|
CORRESPONDENCES
|
The White Wreath Association
recieves correspondence from all over Australia and much of it will be
posted here as it comes in.
This is a very big
page to download completely.
Please be patient while
Correspondence loads. (Up to five minutes on a dial up connection)
|
OFFICE OF THE PREMIER OF VICTORIA REPLAY
 UPDATED 16 OCTOBER 2008
Qld Health
Government has asked us for our input into the Guidelines for the Management
of Patients with Suicidal Behaviour or Risk.
In our view and in the
view of scientific research suicide is caused by neurological abnormalities.
Mentally well people have an instinctive reflex to survive. A normal
individual cannot turn off/override this reflex or what the Greeks refer to
as Eros-life force. In an individual with a neurological condition commonly
referred to as a mental illness this life force can become death force or
what the Greeks refer to as Thanatos. Survival instincts are located in the
Limbic System of the brain. All current suicide prevention strategies fail
because they do not acknowledge the neurological base of mental illness.
Mental illness is a 1) Chronic, 2) Progressive, 3) Neurological Disorder
affecting the, 4) Structure, 5) Function and 6) Chemistry of the Brain.
Assessment of mental illness should always cover these six points, currently
it does not
THE FOLLOWING ARE OUR
RECOMMENDATIONS: - BY THE WHITE WREATH ASSOCIATION LTD & PETER NEAME
WHITE WREATH ASSOCIATION RESEARCH OFFICER
1a.
All patients should have a full physiological/neurologic examination, not
just a "mental health assessment," "psycho-social assessment"
and "risk assessment". For eg scars, burn marks and frequent
cut/slash marks are noticed on the patient's skin and the patient say that
they have never self harmed/attempted suicide it is tempting to say that they
are hiding/lying-attention seeking, personality disorders etc. The truth may
well be that the patient is in fact very ambivalent about their self-harming
behaviour. At one interview they will admit that they will self-harm at
another interview they will deny that they will self-harm. 1b. The fact that
they can burn or cut themselves without pain is a feature of both localised
reduction in pain sensation and disturbance of the limbic/serotonergic system
of the central nervous system (i.e. the brain) At present the tendency is for
professionals to interpret signs of self-harm as willful attention seeking by
manipulative antisocial personality disordered patients. Rejection by the
mental health system leads to further suicide attempts and a high-completed
suicide rate. The fact is any mental illness from anorexia to schizophrenia
can involve self-harm/self destructive behaviour.
2.
Self referral and or referral by relatives should be treated as an emergency-
if the patient refuses admission then compulsory provisions of the Mental
Health Act should be used.
3.
Public safety is paramount when one talks of patient's safety this must
automatically mean public safety. The link of suicide with murder is almost
without exception ignored by researchers and planners in relation to suicide
policies and responses. Professor Hughes in "Suicide and Violence
Assessment in Psychiatry", Gen.Hospital psychiatry 1996 says, "It
is estimated that 17% of Psychiatric emergency service patients are suicidal,
17% are Homicidal, and 5% are both suicidal and homicidal". "Murder
is one of the strongest predictors of suicide with a 30% suicide rate found
amounts murders in England." Source "serotonin, suicide and
aggression; clinical studies" (Golden, Gilmore, Corrigan, Eketrom,
Knight, Carbutt; Journal of Clinical Psychiatry 1991) Recent high profile
murders, murder suicide and at least one mass killing in Queensland were all
preceded by one or more suicide attempts. In the worst killing the person was
regarded as an "attention seeker".
4.
Threats of suicide and self-harm including actual self-harm should be treated
as if they were actual attempted suicides. In simple terms people are either
suicidal or not suicidal. Personal judgments' about highly moderately,
vaguely, possibly suicidal, should not be used/they are dangerously
misleading.
5.
Prisons have best practice suicide prevention. Key features are: - a. If an
individual or his family says they are suicidal he/she is treated as
suicidal. b. No one grandiose professional can make an arbitrary decision
that a patient who was seriously suicidal one day is no longer suicidal the
next. c. High risk assessment teams made up of five people determine change
in observation category. Each individual on the team must personally feel
safe about the patient before there is a change in observation category. In
simple terms no senior clinician can heavy other discipline/members to agree
with him or her, as currently happens in the mental health system. We believe
this is a good model to follow and would be happy to assist you and help to
set up such a system. (This could put Qld up there with best practice suicide
prevention)
6.
All terms must be defined. For eg risk means, risk of suicide, murder and
violence. Assessment means, a step-by-step process starting with a
disciplined outward physical examination/observation before any verbal
questions are asked. Again we are happy to take part in training
professionals. This is a practical skill and needs to be taught on the
job/workplace possibly with the assistance of a training video. If you are
honest, assessment skills as they are currently taught in universities and
places of training are appalling. In reality many professionals miss obvious
suicidal behaviours/clues. Accurate assessment is the rock on which the
service rests. Safety, patient safety means public safety, therefore part of
this issue is asking the family/loved ones, are they happy with the plan of
action. Minimum periods of observation should be at least five days in the
hospital for example, 48 hours cat. Red or constant observation for example
(refer also to high risk assessment teams mentioned earlier) suicide
literally means: - self-murder.
7.
In more than 80% of completed suicides and other mental health disasters
someone close to the patient and or the patient themselves have tried, in
good faith, to get help from professionals but been turned away.
This
is both an attitude and training problem/issue. Our concerns are reinforced
by the real life experiences of our member s and supporters and the recently
released Sentinel Events Committee Report of the NSW Government.
8.
History: - history taking/currently patients are asked only about their
immediate family where as patients should be asked if there is a history of
" Nervous breakdowns" (the term mental illness means raving lunatic
to most people and they will simply deny it), early death suicide, self harm,
drug and alcohol use to the point where it destroys family life/for at least
3 generations i.e. grandparents and further back if possible, family history,
anywhere, is the one of the strongest indicators of both suicide and murder.
9.
Suicide is special and specially prepared professionals should always be
called in before patients are turned away/released.
10.
Professionals must be accountable or nothing will change/many psychiatrists
see suicide as a nuisance and a "red herring". To the best of our
knowledge no Qld Psychiatrist has ever been held accountable for the death of
a patient.
11.
Mental Health Act/legislation must have provisions written in to ensure early
admissions for suicidal patients (this was always the case for hundreds of
years/such provisions only being removed as part of the
de-institutionalisation/ anti Psychiatry policies of the last 20 years.
12.
The hard scientific or factual evidence is that suicide, violence and murder
are caused by morphological changes in the brain combined with low serotonin.
Simply the structure, function and chemistry of the brain are not normal.
The
newer Selective Serotonin re-uptake inhibitor drugs (S.S.R.I.s) are said to
be safer in terms of it being harder to overdose on these drugs. However
recent suggestions are that SSRIs (Zoloft, Prozac, Effexor, etc etc etc) may
cause up to three to five times the rate of suicide in young
people/particularly below 20 years of age. There are a number of lawsuits
against drug companies, and at least one recent murder in Australia was said
in Court to have been caused by one of these drugs. Depression is widely promoted
as the major epidemic of the modern age and this in turn has lead to a
massive rise in the use of SSRIs, ".... In 1998 Doctors wrote 8.2
million anti-depressant prescriptions, compared to 5.1 million in
1990....", and the source "The new Abuse Excuse" by Claire
Harvey, Monica Videnieks, Australian 25 May 2001.
There
is no scientific evidence that serious mental illness is increasing, it
occurs at the rate of 3% of the population everywhere regardless of drug use,
child abuse, child rearing practices, stress, modern life pressures, youth of
today, on and on ad nauseum. There is evidence that depression is the
"In disease" and that prescribing of all psychotropic medication is
increasing.
We
recommend that anyone that is to be commenced on medication altering mood,
feeling and thinking ability (Psychotropic medication) should be commenced on
this medication in hospital.
The
reality is that it is extremely difficult to get the right medication for the
right patient. Practically all of the newer anti-depressant and
anti-psychotic medication takes 4-6 weeks to get to therapeutic levels. All
psychotropic, psycho-active substances have serotonergic affects on the brain
i.e. from alcohol and cigarettes to street drugs, from speed to Prozac. This
combined with the fact that the scientific evidence is that there is a cause
and effect relationship between low serotonin and suicide, murder and
violence.
In
our view this means that these drugs should be commenced in hospital where
patients are under observation/protection/place of safety. It is also a
clinical observation that in the first few days of commencing an
anti-depressant the suicide rate dramatically increases.
