Tackling The Mental Health Minefield Part 10 - Hot-bedding

(This post continues the story from Tackling The Mental Health Minefield Part 9 - The Nurses: Carers or Prison Warders)

Hot-bedding is a military term, particularly used by the Royal Navy but understood by the other Armed Forces equally, that indicates that there are insufficient beds for all on board and that as one seaman climbs out of his bed to get ready for his watch, so a seaman coming off watch climbs into it to get some sleep. It isn't actually that common these days, although I suspect that it may still be necessary on some submarines.

Beds are at a premium in all NHS hospitals. Many hospitals have more than 100% occupancy (I know that sounds impossible but it happens) and the fact that is that as soon as one patient is discharged, and sometimes even before that happens, another patient is admitted to take the bed. There have been huge cuts in the number of beds available in an effort to save money. If these cuts have been bad in main stream hospitals, in mental hospitals they have been catastrophic.

The problems that arise from this policy are something like this in the Mental Health Trust that looks after my area of London. The trust has seven hospitals which either take patients from a particular area or are specialist psychiatric facilities (eating disorders, young people, addiction). The hospital that you are put in is therefore dependent on which borough you live in, and then the ward that you are assigned to is decided by whereabouts in the borough you live. This is hardly ever deviated from so even though you may be in desperate need of a bed, if there is no-one who is well enough to be discharged then you are left on your own. There can be no doubt that having to operate in this way that there are more attempted suicides or successful suicides than there would be if there had been a bed available when the patient needed it. To show this happened in the hospital that I was in, it is only necessary for me to relate what happened to me.

I was moved from the admissions ward to my permanent ward at no notice because they needed my bed in the admissions ward. This was on a Thursday evening; the following Wednesday I went home for my ill-fated overnight leave. When I went back the next day, my room was already being occupied by somebody else, so it became necessary to discharge someone so that a bed could be made available for me. A couple of days later I was told that I had to vacate my room because it was needed for a male patient being admitted to the ward. I wasn't in any fit state to be discharged or sent home on leave, so I was told that I would be given a bed for the night on another ward. I was to spend the rest of the day on my ward, up to and including night-time medication, then I was to move to this other ward, where I didn't know any of the patients or the staff, for the night only to return to my proper ward for breakfast the next morning when it was hoped that a bed would be available for me. I'm afraid that I really lost it at that point.

My immediate question for the staff was why it was necessary for me to be moved in this way; wouldn't it make more sense for the male patient to be put on the other ward. There seemed to be no sensible answer to this; I was told that this was just the way it had to be. I decided to dig my heels in at this point and said that I would not be leaving the ward after medication and that it was up to the staff to find me a bed somewhere on the ward. And so it came about that I spent the night sleeping on one of the settees in the ladies' TV lounge. The following day, one of the patients was sent out on home leave and I moved into their room. A few day's later I was moved again. The room that I was occupying was in the main corridor and they wanted this room for someone else, so a bed was made available for me in the female corridor. I remained in that room until I went to the assisted-living accommodation about a week later.

In the period that I was in the hospital I was on two wards and slept in six different rooms, one of them not even a bedroom. One of the most important things that most mental patients require is a sense of stability something that was definitely lacking in my case and I am sure that it was this sense of not belonging that caused me to be in hospital as long as I was.

To be continued.

Tackling The Mental Health Minefield Part 9 - The Nurses: Carers Or Prison Warders

(This post continues the story from Tackling The Mental Health Minefield Part 8 - OT? What OT?)

The people that patients have most interaction with while in hospital (apart from other patients) are the nurses. Although in these days of tight budgets the number of nurses on a ward is supplemented with the addition of unqualified staff and in the hospital that I was in these members of staff are known as Care Support Workers. When in an ordinary hospital you have a reasonable idea of who is staff (they wear a uniform) and who is a patient (they will generally be lying in a bed or wearing night clothes and a dressing gown. In a mental hospital it is often far more difficult to make the differentiation. The nurses don't wear uniform and the patients are usually wearing normal every day clothes.

The funny side of all this is that on more than one occasion I had both patients and staff speak to me thinking that I was a member of staff. I'm not sure why this should have happened; whether it was because I didn't look like a mental patient or because I looked as though I knew what I was doing, I'm not sure.

This post will be broken down into several sections and cover areas and say things that I am sure may be upsetting to some mental nurses. Any criticisms that I make are directed at the staff that I had interaction with during my stay in hospital and not to all mental nurses, so those professionals who read this please do not think too harshly of me for I am only reporting it as it was during my incarceration.

Named Nurses

Okay, we all know about named nurses. They are the one's who you can go to when you have problems and they are supposed to be your first port of call if you are having problems. That's fine if the nurses work some sort of regular shifts, but the nurses on the two wards that I was on seemed to work a fair amount of double shifts so you would see a nurse for a couple of days and then you might well not see them again during your stay on the ward. On the first ward I was on I was assigned a male nurse 'M' as my named nurse and I can report that at no time while I was on the ward, and he worked at least four of the eight days that I was on the ward, did he ever introduce himself to me or even talk to me. This defeats the object of having a named nurse, doesn't it?

On the second ward that I was on, my named nurse introduced herself to me on my second day on the ward, and then told me that she was going to be off for the next week. At no time during my three weeks on the ward did she make any effort to actually talk to me, and I am afraid that I have to say that she was the nurse who ran around like a headless chicken when I had my angina attack and wouldn't give me my GTN spray until she had found a second nurse to be with her while she opened the drug trolley.

As far as I can see the named nurse is a good idea in theory but it is rarely going to work properly because of shift patterns and the fact that the nurses rarely seem to leave the office.

The Office

From reading other blogs it is apparent that those of us who have been inpatients in a mental hospital all have the same opinion that the nurses spend far too much time in the office writing reports about the patients and nowhere near enough time actually interacting with the patients that they are writing reports on.

My first ward had a large office that was big enough for most of the nurses and care support workers to spend much of their shift in there. Sometimes the only member of staff who was not in the office was the one going round doing the hourly checks on where the patients were. the office on the second ward I was on wasn't large enough to swing a cat in and yet at most times of the day all the members of staff would be locked away in there except for the person going round the ward doing the hourly checks and the person sat outside the office keeping an eye on one of the patients, J.

