Thursday, 29 July 2010

Mental health and a weekend away

I have had a day that was not so wonderful this week, but apart from that the placement has been going well. Last week, interspersed with the stroke-related dietetics, we had a day with the dietitians at a medium-secure mental health hospital.

It was an incredible experience. The workload of the dietitians there is fairly ordinary - the usual heart disease, obesity, high cholesterol, type 2 diabetes, hypertension and other conditions that you'd find in any population, but the secure setting makes the job quite different and extraordinary. Doors are locked, dietitians are never left alone with patients, and everything is risk-assessed - patients are there because they have exhibited behaviour that presents a danger to themselves and/or to others. The ethical issues are in your face: people are locked up, but must still consent to the treatment that is offered (as long as they are deemed to have capacity to do so).

The thing that had the greatest impact on me is that all these patients have to be contained in the same place, so there is very little 'normality' in evidence, to remind patients what 'normal' is - not even a paperclip can be left on a ward, let alone the option to go out for a pint, watch what you want on TV, use the Internet or a mobile phone. In my everyday life, I never see the kind of disturbing scenes that are routine in one of these units. You're having to live in close proximity to all of this, have virtually all your autonomy removed from you, while you are recovering from your own serious illness. It must be very difficult. The adolescent unit was particularly uncomfortable to observe.

At the weekend there were a surprising number of potential dietetic interventions: lunch with type 2 diabetes and dementia, tea with coeliac disease, more tea with colon cancer, and a movie with alcohol-related concussion.

Mr A's father has diabetes that he manages to control solely with his diet, and he is fit and well and over 80 now. Mr A's mother, unfortunately, has a form of dementia that is making slow but inexorable progress, and she was pretty bad at the weekend. She has developed very fixed ideas, some of which are imaginary or delusional, and she can become very confused. We took The Boy down with us to visit them for lunch.

One of Mr A's mother's fixed ideas is that I am wonderful, so she clamps onto me like a limpet and talks to me incessantly. She was born in Wales, Mr Beeching is terrible for shutting all the railway stations, so was Mrs Thatcher, Mr A was born during the Falklands war (he would have to be about 30 years younger for that to be true), the Germans are awful because of what they did in the war, the Scots are taking over the government (she thinks David Cameron is Scottish because of his name), her mother slept with American GIs during the war, she has inherited a THOUSAND pounds. The Germans are awful because of what they did in the war, so is Mr Beeching and Mrs Thatcher, so are the Scots, and her mother too. She was born in Wales. And so it goes on, round and round.

After lunch we went on to visit a family who used to look after The Boy when he was a child, and discovered that his 'surrogate grandmother' was diagnosed with coeliac disease some years ago. She is one of the jolliest, smiliest ladies I've ever met. The final visit of the weekend was to some friends, one of whom had recently been treated for colon cancer, and is waiting to find out if further treatment is needed. And The Boy himself had recently did some damage to himself by tripping up and planting his face into the ground, losing half a front tooth and giving himself concussion. But he's fine now.

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