13.
Most of what we have said requires very little" New Money". If you
are really serious about suicide then all of these areas must be covered i.e.
funding professional/clinical practice public safety legislation
Guidelines
Australian Government Dept of Health & Ageing requesting copy
November 2008
State Coroners Office
August 2006
>
a) Original letter sent to Office of State Coroners from WW Assoc 14 August 2006 b) State Coroners Reply 23 August 2006 c) WW Assoc Reply to Office of State Coroners 29 August 2006 a) Original letter
sent to
Office of State
Coroners from WW Assoc
b) State Coroners Reply
c) WW Assoc Reply to Office of
State Coroners
Top
A Letter From Government of South Australia
Top
This Submission has also been
sent to the following:
(a)
Inquiry into the Management of Offenders in Custody Perth WA May 2005
(b) Bundaberg Hospital Commission of Inquiry May 2005
(c) Peter Forster Review of Qld Health Systems May 2005
|
April
2005
Committee Secretary
Senate Select
Committee on Mental Health
Department of the
Senate
Parliament House
CANBERRA
ACT 2600
Australia
Senate Select
Committee on Mental Health
White
Wreath - Action Against Suicide was formed by Fanita Clark who lost her
newly diagnosed schizophrenic son to suicide in 1999. She knows first
hand how hard it is to "access" mental health care.
We hear
the same pattern of refusal to admit and assess early when a family, loved
ones, and even the patients themselves seek help. We know of
countless tragedies where people have tried five or more mental health
facilities only to be refused admission and to go on to suicide, and in
some tragic circumstance kill their entire family.
The
following submission has been prepared for White Wreath by Peter Neame.
Peter Neame is a Mental Health nurse, Forensic nurse and general
nurse of 34 years; author of four books including "Suicide and Mental
Health in Australia and New Zealand" 1997 and "Profile of the
Mass Killer Amok, Murder, Madness and Badness" 2003. Peter is White
Wreath Assoc Inc Research and Publicity Officer.
RECOMMENDATIONS IN
ORDER OF PRIORITY
White
Wreath has cut back the number of recommendations to only those that are
essential to both save lives and improve mental health immediately. So much
has been said about mental health locally, nationally and internationally.
There have been literally thousands of enquiries and tens of thousands of
preventable deaths, but the objective evidence is that mental health care
for the 3% of the population who are seriously mentally ill is worse than
at any time in 250 years ¨C any time in Australia¡¯s
history.
1.
All suicidal people, that is people who say they are suicidal, whose
friends, relatives and carers say they are suicidal or those who indulge in
acts that are self-harming, attempted suicide or self destruction be
immediately admitted, compulsorily if necessary, to hospital for a period
of no less than three months. Explanation:- This one provision would save
at least 3,000 lives per year.
2.
That Psychiatry become a branch of Neurology ¨C
Mental Health Assessment should be neurologically grounded. Verbal
assessments lead to thousands of deaths per year. Assessments are worse
than at any time in the last 250 years.
3.
Any professional who refuses a patient care and that patient subsequently
suicides, commits murder or serious offence must be named and charged with
murder, manslaughter, arson etc., whatever the subsequent disaster.
4.
That mental health professionals be given immediate training in the
neurology of mental illness.
5.
That all professionals be trained in how to assess people for suicide,
murder and violence.
6.
That all people no matter where they present i.e. at Court for anti social
behavior and violence, at Family Services for ¡°dysfunctional
behavior¡± at
the Family Court and especially all those who are subject to Domestic
Violence Orders be assessed for suicide, murder and violence.
7.
That only Mental Health Nurses and Psychiatrists with a minimum of 5000
hours direct patient contact with the mentally ill be responsible for
training Mental Health Professionals and for the care and management of
mentally ill people.
8. A
return to a three year on the job Mental Health Nurse Training Program with
separate registration.Feminist studies and social engineering witchcraft
and sorcery have replaced a minimum standard of clinical hours experience so
much so that the training in Mental Health of both doctors and nurses is
the worst in the world.
Note: We
have not mentioned the need for more beds, money or more resources and
manpower because if individual professionals get frontline assessment right
then these services will automatically follow the increased demand. At
present resources have been taken from the Mental Health Services to
bolster the doubling of the prison population and the massive increase in
through-put of the Court system. Lawyers, judges and prisons get money that
should be spent on the Mental Health System.
INTRODUCTION
There
have been countless enquiries into the prison system and the mental health
system.
More
often than not these enquiries have been subverted or hijacked by the
perceived need to "push prison reform" or "push reform of
the mental health system". Reform meaning closure of beds. With
the wholesale closure of Mental Hospitals more seriously mentally ill
people are "cared for" in the prison system than anywhere else.
There
are no medium and long term mental health beds, down from 32000 in 1960
with a population of 10.1 million to nil now with a population of 20
million. If there were any beds mental health professions would not
fill them for they have been trained only to treat the worried well and
those with self limiting/stress/relationship crises. It takes 5 - 10
years for a seriously mentally ill person to get appropriate care. 75
- 80% of the chronically mentally ill get refused or "gate keeped"
from care because "there are no beds". Conversely if the
mentally ill person commits a serious crime a bed suddenly becomes
available in the prison system.Dorothea Dix campaigned for 40 y ears to get
the mentally ill out of jails and into hospitals from 1841 - 1880. Now
125 years later they are back in jail if they do not kill themselves in the
meantime.
In
1939 Penrose advances the thesis that a relatively stable number of persons
are confined in any industrial society. Using prison and mental
hospital census date from 18 European countries, Penrose found an inverse
relationship between prison and mental hospital populations. He
theorized that if one of these forms of confinement were reduced, the other
would increase. According to this theory, where prison populations
are extensive, mental hospital populations will be small and vice versa.
Thus if there is room in prison and a shortage of hospital beds,
many mentally ill who come to the attention of law
enforcement might well be directed to the criminal justice system.
Another corollary of this theory is that if civil commitment is
reduced, involvement with the criminal courts will increase. Source (Persons
with severe mental illness in Jails and Prisons: A Review,
Psychiatric Services April 1998")
What
is the point? Society "the system" still spends the same
amount on the mentally ill but they have to offend and go through the
Courts to prison. Money from the mental health system has gone into
lawyers' and judges' pockets and onto the prison system. The price
for society is also a massive rise in suicide, murder-suicide, mass
killing, arson, violence and sex offending. Interestingly Governments
were quite pragmatic about creating beds in the 1880's. Prisons, for
example, "Hokititia Goal" were simply renamed Seaview Lunatic
Asylum.
Sixty-eight
percent of the prison population is mentally ill. Therefore all
development about prisons and mental health should occur together.
MENTAL ILLNESS
"The
severe psychiatric disorders including schizophrenia, bipolar disorder,
severe depression, obsessive-compulsive disorder have been like other
neurologically caused diseases such as Parkinson's and Alzheimer's, clearly
proved to be diseases of the brain". Prof. E Fuller -Torrey.
What
this means is that mental illness is a neurological disorder or brain
disease affecting:
Schizophrenia
remains the main reason for people with mental illness attending general practitioner
clinics but depression gets all the publicity. Schizophrenia is the
main cause of suicide but depression gets all the publicity. Why?!!!
Serious
mental illness affects 3% of the population the world over no matter what
the upbringing practices are, use of drugs, stress, prejudice against gays
etc etc ad nauseum. This one fact tells you in an epidemiological
sense that mental illness is not caused by external social factors.
Health professions are taught that suicide-mental illness is a
"complex bio-psycho-social illness". This is only really a
pseudo-sophisticated interpretation of the totally discredited Flower-Power
anti science, anti psychiatric view that the mentally ill are the
"sensitive victims of a sick society".
99.9%
of mental illness happens at conception.
0.1%
may be caused by disease, toxin, or injury to the brain.
Serious
mental illness affects 600,000 Australians of which one third cope well
with little or no intervention, one third require treatment for life and
one third require hospitalisation and treatment for life.
The
constant repetition of the "one in five will suffer a mental
illness" is just the extension of the nonsense that the mentally ill
are the sensitive victims of a sick society who can of course be cured by "caring
in the community", empathy, therapeutic alliances, counseling, phone
counseling, rebirthing, getting in touch with our inner, outer and sexual
self.