J would walk up and down the main corridor of the ward for hours. She wasn't allowed any leave and rarely had visitors; the only time that she left the ward was to go to the meeting room where ward rounds were held. J also ate constantly if she could get her hands on food. Any food. She would go into the kitchen area and take handfuls of sugar and eat it. The result was that the staff stopped putting sugar out for us to use in hot drinks except in sachets. this didn't stop J, because she would just take a handful of them and eat the sugar, throwing the packets down wherever she happened to be at the time. She would also take the little containers of jam, marmalade and honey that we had at breakfast and supper by the handful and lick the contents out of the containers while walking up and down the corridor. All that the staff ever did was to tell her not to eat the sugar or the jam. She was not told to pick up the rubbish that she would leave lying around. It was the patients who decided that something needed to be done because we were sick of finding half-eaten containers of jam in the box in which the jam and butter were stored. By watching J, and every time she threw rubbish on the floor or put empty containers anywhere other than in the bin, one of the patients would tell her to pick up the rubbish and put it in the bin, likewise with the jam containers. After a week or so of this J started to put the rubbish in the bin automatically. Because the staff spoke to her in such weak tones, and the patients used authoritative voices as one would with a naughty child, so J learnt what was acceptable and what was not. If the member of staff who was assigned to watch her walk up and down the corridor for hours during the day had been used to engage her in some meaningful activity then I am sure that it would not have been long before it was no longer necessary to have a member of staff monitoring her all the time.

My question is, why do so many of the staff need to spend so much time in the office ostensibly writing reports on the patients? Because they spend so much time in there and so little time with the patients, anything that they write must be a fairytale anyway.

Protected Time

Protected times are something that seem to exist in all mental hospitals. They are useful because it means that certain things can be done on the ward without unnecessary people (and that does include visitors) being around. This means that mealtimes were protected times and each morning the hour between 11am and midday, was protected time. There were notices to this effect at the entrance to the wards and they made it quite clear that the hour of protected time before lunch was for the nurses and patients to interact.

The problem was that this never seemed to happen. This hour each morning when nothing was happening (no OT, no psychotherapy group, nobody allowed to use the gym) was, except for Monday mornings when a ward meeting was held, were just an excuse for all the staff to congregate in the office.

It was near the end of my stay in the hospital that I was asked to take part in the group psychology session. Four patients, including myself, one of the nurses, the ward psychologist (who is the psychologist that I see for psychotherapy now) and his trainee were sat in a room with the aim of doing some talking. The other three patients had been present at the group session the previous week so the had done all the introductory stuff and their input was to talk about how things had been since that last session. I, however, was new to this and I was expected to do a bit more talking, which somewhat surprisingly I did, about why I was in hospital and about how long I had suffered from depression. After having done this, the psychologist asked if there was anything else that we wanted to talk about, or to raise for the group to discuss.

I'm not sure how it happened because I am not naturally someone who would speak up in these circumstances, but I found myself talking about how little interaction had taken place between me and the nurses. I said that I had been in hospital for nearly a month and during that time only two nurses had taken the time to actually sit down and talk with me, to find out whether there was anything that they could do for me, and to generally put me at my ease. I questioned the point of the hour of protected time in the morning if the nurses were just going to sit in the office as they did for the rest of the day and ignore the patients. At this point, the other patients at the session also joined in and made similar comments all of which left the nurse, who had decided to come to the session to see what went on, somewhat red-faced.

I think that what I said struck home because the next day on the stroke of 11am, the office emptied and the nurses went in search of a patient with whom they could interact. This practice continued after I had left the ward, but I would question whether they have gone back to their bad habits now we are a few more months down the line.

Conclusions

It is important that anyone reading this should recognize that the views expressed here are my own based on my experience of a month in a mental hospital. I don't wish to offend anyone but I am telling it how it was in the hospital that I was in; I am sure that things are not as bad everywhere, and it is possible that there may be some hospitals that are even worse.

I have been on surgical wards with as many patients as there were in the wards in the mental hospital that I was in, which operated with a similar number of nurses, where the patients were not as mobile as they tend to be in a mental hospital, and yet where I would have regular periods of interaction with the nurses. And on the surgical ward the nurses had to do proper nursing things like changing dressings and helping the patients with their ablutions. So why do mental nurses consistently fail to interact with the patients?

One thing that concerned me greatly was the number of coloured nurses on the ward and the difference in their attitudes to the coloured patients and those who were white. It is bad enough to suffer discrimination because you have a mental illness, it is appalling when the discrimination is actually being shown by the people who are supposed to be helping you, not only because you have a mental illness but also because you are white. Another bad practice that was common among a particular group of nurses was their having conversations in front of the patients in a foreign language. The Nigerian staff were the offenders here, breaking Mental Health Trust policy by so doing.

I found, and have mentioned this in various of the posts in this series, that the nurses seemed to have little respect for the consultant psychiatrists and had no qualms about contradicting their (the consultant's) decisions or arguing with the consultants over what had been said. To have done this is bad enough, to have done it in front of a patient is unprofessional.

So all in all, I do not have a high opinion of the mental nurses (and care support workers) that I came in contact with. Yes, there were a few very good nurses and I was thankful when they were on duty, but the majority of them left a lot to be desired. I was left with the feeling of being discriminated against because I was not schizophrenic or a drug addict, because I was white, and as another patient said of me, because I was probably more intelligent than most of them.

To be continued.

Tackling The Mental Health Minefield Part 8 - OT? What OT?

(This post continues the story from Tackling The Mental Health Minefield Part 7 - The GTN Story)

Having to spend a long period in hospital, and these days anything more than a week can be considered a long time, means that there can be a lot of empty hours to fill. When that hospital is a mental hospital then one can expect to be mobile and the empty hours can seem interminable. Mental illness can make it difficult to concentrate, or to be able to do something for a long period of time. My experience of mental illness is depression and I have tried many things to deal with the hours of the day. I read, I study, I do crossword puzzles, I knit, I do embroidery and I make cards. Sometimes I can't do any of these things for more than an hour at a time and sometimes I can spend all day on one of these activities as long as I don't encounter any problems. Problems are very difficult to deal with and so I end up putting whatever it is I am doing aside until I am feeling a little better and can deal with the problem.

During my stay in hospital, life soon settled into the routine so loved of such organisations. Breakfast would be served at about 8am, meds and obs at 9am, lunch served at about 12.15pm, meds at 1pm, dinner at about 5.15pm, meds at 6pm and night-time meds at 10pm. I expect that it is pretty much the same in any hospital.

Visiting hours were 2pm to 5pm and 6.30pm to 8.30pm. The difference between visiting hours in a mental hospital and an ordinary hospital is that there are very few visitors; most patients have no-one visit them from their admission to the day that they are discharged.

