My team practices pretty eclectic psychiatry.
This week alone we've worked in people's homes, on the streets as we've gone for walks, in a garden centre, in a cafe, in a pub and on one lady's garden path. Heck, 3 patients were even seen in an out-patient clinic :-)
All of this was purposeful. Whether it was one lady's anxiety and phobia necessitating walking to her garden's gate and being there 'til distress diminished, or a social phobia and sitting in a cafe with the hustle and bustle or wanting to get back "to normal" after a bereavement and bimble about looking for bedding plants, we're in the business of alleviating distress and working with patient's problems in a way that fits with them. Everyone's different, after all.
Too, medication's just part of the solution. Seeing a bereaved gentleman at his home with his son yesterday evening the nurse and I were struck by his progress over the last few weeks which I attribute wholly to the support (and CBT principles) his community nurse* proffered.
The medication he has of olanzapine 5mg (used as a treatment for his bipolar disorder in the past and his son's at present) was reintroduced when sleep got worse (down to 2 to 3 hours), Activities of Daily Living became increasingly impaired, anxiety rose (so he'd not leave the house) and thoughts became more disturbed with negative ruminations. A month on and things hadn't changed but he then was less chaotic in his thoughts and could work with the nurse to effect practical behavioural change and spend hours with her doing this work.
Which is good, because he's now dramatically better.
But what got him better, to my mind, was the nursing input and the medication. The medication afforded enough resilience, cohesion and alleviation of distress to engage in the somewhat cognitive and mostly behavioural work, the medication wasn't a cure and didn't effect the change itself.
Working with people at their pace, introducing nursing when there's a window of opportinuty and they're ready for it, use of medication at the lowest doses, treatment in the community at the most suitable location, work with the patient and family, use of different modalities as interventions, as I started off saying I'd like to think we're a team with a pretty eclectic approach.
I was dipping in to Bob's blog and reading about Soulful Psychiatry. The language used by Dr Roberts sounds appealing. I'm not sure who Dr Roberts is, she's not listed as a medic. Some themes espoused sound appealing. The antipsychiatry and antidrugs does not sound appealing. As Bob himselves says, he's spent ages on in-patient wards and now his mix of medication and removing stress has thankfully kept him well for ages. What are your thoughts on talk of things like Soulful Psychiatry? So much mumbo jumbo? Dangerous anti-psychaitry propaganda that's increasing the stigma of psychiatry? Maligning mental health care making it less accessible by people who could benefit from it? Or it it useful in highlighting elements that can be introduced in to main stream mental health clinical practice?
* I used to call them CPNs (Community Psychiatric Nurses) but nowadays there's a vogue for them to be CMHNs (Community Mental Health Nurses) for reasons I can't quite fathom, so I largely eschew.