Why
one in five?!! This is four million people in Australia a massive
target population for the sale of antidepressants and other expensive
psychotropic medication. Also a target population for the other
"social therapies" for which there is not a scrap of scientific
evidence. When you say one in five you are implying everyone can be
mentally illness. This is factually incorrect nonsense.
The
end result is that 75-80% of the seriously mentally get no treatment
whatsoever. The government on advice by Psychiatrists and Social
Planners made conscious deliberate move away from treating serious mental illness
- an illness that is a progressive neurological disorder that tends to get
worse over time - an illness that is not positive and trendy, to the
worried well.
By
pretending mental illness is everything but a severe progressive
neurological illness that is 100% caused by biological factors we have made
society a much more dangerous and miserable place. Almost all the
200,000 homeless people in Australia are mentally ill, 68% of the prison
population is mentally ill and although total crime has decreased violent
crime has increased.
Yorkshire
Post - Monday September 19th, 1994
The
self-evident folly of Care in the Community
One
day it will be admitted that Care in the Community was a blunder; but by
then it will be too late to undo the damage. Blame will inevitably
fall on the Government and not on the expert professions who bulldozed it
through 20 years ago.
Not
only does the policy not work; it could never conceivably have worked.
Commonsense tells us that, if you take 100 patients from a long-stay
"mental" hospital where they are under proper supervision, with
all facilities on site, there will chaos if you scatter them throughout the
community.
Complaints
about under funding are useful political ammunition for Labour and union
demagogues but they are irrelevant. No amount of funding could
guarantee regular supervision of every individual by trained staffs. The
notion is absurdity, as a labour government would very soon discover.
Parents and relatives of patients in long-stay hospitals have always
been united in condemning the wholesale closure of these institutions.
Against
almost impossible odds, they are still campaigning for hospitals to be kept
open.
One
Yorkshire relative wrote to Sir Keith (now Lord) Joseph to express concern.
He replied: Alas I was one of those who launched the plan to
move people from old institutions into community care. I left the
Department before it became clear that provision in community was lagging
badly and there would still be a need to have refuges for those who
couldn't cope.
"The
White Paper which I fathered was over-optimistic about the provision of
community care facilities." Lord Joseph is one of those rare
birds a politician who admits he was wrong.Relatives support groups have tried
unsuccessfully to discover the fate of former hospital patients who have
been "released". Even the Chief inspector of Prisons has
had difficulty in finding out how many have ended up in jail."
The
only evidence comes from regular news reports of murders, accidents,
suicides and other tragedies. (An epileptic patient, who had spent 40
years in a West Yorkshire hospital, was found drowned alone in a bath after
being "relocated".)
There
is no proper coordination between hospitals, prisons, psychiatrists, GPs,
nurses, social workers and housing departments. It is not their
fault. They are stuck with an impossible task and, until someone
admits it is impossible to guarantee Care in the Community, the chaos will
continue."
Professionals
blame government for problems in mental health but it is professionals who
refuse people care at the front line and discharge unwell people
inappropriately.The Burdekin Report and the National Mental Health Plans
have made the situation worse.The reality is that "Modern Mental
Care" and mental health planning is the direct cause of all our
current problems in mental health.
MENTAL HEALTH ACTS,
LAWS, LEGISLATION
If
the Senate Select Committee on Mental Health is serious you will quickly
realize that changes that will save lies, reduce misery, homelessness and
suffering - must happen at the front line - at the point of first contact
whether it be family/social services, family court, general practice
clinic, police, prison, criminal court, counseling services. Where
ever a mentally ill person first turns up.
Simply
changing laws - bits of paper like National Mental Health Plans changes
nothing. However, important mental health legislation changes must
be:-
Legislated right of access for voluntary
patients
Legislated right of admission as first
line of treatment for anyone who is suicidal, claims to be suicidal or said
by the friends and loved ones to be suicidal. When I first started 34
years ago - suicide meant automatic admission - now the suicide rate in
young men is 400% higher.
If
patients can get treatment early on in their illness then they can be
prevented from becoming or graduating to a forensic patient, committing
suicide, or just general deterioration in their mental state.
Health
Care generally depends on three levels of prevention i.e.
Primary or first level prevention:- i.e.
eliminating the illness altogether. Nothing whatsoever has to date
been shown to prevent or reduce the level of mental illness therefore prevention
in mental illness must start at the next two levels.
Secondary Prevention:- Intervening as
early as possible where the illness has been diagnosed/suspected for
example intervening early in families where there is a pattern of
mental illness, drug abuse, early
offending, suicide, arson, homicide or indeed anything that may be
associated with mental illness.
Tertiary prevention:- At this level or
prevention the illness is well established and treatment/management is
aimed at preventing the worst outcomes, for example long term
institutionalization, loss of job, social contact, family, homelessness,
side-effects of medication, imprisonment.
By
definition any mental health act that does not incorporate a legislated
right to early intervention and focuses entirely on compulsory/committed
patients is by definition an unsafe and deficient act. Unfortunately
many mental health acts throughout the world have been reformed in this
way. The presumption of these reforms is that voluntary patients can
access care when they need it. This idea/dogma primarily from the
`antipsychiatry movement' which has been adopted as main stream psychiatric
practice (the common result of which is that when people try to access care
they are almost always turned away). The idea/dogma that patients can
and will voluntarily seek help ignores the fact that serious mental illness
affects the very thought processes of mind. In the very early stages
of a serious mental illness patients may recognize that they need help, but
once the illness takes hold patients, commonly will not accept they are ill
and in need of treatment. This is in stark contrast to a physical
illness where the more discomfort/sickness one feels the more one is likely
to seek help and be cooperative and thankful for that help.
In
practical every day life what does this mean?.....Quite simply it means
that patients have to be very ill to get services and this means by
definition that there will be a subsequent rise in suicide, murder,
murder-suicide mass killing, arson, crime, sex offending, violent offences,
homelessness, drug and alcohol problems and the straight physical disorders
associated with all of these things such as Hepatitis C and Tuberculosis.
Unfortunately
changes to legislation are usually not to direct future practices as much
as to put in p lace legal framework for what is already happening.
Thus mental health disasters will only be prevented when
professionals change their practice back to early intervention and when
governments spend serious money on serious mental illness rather that on
the worried well-which of course are where the votes are, if there are any
votes in mental illness.
DRUGS AND OTHER
"EXTERNAL CAUSES"
There
should b e 70,000 mental health beds - that is medium and long term beds
nationwide. There are no medium and long term beds - mental illness
is now more common and visible to everyone therefore there is a rise in
single issue causes - quick fix - moral crusade - election
campaigning.
Indeed if the select committee merely
uses the inquiry to "beat the government around the head" you
have lost the point completely.
Drug
crusades do not alter the drug problem or mental illness. There is
no scientific evidence that drugs cause mental illness even tough drug induced
psychosis is an accepted diagnosis.Psychiatric diagnosis is not
scientific and relies solely on an emotive-subjective interpretation of the
outward presenting symptoms - there is no objective test for mental
disorders - no scientific test. Repeated studies in Scotland,
England, U.S.A. and Europe have shown that patients with similar social and
verbal skills as the psychiatrists get favourable diagnosis where those
from lesser backgrounds do not.Professionals, politicians and others use
drugs to say that people cause their illness by abuse of drugs and are
therefore responsible for their own illness - part of the ancient moral
prejudice against the mentally ill.
HOW OUR BRAINS FEND
OFF MADNESS
28
August 2004 "New Scientist" - Rachel Nowak, Melbourne
Cannabis
like substance produced by the brain may dampen delusional or psychotic
experiences rather than trigger them.
Heavy
cannabis use has been linked to psychosis in the past, leading researches
to look for a connection between the natural cannabinoid system and
schizophrenia. Sure enough, when Markus Leweke of the University of
Cologne, Germany, and Andrea Giuffrida, and Danielle Piomelli of the
University of California, Irvine, looked at levels of the natural
cannabis-like substance anandamide, they were higher in people with
schizophrenia then in healthy controls.
The
team measured levels of anandamide in the cerebrospinal fluid (CSF) of 47
people suffering their first bout of schizophrenia, but who had not yet
taken any drugs for it, and 26 people who had symptoms of psychosis and
have a high risk of schizophrenia. Compared with 84 healthy
volunteers, levels were six times as high in people with symptoms of
psychosis and eight times as high in those with schizophrenia.
This
is a massive increase in anandamide levels,'Leweke told the National
Cannabis and Mental Illness Conference in Melbourne, Australia, last week.