So what do patients do during the rest of the empty hours in a day? Well, there are of course ward rounds, but while these may take a considerable time during the day, the patient only attends ward round for a limited time. Most of my visits to see the consultant psychiatrist and whoever else was in the room (see Tackling the Mental Health Minefield Part 6 - Throwing The Christian To The Lions) were no longer than about 10-20 minutes twice a week.

While I was on the admissions ward there was nothing organised for us to fill the empty hours. As is common to most accounts of time sent on mental wards, we were expected to spend most of our time in the communal areas. These were the TV room and the dining area/day room. During my time on the admissions ward I went in the TV room twice; both occasions being for ward meetings. The dining area/day room had tables and chairs sufficient for 12 people, but the ward could take up to 16 patients, which meant that if the ward was full it was impossible for everyone to be able to sit down together at meal times or during other periods of the day. So I spent some time in the dining area/day room particularly when I had made myself a hot drink or for meals, sometimes I would read a book or doing sudoku puzzles. I had always found sudoku puzzles impossible to do even though I understood the requirements for completing them because I have number dyslexia. However, one of the patients that I was on the admissions ward with spent time explaining how to do them and I became hooked. Most of the rest of the time I spent in my room trying to catch up on sleep that I wasn't getting at night or reading. There were no organized activities for us to take part in.

When I was on the second ward, there was an activity semi-organised for each morning (Monday to Friday) between the hours of 10-11am but these rarely took place. The two which did seem to be regular events were a session of creative writing on a Tuesday morning and a group psychology session on a Thursday morning.

The first Tuesday that I was on the ward (I had been on the ward for five days then and in hospital for two weeks) two occupational therapists approached me when I was in the main corridor of the ward walking from the laundry room with my arms full of the washing that I had just done, and tried to get me to join in with the creative writing. I took my newly laundered clothes back to my room and went to the OT room to wait for the OTs to round up any other patients who could be dragged along. They were unsuccessful, so there I was sitting in a room with two OTs and all they could suggest to me was that I might like to write about what had led to me being in hospital. Now maybe I was just being over-sensitive, but I really didn't think that was a very good thing for me to be doing at that time. So I thanked them very much and left to go back to my room to read my book.

I was absent from the ward on the following Thursday morning as a result of being on my first attempt at home leave. I arrived back on the ward at lunch time so I missed the group psychology session. The following week however, I was persuaded to join three other patients from the ward and one of the nurses at the group psychology session and spent an hour away from the ward with one of the psychologists and his trainee psychologist. Each of the patients were given time to talk about how they ended up on the ward, the other three having been present at the previous week's session they went first and then it was my turn. I was asked a number of questions which I have to admit I answered only briefly and then I was asked about my depression and how long I had been suffering from it and how I had ended up in hospital. I answered at length and what I had to say somewhat surprised the other patients who had no idea that I had been suffering for so long or that this was my first admission to hospital.

Then we began to talk about life on the ward and I raised the subject of the 'protected hour' that we were supposed to have everyday between 11am and lunch. As this is going to be the subject of another post in this series I won't go into too much detail here, but from being someone who pretty much kept to myself on the ward although I did talk with a number of the other patients, I suddenly found that I had become a spokesman for not only those patients at the group psychology session but also those who weren't.

So, at the end of this post I go back to the subtitle that I used. OT? What OT? I know that some things that traditionally come under the title of occupational therapy involve cost and money is something that seems to be in short supply in mental health services, but the significant lack of anything that could be termed as 'helpful' in making the empty hours pass more quickly for the patients was alarming. The wards had televisions, and a small supply of books, but nothing much else. The result was that some patients spent most of the time in their rooms and socialised only at meal times. It is probable that the nurses wrote up their notes on the patients on each shift and commented that the patients didn't seem to do much, but it has to be said that there really wasn't anything to do. I would have loved to be able to do some knitting, but knitting needles were not allowed on the ward. I understand that they could be used as a weapon if used in public areas, but if I was to knit in my room and return the knitting to the staff when I had finished for the time being would certainly have helped me considerably.

I was lucky: I was only in hospital for a month but by the time that I left I was desperate to do some knitting or something other than read a book and do sudoku puzzles. As far as I am concerned this is an area what definitely needs something done about it. I know that some patients probably wouldn't want to partake in anything but there are definitely some who could almost certainly be helped considerably if there was something to help to pass the time in an environment that is not always conducive to improving one's mental health.

Tackling The Mental Health Minefield Part 7 - The GTN Story

(This post continues the story from Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions)

In one of the earlier posts in this series (Part 2 - The Admission Process) I wrote about many of my possessions being taken away when I was admitted to hospital. One of these was my GTN spray, which is prescribed for me because I have Prinzmetal's angina. Prinzmetal's is also known as variant angina and is relatively rare in comparison to the other forms of angina. The pain is caused by one of the arteries in the heart going into spasm, and can occur at any time, even when at rest, and is not caused by exercise and a cardiac stress test cannot be used to diagnose it. I had suffered from its symptoms for a number of years before it was diagnosed and since then daily medication has kept it pretty much under control although I do still have occasional attacks and I always carry a GTN spray to reduce the pain. No matter how hard I argued with the nurse that I should keep the GTN spray, he would not accept that and I was told that if I had an attack that I was to go to a nurse who would get my GTN spray out of the drugs cupboard in the Clinic Room.

I had been in hospital about six days when, early in the evening, I had an angina attack. I was in the communal/dining area, so I walked calmly to the office at the end of the corridor and having knocked on the door and it been answered I explained that I was having an angina attack. The nurse who had answered the door immediately picked up the keys for the Clinic Room and for the drugs cupboard and ran to open up while I calmly walked to meet her. By the time that I got into the Clinic Room she had my GTN spray out of the cupboard and ready for me to use. After taking the usual two puffs under the tongue I sat down on the chair for a couple of minutes to make sure that the GTN spray was doing its work. One of the side-effects of the spray is that it can cause one to become light-headed or occasionally very dizzy, so it is always advisable to sit down for a few minutes after using it.

After about five minutes I was feeling much better and the pain had gone so I went back to the communal area to rejoin the three patients that I had been sitting with. Sometimes after having the angina pain I have a repeat attack about an hour or so later and that is exactly what happened on this occasion. This time one of the other patients went to the office to call a member of staff and the process was repeated. After the second attack, I went to my room and laid down for a while. I was fine, and the next day things were back to normal.

A couple of days later I was moved to my permanent ward and before I left the Admissions Ward I had to make sure that my GTN spray was removed from the drugs cupboard and made the move with me. Once again during the admission process to the new ward I asked that I be allowed to keep the GTN spray with me. Once again the answer was no, but to make matters worse the nurse had to ask what it was for.

