treatment I have received through the NHS has been very good.   My GP is very sympathetic, caring and patient and readily changes my medications as directed by my consultant Psychopharmacologist  (to whom I was referred by my consultant psychiatrist as my depressive illness was proving difficult to treat.)

My only criticism was three to four years ago when my consultant psychiatrist prescribed a course of Electro Convulsive Therapy (ECT) for me.  I raised my concern that I was on Monoamine Oxidase Inhibitors (MAOIs) and there could be an adverse reaction with the general anaesthetic that would be given.  I was assured on more than one occasion that all would be well, unfortunately this was not the case as my blood pressure, and resting pulse went up to very high levels and I was admitted to the acute assessment unit at …. Hospital.

I have found my treatment at clinic 7 very beneficial as the  consultant (Dr Mlaizia), has tried different  types of anti-depressants at varying levels both to lessen my depression and increase my general motivation and activity. This has met with some success.

Several years ago my then consultant psychiatrist referred me for a course of treatment at the Priory Bristol, and I’m afraid to report that I found this stay unhelpful.

Depression Society Spirituality and Philosophy

To many the notion that the human mind can be in a state of anguish, when there is nothing to agonise about and find that this same tormented mind can ransack the body and soul and suck out strength, feelings and positive emotion, or indeed any hint of happiness is hard to contemplate. Indeed to the many who have not passed through this dark valley of doubt and fear, and at times total despair such an illness would seem beyond belief. Why even the complexity, the qualitative, some may say anecdotal nature of medical opinion provides the opportunity for perplexing doubts and misleading interpretations as to the true nature of this morbidity.  No peaceful reassurance of an absolute quantitative diagnosis, thus leaving sufferer and casual observer to ask the question, is this an illness?  Is this idleness? Is this self pity or some other deceitfully constructed malaise of avoidance to life? Or is depression all of these and more.

If this apparently meaningless mental torment is indeed genuine, is it a malfunction of mind, body or spirit? Again the answer is all three, for the mind controls the body and the brain gives us the ability to comprehend mankind’s unique relationship with our creator, thus mind and spirit are linked through comprehension and faith. Spiritual depression is sometimes quoted in isolation from mind and body as if some act of disbelief has been the prerequisite to the specific state of spiritual depression. To claim that such a person is suffering in this way adds much to the despair and crushing guilt. For to study the Bible, and thereby feed the soul requires an element of focus and concentration much greater than a few fleeting moments, a basic function so often denied the depressed mind. This failure can so increase the sense of guilt, of sin, to the point where the despair and the sense of eternal death trouble the mind to a very great extent. Bertrand Russell in his essay “a free man’s society” so clearly articulates these, where in deep depression he claims, “all the inspiration, all the devotion, all the labour of the ages, all the noonday brightness of human genius are destined to extinction in the vast death of the solar system”, in spite of doubts, deep down inside the Christian depressive can know that Bertrand Russell’s terminal pessimism is incorrect, for the Bible claims an undeniable redemption for all of us’ right through from the book of Genesis to Revelation, regardless of  our mortal state.

So why do so many Christians focus upon depression in a manner that infers some error on the part of the sufferer that needs “spiritual healing”. It has been said that depression is the only physical illness that has spiritual symptoms, how true I have found this to be. Yes there is the physical dimension of bio-chemical imbalance, but it would seem that there is much we do not know about depression, it is therefore also a mystery.

However what many do not accept or comprehend is that until the mood is lifted through medication to the extent of rationally being able to comprehend Biblical truths one cannot hope to improve the spiritual state, indeed not to accept this relationship is at best distressing, and at worst fatal.

In spite of an awareness of depression only those who have experienced severe clinical depression over prolonged periods of time to the extent that they would rather stop living, have the right and “qualification” to testify to the trauma it can bring.  Indeed some medical opinion states that depression in its severest form constitutes one of the worst forms of suffering know to man.  This view is vividly demonstrated by Primo Levi who in the last few years of his life confessed that “it is a fact that one who has not been profoundly depressed is not able to comprehend its horror and loneliness, they can listen, sympathise and imagine, but they cannot feel”.  Primo Levi has said that what he experienced in Auschwitz was not as bad as when he was in the grip of deep depression.