And that is just in the CSF. Levels could be a hundred times
higher in the synapses, where nerve signaling is taking place, he says.
But
were the high anaddamide levels triggering the psychotic symptoms or a
response to them? Leweke, and his colleagues found, to their
surprise, that the more severe people's schizophrenia was the lower their
anandamide levels.The team's theory is that rather than triggering
psychosis, the substance is released in response to psychotic symptoms to
help control them. People with the worst symptoms might be unable to
produce sufficient anadamide to prevent them.
At
some point in their lives, between 5 and 30 per cent of healthy people have
had symptoms such s delusions or hallucinations, which can be triggered by
something as simple as sleep deprivation. `All of us are
potentially psychotic," says David Castle of the University of Melbourne.
So for the body to have a system that prevents these experiences
getting out of hand makes sense, he says.
The
new findings suggest antipsychotic drugs could be developed that target the
anandamide system, but it will not be simple. The active ingredient
in cannabis THC binds to anandamide receptors. But people with
schizophrenia who use cannabis actually have more servere and frequent
psychotic episodes than those who do not. This may be because THC
makes anadamide receptors less sensitive.
Leweke's
team also found anandamide levels lowest in people with schizophrenia who
used cannabis more frequently, suggesting it may disrupt the system in
other ways too.Up to 60 per cent of people with schizophrenia use cannabis.
A study by Castle, also reported at the Melbourne meeting, has found
that people use the drug to get rid of unpleasant emotions associated with
the disease such as anxiety and depression."All people who have a drug
addiction to the point where it destroys their lives have an underlying
mental illness - mental illness is the cause not the other way
around.
MANY MENTALLY ILL LACK
CARE
Adapted
from an article by Carol Nader in "The Age" 25 February 2004 Many mentally ill people who also have significant drug
problems are being denied access to the mental health system because
they're considered too difficult to treat, experts say.And patients who are
admitted to psychiatric clinics in hospital are easily gaining access to
illicit drugs.General practitioner Michael Aufgang, who specializes in
treating drug addiction, said many advanced psychiatric patients also had a
drug problem, but `the most needy are left without treatment'.
Sometimes
the role of the emergency department is to be a caring and supportive
environment for these people, and we need to accept that, rather than say
they don't belong here,' he said.Melbourne University professor Patrick
McGorry said there was resistance to linking psychiatric and drug
counseling services. Because resources were so stretched, `if they
can see a way not to get involved in a case, they'll do it'.
One
woman, who did not wish to be named, talked about her son who died from a
heroin overdose a year ago. She said her son, who was 27 when he died
and was a heroin addict from the age 14, developed a mental dysfunction
after trying to get off a methadone `cold turkey' program. He spent
several months in a psychiatric ward, but she said the hospital did not
treat his drug problem.
`It's
almost like you go to hospital with hospital with cancer and a broken arm,
and they treat your broken arm but not your cancer,' she said.
`That's what happened. They don't liaise with the drug
counselors, and its killing kids.'
Opposition
health spokesman David Davis said there was a need for integrated services that
dealt with the complex needs of patients, rather that `a series of services
that treat in a fragmented way the different problems of the one patient'.
"Unfortunately
the morphological deficits that underlie the chemical imbalance often
remain unchecked. In many instances, pharmacologic treatment must be
sustained indefinitely, with the added burden, in many cases, of increasing
dosage due to decreasing efficiency of the drug/receptor interaction".
"Awakening the Sleeping Giant" Those readers who have
viewed the film "Awakenings" would have seen this same effect
after initial `miraculous cure' Dopamine, steadily lost its effectiveness -
a common experience with patients who are seriously mentally ill and
regarded as `treatment resistant'.
"Drugs
that produce hallucinogenic effects in humans, such as lysergic cid
diethylamide (LSD), mescaline, and dimethoxymethyl amphetamine (DOM),
demonstrate high affinity for 5-HT" and 5 H'c receptors".
(Behavioural Studies of Serotonin Receptor Agonists as Antidepressant
Drugs).
"In
addition, it has been shown that morphine, amphetamine, cocaine, and
nicotine self administration, as well as intracranial self stimulation, are
all decreased following 5-HT uptake inhibition" `S.S.R.I.'s Effects on
Motivated and Consummatory Behaviours'.
SCHIZOPHRENIA AND DRUG
ABUSE
(From
headlines, the Newsletter of the Neuroscience Institute of Schizophrenia
and Allied Disorders Sept 2001)
"For
many families coping with non-compliance, it will come as no surprise that
many schizophrenia patients abuse drugs. Even excluding their very
high levels of tobacco smoking, around half of all patients appear to use
whatever mind-altering substances are available to them. The most
common drugs, in descending order of usage-frequency are alcohol, cannabis,
amphetamines, opiates such as heroin, and hallucinogens. The reported
effects include increased rates of relapse and hospitalization; worsening
of psychotic symptoms; increased aggressive behaviour, and increased period
of homelessness.
This tendency
to drug abuse is so much higher than found in healthy people of equivalent
age groups that it warrants being recognized as a symptom of the illness.
And when drug abuse is added to the other problems of non-compliance,
it adds yet another burden of distress upon families and carers."The
modern approach is to admit that there is an association of mental illness
with violence but to `blame' this violence on drugs. The most violent
mass killers are sometimes `obsessively clean living'.
Drug
use is a symptom - not a cause of mental illness - the greater the alcohol
or drug abuse the greater the underlying mental illness. In the gold
rush days of California, Australia, New Zealand, and South Africa, Opium
Dens and Whore Houses were open 24 hours per day - if you had the money you
could buy any mind altering substance or any `depraved sexual act' anytime
of day, any day of the week including Sunday.
One
can read about `decaying morality', `disaffected/displaced youth', drugs,
and debauchery from the earliest recorded history. Drugs do not
`cause mental illness'. Truckloads of moralizing diarrhea have not
contributed to understand mental illness or the "drug problem".
PRISONS THE NEW MENTAL
HOSPITALS
Prison
care for the mentally ill is better than no care at all because prisons
provide services that were once provided by mental hospitals, asylums or
true places of safety.
For a
person whose life is one of chaos, disorganized severely mentally ill,
constant poverty, homelessness and re-offending - sometimes the very day
they are released from prison - prison is a far better, safer environment
where they will get, often for the first time since they left home, dental
care, medical care and mental health services.
I
would echo Prof. John Gunn's comments here "The vast majority of
prison staff are caring and relate well to their charges" Pg 335
British Journal of Psychiatry, 2000, "Future Directions for Treatment
in Forensic Psychiatry". In
1998 there were 49 suicides in custody - in the community there were 2700
yet massive publicity was given only to the prison suicides - the
misleading assumption being that prison's cause suicide. The reality
is that prisons have become the "New Mental Hospitals" and
prevent thousands of suicides per year. Prisons have best practice
suicide prevention.
In
the community most young people who show early warning signs of mental
illness: self destructive/self harm behaviour, withdrawn, aggressive
behaviour, petty offences, excessive use of drugs and alcohol as well as
actually saying they will suicide to the point where parent/loved ones try
to get them help - will be turned away (with tragic consequences) by
outpatients Departments and mental health facilities. See the two
cases enclosed - a murder and suicide at the end of this submission.
The
reality is that in a climate where there are no medium and long term beds
and where mental Health Professionals are taught it is "bad
practice", "anti-therapeutic", likely to cause
institutionalization", "a treatment of last resort". (All
dogma from the anti psychiatry - de-institutionalisation movement), early
imprisonment even mandatory sentencing actually saves lives.The idea
that Prisons are "brutalizing" places is largely nonsense.
The
intellectual arguments about "criminalizing the Mentally Ill" and
conversely "medicalising Criminal behaviour" (the idea that
criminals are not criminals but victims of illness, stress, child abuse,
bad parents etc.) have probably been with us since the beginning of civilization.
So has the fanciful idea that some magical potion, snake oil
solution, "positive environment" exists in the community that
will magically cure mental illness/criminal behaviour. Community has
always been the cheapest option - societies do not spend such large sums of
money unless there is no choice.
A
most recent case covered by the Australian is an excellent example of how
Mental Health Services get it so wrong and why beds are so important.
In this case the police's action to arrest and jail the young 17 year
old is probably the only action that will save his life. The Mental
Health System was "caring for" him in the community
Suicidal
teenager to face charges - Australian 15 April 2005
A
teenager who threw himself in front of a moving car in what his lawyer
described as a "sad cry for help" has been charged with damaging
the vehicle's windscreen.