Life on the ward continued with no further attacks until the day that I was supposed to be having a couple of hours home leave. This was the occasion when I had an argument with the staff about what my consultant had said about me having home leave (see Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions). I'm not sure that it was the argument with the staff that caused me to have an angina attack, or whether it was just one of those coincidences that happen occasionally.

After lunch I was sitting quietly in my room doing a crossword puzzle when an angina attack started. My room was just a matter of yards from the ward office so I made my way there, knocked on the door, and the nurse who was in there answered the door and I told her I was having an angina attack and that I needed my GTN spray. The clinic room with the drugs trolley was next door to the office, but the nurse headed off along the corridor towards the communal area rather than going to the clinic room. When I shouted at her that I needed the spray immediately, she said that she needed to find another nurse because there had to be two of them to dispense drugs. I'm afraid at this point I really lost my temper and shouted so loudly that patients and staff came running from all directions.

At this point the nurse decided that perhaps she had better get the spray for me so I followed her into the clinic and waited while she fumbled with the keys to the drugs trolley. Then there was the problem that she didn't know what she was looking for, so I just snatched it from the trolley myself and sprayed twice under my tongue. I sat down on the chair which was used by the patients when obs were being done, laid back and closed my eyes for a few seconds while I waited for the GTN to take effect. Of course there was rather a large audience for what followed and the nurse was still more interested in finding a second nurse than in ensuring that I was okay.

The ward SHO had heard all the noise and came out of her office to see what was happening. Seeing everyone standing around the clinic doorway at a time when no medication would normally be dispensed alerted her that something untoward may have occurred and that she may be needed so made her way along the corridor (I was told about this later by one of the other patients). The SHO came into the clinic and asked what had happened and the nurse said that I had come to the office complaining of chest pains and that she had tried to find another nurse so that they could get my GTN spray together. The doctor was appalled, and proceeded to ask the nurse whether she would have gone looking for another nurse if she had found me lying in the corridor and not breathing. It being a question which did not need an answer, the doctor continued by saying that in the event of something like this happening then the nurse should ignore normal procedures and give an angina patient their GTN spray immediately.

While this was going on, I was just sitting in the chair waiting for the pains to stop. After about 10 minutes, with me still experiencing pain and being monitored by the doctor, it became necessary for me to use the spray again. This time it seemed to do the trick because a few minutes later I was feeling much better and was able to stand and walk back to my room after having had the spray again locked up in the drugs trolley. The SHO came to see me about half an hour later and asked me to go along to her room so that she could carry out an ECG. this turned out to be another farce. First of all, the ECG machine belonging to the ward was not working so one had to be borrowed from another ward. One this had been procured I climbed onto the examination couch and the doctor proceeded to attach the sticky pads to my body and the various leads to the sticky pads. It was a bit like watching someone trying to put together a piece of flat-pack furniture. The doctor stood there with the instruction manual in one had and was attaching everything with the other hand. Every time she attached a lead, one of the sticky pads on another part of my anatomy would come unstuck. Eventually she managed to get all 12 pads attached to my body and all 12 leads attached to the pads. Then she pressed the 'Go' button on the ECG machine ...... and nothing happened. After about half a dozen attempts she decided that it was all far too difficult for her and decided that I seemed to be recovering quite well and the ECG could wait.

The decision was made that because of the angina attack I should not go home on leave that day and the situation would be reviewed in the morning. I asked that I be allowed to keep my GTN spray with me and the doctor agreed, but the nurse wanted it written on my medical records and as the doctor failed to do this she would not give it back to me.

The next day arrangements were made for me to have an ECG in the main hospital, the grounds of which the mental hospital was sited. The ECG was done immediately and I went back to the ward to collect my belongings and my medication so that I could go on my overnight home leave. Although this leave was for one night only I was required to take all of my belongings with me. As I said earlier in this series of posts, and in a post at the time, the home leave was not a success. I didn't sleep at all that night and when I reported back to the ward at lunchtime it was to find that someone had been put into the room that I had been occupying.

At ward round that afternoon it was decided that I was not fit to be discharged and that I was to stay in the hospital. At the same time, the consultant said that I was to retain my GTN spray so that I could administer it myself immediately if I needed to and asked only that I inform the staff that I had used it. I had two further attacks while I was an inpatient, both of which I was able to control immediately because I had my spray.

What the episode of the GTN spray taught me was that you really don't want to be in a mental hospital if you also have a non-mental illness. I would hate to be an asthmatic having a serious attack, or someone having a heart attack, in a mental hospital because if it were staffed with nurses of the calibre of the one who I had the misfortune to encounter, your chances of surviving the attack could be severely compromised.

To be continued.

I Can't Believe It

I've won an award. Okay, so it's only a virtual award, but it still means a great deal to me. I was joint winner of the Best Mood Disorder Blog in the Mental Nurse TWIM Awards.

The Tackling the Mental Health Minefield posts were responsible for me being nominated and while they have been difficult to write (and still are because there are several more to come) I felt that it was important that the mental health system needed to be described from a patient's point of view.

Mr Smiley encouraged me when I first started writing this blog, and when I told him that I was thinking of writing a series of posts about my experience of being in hospital, he thought that it was a great idea. He has always encouraged me to write about my experiences and much of my lecture on a patient's experience of psychotherapy is based on a series of emails that I wrote to him over the period of that therapy. I'm sure he will be very happy that his encouragement has resulted in this recognition.

Tackling The Mental Health Minefield Part 6 - Throwing The Christian To the Lions

(This post continues the story from Tackling The Mental Health Minefield Part 5 - Please Sir, Can I Have Some More)

Those familiar with how things are done in mental hospitals will probably be able to guess what this post is about from its title. Blood sports may have been banned, but something pretty akin to them is still practised in mental wards up and down this country. It is the ward round.

Ward rounds are something that may occur in any hospital. If you are a patient in one of our large teaching hospitals you may encounter something akin to those seen in Doctor in the House or Carry on Doctor. But ward round in a mental hospital is more like those olden days when the gentry could visit the local insane asylum and view the wretched inhabitants.

My first ward round was the day after I was admitted to hospital. I was summoned to a room with tables in the centre and sat around them was the consultant, the ward SHO, one of the nurses from the ward and a couple of other people, whose function I can not remember. I was invited to sit down on a chair that was placed some distance from the tables, but the position of which enabled all those present to get a good view of me.