The
17 year old Aboriginal boy was in detention last night after appearing
briefly in Perth Children's Court with a visible scar on his neck.
He
cut his throat with a piece of broken bottle early last November and just
weeks later in the goldfields town of Boulder he allegedly threw himself in
front of a Subaru sedan as drove through a roundabout, landing on the
bonnet on the passenger's side and cracking the windscreen.
He
allegedly told the driver he was trying to kill himself then ran away.
Magistrate
Sue Gordon, chair of the Prime Minister's National Indigenous Council,
expressed concern for the boy's mental state. His lawyer, Peter
Collins, said his mental health had worsened since he was placed in
detention a month ago for an unrelated breach of bail and other offences
He
has been known to police for about five years and recently pleaded guilty
to four charges, including assaulting a police officer. But mental
health advocates described the latest charge against him as callous and
disappointing.
Associate
Professor Ted Wilkes, who this week helped to launch a report into
indigenous youth that found almost one in four was at high risk of mental
illness, said he was flabbergasted that police would consider such a
charge.
"It's
cruel for any human being in crisis to be treated like that," he said.
"With indigenous youth, we need tolerance and compassion to
break the poverty cycle and all that comes with it."
Professor
Sven Silburn, chair of the state's Ministerial Council for Suicide
Prevention, said he would ask Police Commissioner Karl O'Callaghan for more
information about the circumstances.
"What
this is going to do for Kalgoorlie's reputation and for race relations in
that town cannot be good," h e said.
Commissioner
O'Callaghan is on leave and a spokesman refused to comment on the damage
charge.
Mr
Collins told the court police in the goldfields city of Kalgoorlie charged
the then 16 year old as part of a "no tolerance" policy to
antisocial behaviour.
Mr
Collins told Ms Gordon that Kalgoorlie police had refused to drop the
charge, despite discussions with Perth prosecutors, who believed it was not
in the public interest to proceed.
Ms
Gordon will today consider a bail application for the youth provided a
relative can commit to supervising him and ensuring he gets psychological
treatment.----------
Suicide
is not a romantic "cry for help" it is the result of a serious
mental illness and maybe the first warning sign of serious mental illness.
Martin
Bryant's father committed suicide. The young Jeff Weise, 15 years
old, who shot 10 people before committing suicide in a school massacre at
Red Lake, Minnesota, USA on March 24, 2005, father also committed suicide.
Both had exhibited weird anti social behaviour for years before the
massacre including direct threats. In Bryant's case there were many
suicide by-car attempts one which left him seriously injured and his partner
dead. Bryant's first mental health referral was at age 4 years and he
is Australia's best example of "Community Care" or "Care in
the Community".
Alcohol
and Drug Services will not alter the prison rate because the underlying
reason why people become addicted is mental illness, not as Drug and
Alcohol Treatment Specialists would have you believe - the other way
around. It has been known for centuries that people with mental
illness use alcohol and drugs as self-medication. All of us have
access to drugs and alcohol. Less than 3% become addicted.
Recent research shows that over 90% of people who have a drug and
alcohol problem have underlying mental illness. Countries that ban
drugs and alcohol have exactly the same rate of mental illness.
As part
of the De-institutionalisation anti psychiatry movement drug and alcohol
services become a "Specialty" a totally artificial creation.
So
what happens now to the 90% of people with a dual diagnosis i.e. mental
illness plus drug additction, they turn up to drug treatment facilities and
they are told that they have a mental illness therefore they should
"access" Mental Health Services. If they can find a mental
health service they are told that they have a drug problem therefore they
should "access" drug treatment services. The end result is
that they get no treatment. However it should be recognized that
probably 90% of Forensic patients will not comply with treatment and even
if they do - compliance does not mean an end to violence and re-offending
something deliberately ignored when people talk of "community
alternatives".
What
am I saying here? Quite clearly the individuals who are seriously
mentally ill and now outnumber the old fashioned "honest Crim "
who made crime his occupation/business, are very ill and need institutional
care. 60% New Zealand, 68% UK and 63% USA of the prison population
are said to be mentally ill on the basis of recently conducted research.
Dual
diagnosis that is having a mental illness plus a drug/alcohol problem or a
mental illness and an intellectual handicap or as more likely the case with
intellectually handicapped people - all three. Dual diagnosis
or multiple diagnoses is again a "mutagenic child" of the
de-institutionalisation - anti psychiatry movement. For example, an
individual who is charged with a number of offences from willful damage to
assault and has a diagnosis of:
Which
diagnosis are we treating today???? Here is a real life, very common
results in order of most likely occurrence:
At
the Mental Health Service we are short of beds as we almost always are and
there is also not-to-put-too-fine-a-point on it the added incentive of
getting rid of a "difficult patient".
"Well
this man has a personality disorder, therefore he is not mentally ill and
therefore, we can send him back to prison".
Day
2. (Same shortage of beds and anti psychiatry ideology)
"This
man has a drug treatment problem more appropriately handled by drug
treatment services in the community or prison".
"This
man is intellectually impaired more appropriately treated "in the
community" but since he is facing charges he can "access"
facilities in prison".
Plan
- discharge back to prison.
"This
man is now stabilised on h is medication".
Plan
- discharge back to prison.
When I
started training as a psychiatric nurse in 1971 we had Primary and
Secondary Diagnoses - the primary diagnosis is where treatment was
concentrated. In the above example Schizophrenia has caused all of
the other diagnoses including the alleged borderline or diminished
intelligence.
The
truth is, despite State and Federal Ten Year Mental Health Plans, full of
grandiose generalizations there is no effective State or Federal Mental
Health System. Health care depends on:
Nothing
has ever been discovered that prevents mental illness - it occurs at the
same rate everywhere. So early intervention depends on medium and
long-tem beds. Remember that closure of Psychiatric Hospitals was
followed by the closure of Social Welfare Homes, Youth Detention Centres,
Centres specifically designed for the Intellectually Handicapped.
Intellectual Handicap by itself does not lead to institutional care
unless very severe. Most intellectually handicapped people who were
in mental hospitals and now jails were there because of mental illness and
/or drug abuse. The rate of mental illness in intellectually disabled
people is 50% higher than of the general population. Indeed all
recent research points to something also noted centuries ago, that mental
illness, criminal behaviour, suicide, intellectual disability, drug and
alcohol abuse, personality etc is genetic in origin.
So
with the closure of all other institutions prisons have become the last
repository for all those who are at risk to themselves or others or who
just cannot cope.
"Overall
prison populations in Australia have increased from 12,113 in 1987 to
19,082 in 1997". ("Some jails face the challenge from
ageing inmates". Source - Courier Mail, Monday May 31, 1999)
During
the same period mental hospital populations decreased from 10,163 to 4,000,
a decrease of around 6,000 beds - a very similar figure to the increase,
6,969 of prisoner population.
MENTAL HEALTH
PROFESSIONALS
It is
the action of the individual clinician (doctor, nurse, social worker,
psychologist, counselor etc) from the first point of contact that
determines whether a mentally ill person dies or lives. Too many die.
Policies,
legislation, documents are just bits of paper and real agenda of the
current system recommended by the Burdekin Report and all federal and State
plans since is "Gate keeping or refusing the seriously mentally ill
care and transferring what resources there are to the worried well who have
self limiting conditions not requiring any treatment at all.
Professional
training has been subverted with social engineering concepts of
"feminism", "freedom", "self
direction", "least restrictive practices", "patient's
rights" and privacy laws. It is now a patients right to kill
himself and his family.
A 13
year old boy had been telling a school counselor about his suicidal desires
for nearly a year when he finally hung himself at age 14 years. His
mother only found out that he had been suicidal after his death - the counselor
refused to tell t he family on the grounds of privacy/confidentiality.
Health
professionals refuse to tell parents about their child's illness "on
privacy grounds" even though the parent will subsequently be given the
impossible task of caring for their seriously mentally ill loved one.
All part of a self-fulfilling cycle of nonsense that ends in death.
When a person has a heart attack or serious life threatening accident
do we go through this pseudo-sophisticated hand wringing nonsense - no! And
that is the real prejudice on mental illness - not taking it seriously or
substituting inquiries, planning documents, national and states' mental
health plans for action, paralysis by analysis.
Many
perhaps as much as 99% of mental health professionals unaware that
mental illness, serious mental illness occurs at the same rate everywhere
3%. 80% of known scientifically proven - factual cause of
schizophrenia is genetic.
Professionals
are still being taught that mental illness/suicide is caused by child
abuse, upbringing, stress, prejudice against gays - social causes or social
causation. Thus when a parent demands that their child get
appropriate care they are often accused of abusing their child and suicidal
people are subjected to hours upon hours of grilling about child abuse.
Children
are told to leave home as part of modern psychiatric care - leading to
homelessness, abuse on the streets, even murder and suicide.
PSYCHIATIC DIAGNOSIS,
PREJUDICE AND LABELLING
There
are many labels which professionals who talk about "reducing
stigma", "prejudice" and "labeling" use to refuse
care. These are commonly - "No evidence of mental illness"
(almost always a total lie), "Mainly behavioural" (always a
misdiagnosis) - there is no such diagnosis as behavioural - neurological
disorders commonly lead to deterioration in behaviour.
"P.D." (i.e. personality disorder, therefore untreatable,
therefore a criminal justice problem, therefore not our problem).
A.S..P.D. - Anti social personality disorder (same explanation for
P.D.). Attention seekers - people who self harm (Deliberate self harm
D.S.H., self mutilation), cutting off a limb, penis, breast, ear, or
gouging out their own eyes to sticking pins and objects into themselves and
burning and slicing their skin superficially are labeled "Attention
seekers". In war time and in torture chambers of old superficial
burns, cuts and mutilations were known as the most painful because this is
where the body has most of the nerve endings sensitive to pain.
If
you self mutilate it means you are oblivious to pain and have low skin
conductivity, an outward extension of the serious neurological problems
in the brain but professionals are not taught to assess people in this
factual objective way.
The
"bread and butter" of the mental health system the very reason
for the existence of "A Mental Health System" are the chronically
mentally ill - those who need treatment and sometimes hospitalization for
life. If the same patients turn up to the same services or
outpatients department day after day, year after year with the same
complaints or worsening complaints then it is very easy for that service to
find reasons to reject the patient - especially if the service is based on
"Recovery" and "Rehabilitation" and refuse to recognize
that some people remain seriously ill for life.
In
mental health the way to hell is paved with good intentions. Edward Shorter
in "History of Psychiatry - From the Era of the Asylum to the Age of
Prozac" 1997 describes de-institutionalisation as "one of the
greatest social debacles of all time".
Suicide
is the only life threatening condition where people are routinely refused
admission. In what other life threatening condition would a person be
refused care. There is none this is the real prejudice in mental
health - not taking it seriously. Campaigns about prejudice,
deinstitutionalization, labeling are a deliberate smoke screen for total
neglect and complete rejection of those most in need of care. In
other words the "Inverse Care Law" applies. The more
seriously mentally ill an individual is the less care they get, conversely
the healthier you are the more care you get.
Schizophrenia
or earlier `dementia praecox' is the `bread and butter' of the mental
health system. It is the most debilitating illness requiring the most
use of resources worldwide. It used to be said in a time before the
memory of almost all `modern psychiatrist' and those working in the mental
health field, "if you get the treatment of Schizophrenia right,
almost everything else in the mental health field will improve".
This is because Schizophrenia has everything from mood swings to
catatonia, from complete starvation to homicidal violence, from complaints
of pains in the bladder, bowel, heart, to pains in the head, from suicidal
depression to grandiose mania.
However,
as a direct result of monetarism, the de-institutionalisation
movement/psychiatric survivors movement, government planners and
psychiatrist made a conscious deliberate move away from the chronically
mentally ill who have their illness for life and never cured, to the
worried well - those suffering from `stress disorders' and mild
depression. This suited completely the doctrinaire treasury `whiz
kids' straight out of university who believed the best form of government
spending is no government spending and the Psychiatric Profession who could
go from $80,000 - $200,000 / year treating the chronically mentally ill to
a million dollars plus a year, treating the worried well who would come
right even if they were wrongly treated. Ministers of Health could
claim that they had saved millions whilst the transfer of costs to the
prison system could be championed as the Government `getting tough on
crime', a socially acceptable vote winner at the expense of the chronically,
mentally ill.
To
both achieve this aim and `cover their tracks' both government and the
Psychiatric Profession needed to `up-grade' psychiatric diagnosis or in
reality `cook the books'.
Starting
from the late 1960's to mid 1970's:-
Drug and Alcohol services were
de-institutionalised and removed from Mental Health Services, hence the
total chaos in this area.
Intellectually disabled services were
de-institutionalised and removed from Mental Health Services.
Many dangerous and violent Schizophrenic,
depressive, manic and manic-depressive patients were re-categorised or
re-diagnosed as Personality Disorder.
Personality
disorder is short for Personality disordered therefore not our problem - a
criminal justice matter etc.
As a
result many seriously mentally ill patients were dumped in inadequate
accommodation in the community, on the streets, prison;, or in other
facilities not capable of coping with the myriad of problems presented by a
person suffering from Schizophrenia.
DANGEROUSNESS AND
POLICE SHOOTINGS
An
acutely mentally ill patient confronted by police, by definition finds it
hard if not impossible to communicate and hard if not impossible to
understand. They have a neurological disorder which impairs thought
formation, hearing, understanding,, perceiving. Talk therapy does not care
or help mental illness and unfortunately Police are the front line mental
health practitioners. They receive their preparation to handle
acutely dangerous people from the very same people who routinely turn
mentally ill people away from care. Therefore almost all people shot
by the police are mentally ill.
The
hard or scientific evidence is that medication and / or reduction In
symptoms does not make a dangerous person safe.
"Even
though they may receive neuroleptic treatment, many patients suffering from
schizophrenia, schizo-affective and paranoid disorders as well as other
psychoses remain violent." Jari Tiihonen, International
Psychiatry Today vol 3 no.4 1993.
"In
short managing the risk of the offending behaviour can only rarely be
reduced to simply controlling active symptoms of the illness." Pg 16 Review
of Queensland Forensic Mental Health Services, P Mullen and
Chettleburg Feb 2002, referred to hereafter as the Mullen Report.
I
refer you to telegraph.co.uk "When will they ever learn?"
20/3/05. In this case a social worker, psychiatrist and a judge all
said the killer was safe. Immediately following release from hospital
he killed his mate, cut off his arms and fried his brains in butter before
eating them. Then the heroes responsible for his care moved him out
of high secure care into medium secure and he promptly killed another
patient. He had already killed a young woman and the
"system" encouraged him to kill two more. The report pointed
out that this hideous nonsense has been going on for 15 years in England,
as it has in Australia and New Zealand.
Psychiatrist
and their organisations are the most irresponsible link in the chain and
judges, when they make orders that an individual be assessed and treated in
the community, instead of a place of safety are directly to blame also.
This
downplaying of dangerousness has led directly to another Inquiry into
Mental Health in Australia and a crisis in t he prison system in Western Australia.
A man
who had tried suicide in 2004 in NSW was cared for in the community and
killed entire family. Four lives lost where only one person was
presenting as a risk, a 400% increase in mortality. No other illness has
such a high mortality rate.
There
is no accountability of psychiatrists, judges, lawyers, psychologist,
social workers and sadly even some nurses who let dangerous people out to
suicide, murder, murder-suicide, mass kill, rape and commit repeated
arsons. The professionals blame "The system" ipso facto the
government. No government or opposition member takes any part in the
assessment treatment and management of the mentally ill. Blaming
the system is the greatest escape route of all. Unless professionals
and their associations are held directly accountable then there will be no
improvement whatsoever.
Madness
and Badness almost all dangerous people whether assessed as mad or bad have
problems with the limbic - serotonergic system specifically the amygdale or
emotional brain. They are lethal killing machines or re-offending
machines because they have no concern for consequences, for themselves, for
their victims, or for society's norms, values and laws. The only
management form that is safe is security and containment.
In
secure setting almost all killers, rapists, violent offender's arsonists,
and sex offenders appear model patients / prisoners. This is because
the rules of the hospital / prison form as external code/conscience that
they are unlikely to ever have. This explains in a factual
neurological way why apparently model patients / prisoners the
best behaved, most loved, empathized with, high performing on
every test and tick sheet go on killing or re-offending sprees the
moment they are released. It is impossible to overstate how dangerous
these predatory killing machines are.
Why
does the "system" or truthfully individual professionals get it
so wrong so often. They base their assessments on verbal questioning,
tick sheets, IQ tests and their personal emotional subjective feelings.