It should be remembered that people in mental hospitals, particularly those recently admitted, are very vulnerable. To encounter this sea of faces is nothing short of terrifying. I was,frankly, terrified. I can remember little of what went on other than being asked a raft of questions many of which I found difficult to answer and when it came time for me to leave the room tears were flowing freely.

As this was the admissions ward, there was a ward round each day, Monday to Friday. the first to be seen were those who had been admitted the day before, then such others on the ward that the consultant wanted to see. I was not due to see the consultant the next day but made a request to see him because I needed some leave to get some clothes. I still had nothing but those that I was wearing when I was admitted.

I went in to see him and made my request. He asked me where I lived and I told him, and then said that I was not planning to try to get home to get additionally clothing but would be going to the shops just a few minutes walk from the hospital. He then said that as I was an informal** patient I could have leave and then asked if two hours would be sufficient time. I replied that I thought that this would be plenty of time and then made a second request. I asked whether it would be possible for me to go unescorted to the garden when I wanted a cigarette. He replied in the affirmative and was immediately overruled by the nurse who was sitting in the ward round.

This shows the sheer stupidity that exists in our mental hospitals. I was allowed to go out of the hospital, on my own, for two hours and wander around the shops, but I was not allowed to stay within the confines of the hospital and go about unescorted.

My next ward round was on the following Monday; this time there were also a couple of medical students sitting in. I was still in a very low state of mind and my time in there was short because I just dissolved into tears almost immediately. I was seen again on Wednesday and the consultant asked that the home treatment team (HTT) be contacted so that they could come to see me. (I will write more about the HTT in a later part of Tackling The Mental Health Minefield.)

I wasn't seen at Thursday ward round and that evening I was transferred to another ward. This occurred without warning; I was just going to make myself a cup of tea when a nurse told me to get my things together because a bed had become available on the ward that I was moving to and they needed my bed on the admissions ward for a new patient. It should be noted here that the literature that I was given when I first arrived at the hospital said that I would only be on the first ward for two or three days, or exceptionally a week if it was thought that I could be discharged from there. I had been on the ward for nine days. So much for believing anything in the literature.

The ward that you were moved to depended on where you lived. This meant that the patients on my new ward all lived in my particular part of London. The ward had two consultants, and which consultant you saw was decided on your initial admission to the hospital, so while I had been allocated to a particular consultant while I was on the admissions ward, this was not the consultant that I saw. The admissions ward had its own consultants who saw all the patients on that ward no matter which part of the area served by the hospital that they came from.

On the new ward, the consultants held their ward rounds on different days, and each saw patients on two days. My consultant's ward rounds were held on Mondays and Thursdays, which meant that because I was moved on the Thursday evening, I would not be seeing a consultant until the following Monday. This time the ward round was actually held outside of the ward proper. This was because there wasn't a suitable room available within the ward. However, just outside the ward there was a Meeting Room and four times a week this was used by the consultants for their ward rounds.

At my first ward round on the new ward I went into the room with trepidation, as before, only to be greeted by a lot of new faces, so introductions were made. As well as my consultant and her SHO (who sat at a laptop recording what went on), there was a psychiatrist from the Assessment and Brief Treatment Team (ABT) at the CMHT, the ward's social worker, someone from the Home Treatment Team (HTT) at the CMHT, an occupational therapist, one of the nurses from the ward (who made notes for use on the ward, but obviously not carefully enough because of the problems that followed), and myself. Fortunately this room was furnished a little more comfortably and nice armchairs were provided instead of the tatty office chairs that were used on the admissions ward.

After all the usual questions from the consultant, she decided that I should be given some home leave to see how I coped. So she said that I was to go home for a few hours during the afternoon of the following day, Tuesday, and if that went well I should spend the night at home on the day after that, Wednesday. This meant that I would be back on the ward for the next ward round and further decisions could be made then. The problem, as those of you who read the posts that I wrote while I was in hospital will know, is that the nurse wrote down that I was to go home for two nights.

Tuesday morning, one of the nurses came to see me in my room and told me that my medication for my two days at home was ready for me and asked what time I would be leaving. No matter how many times I said that was not what my consultant had decided, the attitude was that the nurse who was at the ward round had written the consultant's instructions correctly, and that I, the patient who was obviously so stupid that she hasn't heard things correctly, was wrong. I insisted that they check with the SHO, but they wouldn't do this so I was left getting angrier as each minute passed. Things came to a head just after lunch when I was asked again when I would be going for my two nights home leave. I said that I would be going home for a few hours, but would be back in time for dinner. This again caused the nurses to tell me that I was to go home for two nights. Half an hour later I had an angina attack (more about this and the problems that I encountered in a later post) and all thoughts of me going home for any home leave that day were put on hold.

On Wednesday, I did collect some medication and go home for the night. It was not a success. I did not sleep at all, and by the next morning I was in a terrible state. I went up the road to catch a bus and make my way back to the hospital. That afternoon's ward round was almost more than I could manage. It seemed that the whole world had come to sit in on this one. I did a quick count as I entered the room and there were more than 12 people in there, and that didn't include me. Apart from those who had been present for the previous ward round there were a host of medical and nursing students. It was apart to my consultant that things were not well with me and she asked all those not absolutely necessary for the ward round to leave. This left just five of us in the room and although I felt less overwhelmed I was still very upset. When my consultant asked about the home leave and I explained what had happened with the nurses saying that I was to go home for two nights and me saying that was not what had been agreed between her and me. At this point my consultant went mad. She understood why everything had been so difficult for me and when she reiterated that what she had wanted was for me to try a few hours home leave before having an overnight home leave the following day. At this point the nurse(the same one who had been in the previous ward round) piped up that I should have gone home for two nights because she had written that down. I was surprised that my consultant didn't ask everybody to leave before she decided to tell the nurse that she had better listen better in future because she had never intended me to go home for two nights, and was perfectly certain what she had said and that I had understood it too.

This whole episode delayed my recovery. Instead of being ready for a longer home leave in a few days, possibly over the weekend, I ended up having to stay in hospital for another two weeks before I was ready for more leave.

Every ward round that I attended after that went without too much of a hitch, but my consultant always made sure that there were only people who were absolutely necessary present. No more medical students, nor more nursing students, and no-one who was not involved in my immediate care over the next few days.

I found out afterwards that I could have asked for just myself and the consultant to be present when I was seen, but like so many of these things, you don't find out until it is too late. I really believe that ward rounds where there are so many people present are not good for the patient, especially if they are distressed and have no-one who can be with them such as a partner or other family member. I likened it to a blood sport at the start of this post and it does very much feel that you, the patient, are the fox, and all the other people present are the hunt and the hounds. Definitely not conducive to a speedy recovery.