Commonsense is extinct in psychiatrists, social workers and
psychologists and this group of professionals express open disdain for
the public interest, public safety, and public opinion. The jury
system has survived a long time because the historical lesson is that
"Experts should be on tap not on top". Members of the
public have on average much more commonsense than any judge, lawyer or
psychiatrist.
Assessments
should be based on:-
The presence or absence of neurological
symptoms.
Total history from the day an individual
is born, not just a potted history aimed solely at "Recovery" and
"Rehabilitation" of the individual killer/perpetrator. Real
events such as violent acts are not included in reports or downplayed with
sophisticated language. E.g. a young man who stabbed his mother to
death, stabbing her 98 times becomes "An intelligent young man who has
committed an index offence". "Centre for the criminally
insane" becomes Forensic services then High Secure Care. Attempted
murder of a nurse becomes "Violence in the context of the `repressive
atmosphere' of a locked facility". These are not
mere euphemisms or political correctness. Such downplaying of
dangerousness leads to murder of innocent members of the public.
|
Top
|
LETTER FROM GORDON NUTTAL MP MINISTEROF HEALTH TO WHITE
WREATH ASSOC INC
White
Wreath Association Inc
BROWNS
PLAINS BC QLD 4118
Dear
Ms Clark:
Thank
you for your letter dated 15 June 2004 regarding feedback on the draft
statewide guidelines for the management of patients with suicidal behaviour
and risk being developed by the Mental Health Unit, Queensland Health.
Your
recommendations were noted and taken into consideration in producing the
final document. A copy of the finalised document is enclosed.
I
note that a successful meeting between the White Wreath Association and the
Acting Director of Mental Health occurred in October 2003. I offer my
support for such a meeting to occur again. If White Wreath
Association would like to arrange an appointment with the Acting Director
of Mental Health, please telephone (07) 3234 0675 to arrange a suitable time.
y
>
|
Top
Top
Top
|
REPLY FROM WHITE WREATH
ASSOCATION INC TO
GORDON
NUTTAL MP MINISTER OF HEALTH
Thank
you for your letter Ref. No. M1121634 date 13 July 2004.
These guidelines are a vast and very positive
improvement and are now, we believe, the best in Australia.
We would like a face to face
meeting with you and the Director. Your interest in this area is pivotal
to the success of suicide/mental health policies. Our group brings
together families and carers, particularly mothers, and when a
suicidal/mentally ill person is discharged from care it is frequently to
their family/carers.
You say you have taken our
recommendations into consideration but you have not acknowledged White
Wreath or Mr Neame in your list of sources/ references as we requested in
our correspondence.
Page 3 of your guidelines ¡..suicide
should always be regarded as a medical emergency. You are trying to
have a bob each way. Here are three recent reasons why it should be
regarded as an emergency; two from Queensland and one from New South Wales.
A young woman who was
regarded as mildly suicidal was sent home where she killed another three
year old child. She had previously killed her own son. Two
children killed.
A man who was being assessed
treated for suicide/mental illness and being managed in the community.
He had expressed the desire to kill his family. Four lives
lost.
A man who has been treated in
the community in New South Wales for depression and a recent suicide
attempt killed his entire family. Another four lives lost.
Ten
lives lost three times or 300% the number of people originally presenting
as a risk.
The
stakes are very high and because they also involve murder and violence,
very political.
Nowhere in your policies do
you mention the link of suicide with murder, violence and public safety
(see point 3 and 12 of our recommendations).
In our view there should be a
legislative requirement to admit and assess suicidal people as in-patients.
Page
6 of your recommendations - bottom line - you are trying again to have a
bob each way in what is a true emergency.
Because
suicidal people arrive as out-patients, standing and in apparent good
physical condition it is easy to regard the situation as not serious.
Follow up - safe follow up in
the community does not exist and the hard evidence is that no mater how
much money is spent in the community, safe follow up of actively suicidal
patients is a total lie, totally impossible.
Page 4 - You obviously
do not know what we are talking about when we say the patient should have a
physiological/neurological examination as well. Verbal assessment is
the beginning of the chain of events, which leads to suicide, murder
suicide and mass killing.
English enquiries into forty
mental health related murders and other mental health disasters said ¡°Listen
to those closest to the patient¡±.
Families must not only be consulted but their views should be noted
in the patient's file especially if they are counter to the proposed plan
of action. Explanation and active involvement from the family from
woe to go is one of the most effective ways of preventing disasters.
|
Top
Top
|
12
March 2004
Qld
Health Government has asked us for our input into the Guidelines for the
Management of Patients with Suicidal Behaviour or Risk.
THE FOLLOWING
ARE OUR RECOMMENDATIONS: -
BY
THE WHITE WREATH ASSOCIATION INC & PETER NEAME WHITE WREATH ASSOCIATION
RESEARCH OFFICER
1a. All
patients should have a full physiological/neurologic examination, not
just
a "mental health assessment," "psycho-social
assessment" and "risk assessment". For eg scars, burn marks
and frequent cut/slash marks are noticed on the patients skin and the
patients say they have never self harmed/attempted suicide it is tempting
to say they are hiding/lying-attention seeking, personality disorders etc
etc. The truth may well be that the patient is in fact very ambivalent
about their self-harming behaviour. At one interview they will admit that
they will self-harm at an other interview they will deny that they will
self-harm.
1b. The
fact that they can burn or cut themselves without pain is a feature of both
localised reduction in pain sensation and disturbance of they
limbic/serotonergic of the central nervous system (ie. the brain)
At
present the tendency is for professionals to interpret signs of self-harm
as wilful attention seeking by manipulative antisocial personality
disordered patients. Rejection by the mental health system leads to further
suicide attempts and a high-completed suicide rate. The fact is any mental
illness from anorexia to schizophrenia can involve self-harm/self
destructive behaviour.
2. Self
referral and or referral by relatives should be treated as an emergency- if
the patient refuses admission then compulsory provisions of the Mental
Health Act should be used.
3.
Public safety is paramount when one talks of patient's safety this must
automatically mean public safety.
The
link of suicide with murder is almost without exception ignored by
researches
and planners in relation to suicide policies and responses.
Professor
Hughes in "Suicide and Violence Assessment in Psychiatry",
Gen.Hospital
psychiatry 1996 says, "It is estimated that 17% of Psychiatric
emergency
service patients are suicidal, 17% are Homicidal, and 5% are both suicidal
and homicidal".
"Murder
is one of the strongest predictors of suicide with a 30% suicide rate found
amounts murders in England." Source "serotonin, suicide and
aggression; clinical studies" (Golden, Gilmore, Corrigan, Eketrom,
Knight, Carbutt; Journal of Clinical Psychiatry 1991)
Recent
high profile murders, murder suicide and at least one mass killing in
Queensland were all preceded by one or more suicide attempts. In the worst
killing the person was regarded as an "attention seeker".
4.
Threats of suicide and self-harm including actual self-harm should be
treated as if they were actual attempted suicides. In simple terms people
are either suicidal or not suicidal. Personal judgements about highly
moderately, vaguely, possibly suicidal, should not be used/they are
dangerously misleading.
5.
Prisons have best practice suicide prevention. Key features are: -
a. If
an individual or his family say they are suicidal he/she is treated as
suicidal.
b. No
one grandiose professional can make an arbitrary decision that a patient who
was seriously suicidal one day is no longer suicidal the next.
c. High
risk assessment teams made up of five people determine change in
observation
category. Each individual on the team must personally feel safe about the patient
before there is a change in observation category. In simple terms no senior
clinician can heavy other discipline/members to agree with him or her, as
currently happens in the mental health system. We believe this is a good
model to follow and would be happy to assist you and help to set up such a
system. (This could put Qld up there with best practice suicide prevention)
6. All
terms must be defined. For eg risk means, risk of suicide, murder and
violence. Assessment means, a step-by-step process starting with a
disciplined outward physical examination/observation before any verbal
questions are asked. Again we are happy to take part in training
professionals. This is a practical skill and needs to be taught on the
job/workplace possibly with the assistance of a training video. If you are
honest, assessment skills as they are currently taught in universities and
places of training are appalling. In reality many professionals miss
obvious suicidal behaviours/clues. Accurate assessment is the rock on which
the service rests. Safety, patient safety means public safety, therefore
part of this issue is asking the family/loved ones, are they happy with the
plan of action. Minimum periods of observation should be at least five days
in the hospital for example, 48 hours cat. red or constant observation for
example (refer also to high risk assessment teams mentioned earlier)
suicide literally means: - self-murder.
7. In
more than 80% of completed suicides and other mental health disasters
someone close to the patient and or the patient themselves have tried, in
good faith, to get help from professionals but been turned away. This is both an attitude and
training problem/issue.
Our
concerns are reinforced by the real life experiences of our member s and
supporters and the recently released Sentinel Events Committee Report of
the NSW Government.
8.
History: - history taking/currently patients are asked only about their
immediate family where as patients should be asked if there is a history of
" Nervous breakdowns" (the term mental illness means raving
lunatic to most people and they will simply deny it), early death suicide,
self harm, drug and alcohol use to the point where it destroys family
life/for at least 3 generations i.e. grandparents and further back if possible,
family history, anywhere, is the one of the strongest indicators of both
suicide and murder.
9.
Suicide is special and specially prepared professionals should always be
called in before patients are turned away/released.
10.
Professionals must be accountable or nothing will change/many psychiatrists
see suicide as a nuisance and a "red herring". To the best of our
knowledge no Qld Psychiatrist has ever been held accountable for the death
of a patient.
11.
Mental Health Act/legislation must have provisions written in to ensure
early admissions for suicidal patients (this was always the case for
hundreds of years/such provisions only being removed as part of the
de-institutionalisation/ anti Psychiatry policies of the last 20 years.
12. The
hard scientific or factual evidence is that suicide, violence and murder
are caused by morphological changes in the brain combined with low
serotonin. Simply the structure, function and chemistry of the brain are
not normal.
The
newer Selective Serotonin re-uptake inhibitor drugs (S.S.R.I.s) are said to
be safer in terms of it being harder to overdose on these drugs. However
recent suggestions are that SSRIs (Zoloft, Prozac, Effexor, etc etc etc)
may cause up to three to five times the rate of suicide in young people/particularly
below 20 years of age. There are a number of lawsuits against drug
companies, and at least one recent murder in Australia was said in Court to
have been caused by one of these drugs.
Depression
is widely promoted as the major epidemic of the modern age and this in turn
has lead to a massive rise in the use of SSRIs, ".... In 1998 Doctors
wrote 8.2 million anti-depressant prescriptions, compared to 5.1 million in
1990....", and the source "The new Abuse Excuse" by Claire
Harvey, Monica Videnieks, Australian 25 May 2001.
There
is no scientific evidence that serious mental illness is increasing, it
occurs at the rate of 3% of the population everywhere regardless of drug
use, child abuse, child rearing practises, stress, modern life pressures,
youth of today, on and on ad nauseum. There is evidence that depression is
the "In disease" and that prescribing of all psychotropic
medication is increasing.
We
recommend that anyone that is to be commenced on medication altering mood,
feeling and thinking ability (Psychotropic medication) should be commenced
on this medication in hospital.
The
reality is that it is extremely difficult to get the right medication for
the right patient.
Practically
all of the newer anti-depressant and anti-psychotic medication takes 4-6
weeks to get to therapeutic levels. All psychotropic, psycho-active
substances have serotonergic affects on the brain i.e. from alcohol and
cigarettes to street drugs, from speed to Prozac. This combined with the
fact that the scientific evidence is that there is a cause and effect
relationship between low serotonin and suicide, murder and violence.
In
our view this means that these drugs should be commenced in hospital where patients
are under observation/protection/place of safety. It is also a clinical
observation that in the first few days of commencing an anti-depressant the
suicide rate dramatically increases.
13. Most
of what we have said requires very little" New Money". If you are
really
serious about suicide then all of these areas must be covered i.e.
professional/clinical
practise
|
Top
Top
Top
.
Top
Reply
to Minister for Health and Ageing......
Minister
for Health and Ageing Hon Tony Abbott
Premier
Hon. Peter Beattie
Minister
for Police and Corrective Services Hon Ms Judy Spence
Minister
for Health Hon Gordon Nuttall
Health
Rights Commission David Kerslake Commissioner
We
wish to draw your attention to a situation which we have come to believe is
very common. In this case the Mental Health Services were reined against
the young man and his family. The end result could have well been a murder
suicide. Accurate initial assessment is vital in any service as illustrated
on page 3 Courier Mail today (14 April. Death Turns Focus on Hospitals.)
1.
Qld Health do an independent assessment of the young man away from
the culture of Logan Hospital, which is to downplay the seriousness of
suicide/mental illness.
2.
Urgent review of current clinical assessment of possible admissions before
more lives are lost.
3. An
apology to the family from the Director of Psychiatry of Logan Hospital.
4.
Personal accountability of Clinicians who refuse to update their skills and
thereby cause loss of life.
In
this case the very practices of the Psychiatric Profession was to push the
patient closer towards suicide and murder suicide.
5.
The concerns of the family and the patient must be paramount.
6.
Public safety must be paramount. In this case the assessing clinicians
completely and totally ignored the wider public safety concerns to the
patient to his family and to the wider public.
Brief
History and Outline.
Prior
to being contacted by this family White Wreath had been in correspondence
with the Director of Psychiatry of Logan Hospital over similar if not
identical situations. We offered practical advise in terms of a direct
presentation to Clinical Staff at Logan, the Director of Psychiatry
intimated that their suicide assessment policy was the best.
In
this case the police had three involvements with the young man, the
hospital three presentations. Therefore no money whatsoever was saved by
refusing him admission.
He is
aged 20 male, family history of mental illness. By definition he is in the
highest risk group of suicide.
He
showed both suicidal and homicidal tendencies and confirms what we have
said in our Suicide Recommendations to Qld Health particularly 1a, 1b, 2,
3, 7, & 8 (Recommendations sent out Feb 2004)
These
recommendations are based on international best practice
The
young man and his family has given us permission in writing to represent
their case and they have told us that they are prepared to speak out in
public.
We realise
it is easy to blame government and politicians but infact in this case and
the case on page 3 Courier Mail 14 April it is the initial assessment that
was cursory and superficial and we note also that medical associations are
moving to blame the government, the government can not be present at every
admission.
The
following is the history of the young man outlined by him and his family to
me last night.
First
presentation Saturday 20 March - waited in emergency approx 4-5 hours.
Finally assessed by Psychiatrist for 30 minutes. Psychiatrist rang father
at 11pm and asked him to bring pushbike. Dad refused saying my son is
suicidal he needs to remain. The patient said he was suicidal and said he
needed to remain. Doctor called taxi to take patient home. Taxi driver
dropped patient off 10-15 klm away from home. Doctor gave patient
Largactil, Valium and other medication, which almost put him to sleep (even
though the doctor said there was nothing wrong with the patient) Patient
ended up sleeping in a bus shelter.
Following
Day 21 March patient became angry and agitated presented himself at
Jacaranda Police Station (Logan) saying I'm not well I want to kill myself
and others. Police took him to Logan Hospital (their response was more
appropriate than the hospital response) Patient again waited 4-5 hrs
assessed in 10-20 minutes sent to Pindari Salvation Army Hostel, there
overnight.
Father
received a letter from sons GP requesting the patient be fully assessed.
Doctor assessed patient as being schizophrenic.
Saturday
the 3 April parents out - patient took a knife to brother who was 17. Two
other brothers ran to next-door neighbours - neighbours called police.
Police came. Family arrived home same time police arrived. Police took
patient to hospital. Family also tried to get patient admitted to P.A
Hospital but told that he was not in their catchment area.
What
other life threatening condition would a patient be refused hospital
admission?
Remember
his presenting History.
Young
male suicidal self - presenting (see point 2 of our recommendations
Internationally self presentations is regarded as psychiatric emergency)
said that he was hearing voices and seeing things. Car stalled he lifted up
the bonnet and saw a severed arm. He saw dead bodies in the back seat of
his car.
Most
importantly this mans concerns were backed up by his entire family yet
their concerns were treated with contempt.
There
have been 5-6 cases on A Current Affair Channel 9 featuring very similar
cases where families and patients concerns were downplayed.
We
know of 5-6 cases over the past few months.
We
don't wish to target Logan but we do wish to ensure that all Psychiatric
Services including Logan lift their game to prevent further deaths.
We point
out that there has been a number of murders, police shootings/deaths in
custody as a result of the initial assessment services not listening to the
patient, patient's family and the police attempting in good faith to get
help for the patient.
|
Top
Top
Top
Top
Top
Top
Top
Top
Top
Top
Top
Top
Top
|