** Informal is a euphemism for voluntary. Political correctness causes the powers to be to use the terms formal and informal in place of involuntary and voluntary.

To be continued.

Swiftly Moving Fingers

This post does not relate to my fingers moving over the keyboard of the computer although I am a pretty quick typist having learned to touch type when I was at school and having used that skill throughout most of my working life I can still type at something like 60 words a minute. Having learnt in the days of manual typewriters, using keyboards today requires little effort compared to those days and I sometimes wonder why repetitive strain injury is so common these days when we didn't suffer from it when we had to type with a definite thumping action.

No, I am referring to the way that my fingers are working on my knitting. I have finished the back of the cardigan and have now started on the first of the fronts. As this is only half the width of the back, and I now have row counts for the various sections that comprise the back that I can use to indicate how much more I have to do on each section of the fronts, I am predicting that I will get the first front finished this evening and probably get a significant amount of the second front done too.

However, while I am doing this knitting I am also trying to draft in my mind the next part of Tackling The Mental Health Minefield. I have started to type it up and I hope to finish it this evening or tomorrow morning at the latest. Thinking up the secondary titles for each of the posts is one of the things that I have been enjoying as I type them up, but the next post's title has been clear in my mind for a couple of weeks and I even spoke about it to Lily from The Student Doctor Diaries when we were having a chat over a cup of tea the Friday before last. So, soon to be coming to a computer screen near you will be Tackling the Mental Health Minefield Part 6 - Throwing The Christian To The Lions.

Tackling The Mental Health Minefield Part 5 - Please Sir, Can I Have Some More?

(This post continues the story from Tackling The Mental Health Minefield Part 4 - Life On The Admissions Ward)

The rest of the posts in this series will give details of a particular aspect of my time in the mental hospital. So the decision has been to decide what would be the first subject to be tackled. In the end it wasn't very difficult to decide; it had to be FOOD. One of the best blogs to have appeared recently has to have been Traction Man's Notes From A Hospital Bed which attracted huge numbers of visitors when he started showing the awful food that he was being served with in his long sojourn in hospital and it was reported on the BBC New website.

Hospital food is nearly always something that one endures while a patient; although you are likely to be given a menu card to choose what you want for your meals, the likelihood of you actually getting what you asked for and it being edible is not high. I should admit at this point that I am a bit of a fussy eater even when I am not in the depths of depression. I do eat a wide range of things, and I am a great fan of food from other parts of the world, but at the same time there are a number of quite ordinary things (cauliflower, cabbage, and Brussels sprouts to name a few) that I really cannot abide and absolutely nothing will persuade me to eat them. I am also allergic to a couple of things (tomatoes and pineapple) which make me really ill if I eat them. Bearing this in mind I was not sure how I was going to fare if I was going to be in hospital for a while. The longest hospital stay that I have had in the past was seven days on two separate occasions (surgery both times) and I managed to lose weight on both occasions.

Breakfast

The first meal of the day was pretty typical of what you might get in any hospital. The day staff came on duty at 8am and one of the oncoming team would go to the kitchen and get the the things ready for us, so that breakfast was usually available by 8.15am. There would be a choice of variety-pack size cereals, usually cornflakes, rice krispies, bran flakes and fruit and fibre. Hot and cold milk would be available to suit the individuals preference. I'm not a great fan of cereals and my choice would always be shredded wheat, but this was not one of the options available so cereal was off the menu for me.

The other item on the menu for breakfast was toast. The staff member who was on breakfast duty would toast a loaf of white bread and a loaf of brown bread. If you like your toast hot then you made sure that you were there ready to snatch some bread off the plate the moment that it came out of the kitchen. Usually there was a choice of butter or low fat spread to put on the toast and if we were really lucky there might be individual portions of jam or even Marmite. I have to admit to having been a Marmite baby so if it was available that would always be my choice of topping.

There was usually enough milk available for you to have a glass of milk with your breakfast (either full-fat or semi-skimmed) but if your preference was for a hot drink, then the vacuum jugs would have been filled with hot water for you to make a nice cup of tea or coffee.

I suppose that I should point out here that we were not allowed anywhere near boiling water, so we had to make our hot drinks from hot water in a couple of vacuum jugs. this was fine as long as you managed to make a drink just after they had been filled, but after that you were left with a lukewarm drink that you would throw away at home but which you drank thirstily on the ward because it could be ages before you could manage to persuade a member of staff to refill them.

The first ward that I was on had only plastic plates, mugs and cutlery; on the second ward the plates and mugs were melamine and there was a selection of both plastic and metal cutlery.

Lunch and Dinner

As is common in hospitals today, the main meals of the day were cook-chill prepared elsewhere and then heated on the wards. This did mean that the food was always hot when it was brought to the dining room. There was always a meat dish and a vegetarian dish, usually a couple of choices of potatoes and at least two other vegetables. Unfortunately gravy was often missing from the food delivered to the ward which meant that because I hate eating vegetables without gravy I often went without. In addition to the choice of hot meals there was also salad (always with tomatoes cut up in it so I could have that as I am allergic to tomatoes) and usually sandwiches (again often with tomato in them). At both lunch and dinner there was a dessert, usually tinned fruit at lunchtime but something more substantial and often hot at dinner such as apple pie or spotted dick, or if it was a cold dessert cheesecake or gateau. Soup was also available at dinner.

Although I am very definitely a meat-eater, I have to admit that I did have the vegetarian option quite often. The vegetarian sausages were really nice and so were quite a few of the other vegetarian dishes. Once everybody had been served, and we were usually all hanging around in the dining room waiting for our meals, there was the opportunity for seconds if there was anything left over.

The only days on which you could predict what would be on the menu were Friday, when there would always be fish and chips for lunch, and Sunday, when there was always a roast for lunch. The menus for the following day were put up on a board in the dining room after dinner so that you knew what was coming the next day. Even though I am a very fussy eater as I have already mentioned there were only three meals during the month that I was in hospital where I didn't like anything on the menu, and as these were all on different days, I didn't go hungry.

Supper

The changeover from day staff to night staff took place at 9pm and as with breakfast one of the oncoming staff would go to the kitchen and toast a loaf of white and a loaf of brown bread. There would often be cheese and biscuits and yoghurts too. If you didn't happen to be in the dining room (which doubled up as a day room on both wards and as the television room on the second ward) then the staff would go round the rooms to tell you that supper was ready.

Conclusion

One thing that was imperative was that the patients didn't go hungry. If you didn't fancy a meal there would be an inquisition as to why you weren't eating. the fact that there was always supper to rely on meant that if you had missed out on a meal you wouldn't go to bed hungry. The food was of a very high standard for hospital food too. I don't know if the same food was served in the adjacent hospital but one assumes that they would try to ensure that the food was quite good in a mental hospital because the last thing that they would want would be a schizophrenic going hungry and taking it out on the staff.

As with many depressives, I lose my appetite when I get really depressed, and I hadn't eaten a proper meal for more than a week when I was admitted into hospital. I hadn't stopped eating, I just couldn't be bothered to eat properly and I had been surviving on a couple of cheese rolls each day. I was encouraged to eat from the moment that I arrived in the hospital starting with the cup of tea and toast that Dr Hugh got for me. It didn't take me long to be eating at all four meals during the day and if I was hungry in between meals I could always ask for some crisps or biscuits (I didn't though). Unbelievably, I didn't put on any weight while I was a patient, nor did I lose any weight like I had on my two previous week-long hospital stays.

To be continued.

Tackling The Mental Health Minefield Part 4 - Life On The Admissions Ward

(This post continues the story from Tackling The Mental Health Minefield Part 3 - The Lovely Dr Hugh)

Having been so exhausted both physically and mentally from the day I had hoped that I would sleep through the night, but it wasn't to be. At 2am I was wide awake and in desperate need of something to drink. I got out of bed, put my cardigan on over my borrow nightwear and headed out of my room to the dining area in the hope of finding something in the fridge or at least the makings for a cup of tea. No chance; the area containing the sink, fridge and tea and coffee facilities were shut up behind a shutter. Desolate, I headed back to my room.

Just as I made it back in my room, one of the night staff came out of the office to see what I was doing. I explained that I had woken up in desperate need of a drink and had gone looking for something to quench my thirst. I would have loved a cup of tea, but I was offered hot chocolate instead. An hour later I was still wide awake and it was decided that it was too late in the night to give me something to help me to sleep.

I was reading my book at about 5am when I was startled by an alarm sounding. Why had nobody bothered to tell me about the alarms that were activated when there was trouble with a patient and extra staff were required from the other wards? The alarm went on for about 5 minutes before being silenced; all I know was that it was not my ward where the emergency was.

I should, perhaps, at this point describe the ward that I was on when I was admitted. As I have already said entry was through two electronically controlled doors, one at each end of a small corridor. Once inside the ward proper there was a kitchen on the left and a laundry room and a unisex toilet on the right. As you progressed down the corridor there was a television lounge on the right and on the left was a large open area with tables and chairs, a sink, a fridge, a table tennis table and a football game like those that you find in pubs. This area was our dining area as well as being the area where we could prepare tea and coffee. As one progressed down the corridor the Quiet Room was on the left and a Meeting Room on the right; then there was an art room on the left and the clinic room on the right. There was then a bedroom on each side of the ward and the last room on the right was a unisex shower. At the end of the corridor was the glass-fronted ward office and stretching out to the left and right two corridors, one of which was the male corridor and one the female corridor.

My room contained a bed (which was very uncomfortable), a chair, a sink, a bedside table sort of arrangement that was beside the sink and a fixed wardrobe with no doors and just shelves for the storing of clothes and other personal items. The door to the room had a large square of etched glass in it so that the patient could be observed from the corridor.

All of the taps in the rooms, bathrooms and shower were of a push button-type which meant that it was impossible to start the water running for a bath and go back to your room to get your towel and toiletries because the water only flowed for about 20 seconds. This meant that getting sufficient water into the bath so that you could have a half-decent soak would take about an hour and because it took so long to fill the water was guaranteed to be cold by the time that you climbed into the bath. Having a shower wasn't much better because again the water only flowed for about 20-30 seconds and trying to grope around for the push button when you are lathered up and have slippery hands and your eyes closed because you don't want to get soap or shampoo in them meant that it was an experience that you would rather not have to undergo too often.

Being in hospital, whether it be an ordinary one or of the psychiatric variety, means that your life will be organized by certain things at certain times throughout the day. Meal times are pretty much fixed and can be the highlight of the day. But it is medication times that are always the most important as far as the staff are concerned and their lives, if not those of the patients', seem to be controlled by them. Medication times were 9am, 1pm, 6pm and 10pm. This wasn't a problem for me because I have always taken my medication in the morning and the evening, and the times would normally be about 9am and 9 or 10pm. I have several things that are taken in the morning, a couple that are taken at night, and one which requires me to take one tablet in the morning and one at night. I am so familiar with my medication that I can get it all together and sorted out in about 30 seconds. I know that the staff have to make sure that they give each patient the correct medication, in the correct doses, but taking 5 minutes to get my four morning tablets ready for me to take was just a bit on the slow side. On top of this, the staff said that for the first three days of my admission my 'obs' would need to be done too. This meant that it took about 10 minutes to deal with me, and as there were an average of 13 patients on the ward during my time on it, it gives some idea of the length of time that the morning medication took to do. The other medication times were not so busy because most patients only had medication in the morning.

Life on the ward was pretty boring. There wasn't much to do apart from watching television, but I hadn't watched any television for weeks because I just couldn't be bothered and having to sit and watch MTV all day was not my idea of entertainment. So I read my book, and because there was nowhere comfortable to sit and read, I ended up lying on my bed reading. Fortunately it was a very thick book, otherwise I think I would have been crawling up the walls with boredom within 48 hours.

Regular readers will know that I am known to smoke cigarettes from time to time. I seem to be able to stop them fairly easily, but I find that when I get very depressed that I start smoking again. Although mental hospitals were originally exempted from the smoking ban, it now applies to them too. It is a fact that it is more than likely that 60% or more of the patients on a mental ward will be smokers. But on the ward that I was admitted to, one couldn't go for a cigarette when the need arose because we had to be escorted to the garden for a smoke. I had smoked quite a few cigarettes while I was waiting around at the first hospital while the inept nurse tried to get me a bed in the wrong hospital. When I arrived at the unit to which I was admitted my first need was something to eat and, more importantly, to drink. While Dr Hugh was making his notes he asked whether I smoked or not, and when I replied in the affirmative, he actually offered to accompany me down to the garden so that I could have one. Bearing in mind that this was something like 10.30pm and the patients were not allowed to go for a smoke after the night staff came on duty at 9pm because there were not enough staff to allow it, Dr Hugh's kindness and consideration was illustrated again.

I was to remain on this ward for nine days, even though the information sheet said that I would only be there for a couple of days until I was admitted to my permanent ward. When I was moved to the second ward, I was given 10 minutes notice and moved at 8.30 in the evening. I was told that I was being moved then because a bed had become available on the permanent ward, but when I arrived there it was apparent that this was a lie because there were two empty rooms in the female corridor when I arrived there and they had been empty for a couple of days. I believe that I know why I was moved so swiftly, but that is a story for another day.

To be continued.

In The Psychologist's Chair

Sorry folks, Part 4 of Tackling the Mental Health Minefield is still being drafted so probably won't be available today. Writing these posts can be a bit of an emotional experience so I can't rattle them off as I do with my normal posts on this blog. However, I am posting about my return to the hospital today for appointment with one of the psychologists there.

As long-time readers of this blog will know, I was receiving psychodynamic psychotherapy until the beginning of May this year. This had lasted for a year, but I felt that it had not been brought to a proper termination given that new subject areas were opened up on the last session. It ended up with something along the lines of "well, you've had your year's worth of therapy on the NHS, I know that you never missed a session even though I didn't make quite a few, but anyway, goodbye".

Somewhat unsurprisingly this had quite a detrimental effect on my well-being, and I am not certain that it wasn't the trigger for my downward spiral into depression that eventually landed me in hospital. Anyway, the subject of this psychotherapy came up a couple of times while I was in hospital and my consultant referred me to psychological services situated in the hospital. I was persuaded to take part in one group therapy session while I was on the ward (there was myself, three other patients and one of the nurses from the ward along with the psychologist and his psychologist-in-training) but in the limited time available not much was really achieved in this session other than the psychologist getting to see me. Through a series of unfortunate circumstances beyond anyone's control (an appointment was made for me, but the ward staff forgot to tell the psychologist that I wasn't actually on the ward anymore, and then I didn't get the message about another appointment until after the event) my first appointment with the psychologist didn't actually occur until this morning.

As usual I arrived at the hospital far too early, so I got myself a cup of coffee from the WRVS kiosk and went into the garden to drink it and have a cigarette or two. Eventually I thought it was close enough to the time of my appointment for me to make my way to the psychology department and I soon found myself sitting on a chair in the corridor waiting for the psychologist to collect me.

We chatted inconsequentially as we walked to his office and on arrival he invited me to take a seat. His trainee psychologist was already seated on the sofa so I sat in the chair which was so obviously meant for me. I wasn't really sure what the purpose of this appointment was but it seems that the idea is that I am being assessed again to determine whether therapy is required, and if it is, then whether it will be carried out at the hospital or whether I will be referred back to the parent organization which was where I had therapy before.

After being 'grilled' for an hour and a half I was let free with an appointment for the same time next week and the knowledge that what happened in today's session definitely shows that therapy is indeed required. I left with the usual questionnaire about what my feelings about certain things have been during the last week and the request that I fill it in and bring it back with me the next time we meet. I've filled it in, and although I had thought that I had been quite reasonable this last week, especially having been buoyed up with the way that the posts about my hospitalization had been received, in answering the questions I realized that things probably hadn't been as great as I was telling myself they had been.

I'm supposed to be doing some studying this afternoon, but my mind is in such a turmoil after this morning's appointment that I am not sure that I could achieve anything meaningful. Perhaps I will have a change of plan and settle for a relaxing afternoon and get back to the 'creative writing' tomorrow. (I know that this is creative writing but the course is about writing fiction and this blog is definitely not fiction).

Lost Weekend

I have almost completed my first weekend at home since I left hospital and it hasn't been too bad although I haven't really achieved much.

Yesterday saw me going to collect my new toy and then trying it out. Today has mostly been spent sleeping. It wasn't intentional, it just happened. I woke early, about 6am, listened to the rain and promptly went back to sleep. I woke for a second time at about 10am, got myself something to eat, took my morning medication, listened to the rain and went back to bed (it was warm and cosy) and promptly went back to sleep again. I woke again in a somewhat confused state to find that it was dark outside and a quick check of my watch showed that it was fast approaching 5pm. Within a few minutes I could hear the rain starting again.

This means that I haven't done anything very productive this weekend, but at least I seem to have managed to be occupied in such a way that I haven't allowed the depression to take a hold on me. That has to be my goal over the next month or so and I am trying to ensure that I have as many things to do as are necessary to stop me having time to just sit and think. Unless I need to, that is. I am trying to catch up with an OU course that started while I was in hospital and that I have only been able to work on during this last week. It's just a short course, so that makes it more difficult to make up the four weeks that I wasn't working on the material.

The course is one of the OU's short creative writing courses, in this case Start Writing Fiction. I'm not sure that I have it in me to write a novel, but I am very interested in Creative Writing (it may even be why I started this blog) having spent so much of my working life employed in writing reports based on research and analysis of data. Fortunately, writing comes fairly easily to me (except when I am really badly depressed) and I have a fair grasp on the English language so finding words to express myself is fairly easy. If I'm analysing things as I write this, it probably also explains why so many of my posts are quite long.

So next week in between visits to my GP (Monday), to a psychologist (Tuesday) and to see the Home Treatment Team (probably Friday, but it's my call), I shall be spending much time in the library working on the course material and preparing my first TMA which is due next Friday, although my tutor has given me a week's extension because of starting the course late. Why the library? Well, if I'm there I find that there are less distractions to stop me getting on with the work than there would be at home. And to ensure that this all happens as it is supposed to I shall make sure that I get an early night tonight, make sure that my alarm is set so that I get up in good time to get myself dressed and ready for my appointment with my GP and that I pack my bag with computer and books so that I can head off to the library straight from the surgery.

I am so determined to try to ensure that I never again get into the state that I was in a few weeks ago, so I am going to make sure that I plan out the week ahead with all the things that I need to do making sure that there is never too much for any one day and that no days are left with nothing to achieve leaving me with too much time to think about my depression. I've done it in the past (I think that was what I was doing when I was working full-time, and studying for a degree at the same time) and I am sure that I can do it again.

And one other thing has been buoying me up over the last few days; the fabulous response that I have had to 'Tackling the Mental Health Minefield' and the huge increase in visitors to this blog. The next instalment is half drafted and will be appearing on a computer near you tomorrow.

OK, So I Lied

Sorry folks, but the next instalment of Tackling The Mental Health Minefield is taking longer to write than I thought and as I am rather tired and I am about to take my evening medication which means I shall probably be asleep within half an hour I am afraid that you will have to wait until tomorrow for it to appear. If things go according to plan, I may even post the third instalment too.