Tag: Mental health

Uncategorized

Danger Zone

clcopeland

Today was a great day.  I flew a plane!

Ok, not an actual plane, I’d booked a session in a simulator next to Glasgow Airport.  For those who don’t know I am a recovering flying phobic.  A couple of years ago I decided to do something about it and went on Virgin’s ‘Flying without Fear’ course.  It was quite an eventful day but one I credit with literally putting a rocket up me to overcome my fear.

https://sparklystar55.com/2016/10/24/i-believe-i-can-fly/

Now of course my fear of flying was merely a symptom. The underlying cause was a crappy anxiety gene that manifested itself in panic attacks.  While you can’t do much about how you’re made up you can modify how things are expressed.  What helped in my case was that I also inherited a ‘don’t tell me I can’t do that’ gene.  Although my family will often say it’s just sheer bloody mindedness.  Whatever you call it it’s something that has got me where I am today and in particular into the seat of a Boeing 737 simulator.

I had decided after my exhilarating flight over Birmingham I would sign up for flying lessons.  Here’s the thing about phobias though, they don’t just go away overnight.  The control freak in me was only happy with learning to fly a big jet engine and by the way, only on sunny days with no wind.

As it turns out that’s not really something that we have in Scotland.  Oh, we do have the planes, just not the weather.  Apparently you also can’t just pitch up and ask for a flying lesson.  Something about training, cost, blah, blah, blah.  Whatever……

So I started doing some research.  I discovered most people start with small planes.  Tiny. Little. Two seater planes. No, not for me thanks very much!

To be honest I wasn’t entirely sure why I had this slight obsession about learning to fly.  A fair amount had happened since the course reinforcing just how far I’d come.  I’d flown my first solo transatlantic flight to Nashville.  I’d dealt with a medical emergency on a flight back from Gran Canaria. First time I’d cannulated someone and given IV opiates at 30,000 feet.

Mostly it was that I’d started enjoying the whole flying experience. There is a whole other world up above the clouds.  The views, the stillness. It’s just beautiful.

So back to my flying simulation – with all this positive affirmation in my head I thought it would be a breeze.  What I didn’t expect was the old familiar anxiety feelings to resurface.  So much so I nearly didn’t go. Ridiculous really!

However I applied the same strategy as I do when on an actual plane – I told them I had until recently had a fear of flying.  It seems one of their instructors also had this and now teaches people how to fly.

We started with a short talk on the principals of flying.  I was then given the option of going in the 737 or being taught in the simulator for little planes.

I have to say the flight deck of a 737 is quite impressive.  So many buttons and dials.  I decided however I wanted to fly properly so we headed back to the smaller one.

I know! I was as surprised when I said I’d prefer the two seater plane.

As I sat on the simulated runway of Glasgow Airport I could not only hear the noise of real life planes landing but feel it too.  It only added to the experience.  I may’ve been feeling teeny tiny but I was raring to go!

The next hour was spent flying around Loch Lomond, practicing banking, going up and down.  I took off (quite easy) and landed (not so easy) a few times.  To make it more interesting at the end wind, rain and low cloud cover was added.  I managed to land but forgot to use the peddles to steer once I’d got on the ground.  It finished with a rather flamboyant 360 spin.  I still managed to walk out the simulator in one piece though.

Whatever your particular phobia is I would urge you to push yourself to overcome it. There is a world of opportunities out there if you can.  For me, it’s been about coming out my comfort zone and into the Danger Zone……

nhs

Día de los Muertos

clcopeland

My previous blog generated a fair bit of discussion around mental health and it’s something that’s still on my mind a couple of weeks later.

Since adopting (or at least trying to adopt) the 4 agreements the one I’m having the most success with is ‘take nothing personally’.  It really is quite liberating!  That said it still needs a degree of self awareness.  You can’t really blame someone else for projecting their reality on to you when in fact it’s you that’s being an arse in the first place.

It also doesn’t mean letting people away with behaving badly either. I’ve become much more aware of other people’s sense of personal responsibility for someone else’s bad mood or perceived injustice.

What I have been less good at is being ‘impeccable with my word’.  Man alive it’s hard!  It’s all good and well when everything is plodding along and you’re full of energy.  However after a day of constant paging, emails and bouncing from one thing to the next the only thing I’m impeccable with is my choice of expletives.

However it was with this fresh perspective that I went to our Consultant away day.  The day had been organised to bring together senior clinicians and management.  I’m not going to get into the detail of the day as the whole premise was to have a safe space to air views.  I would however like to make some observations based on the many away days I’ve been to over the years.

I am beginning to think that the NHS is being run by ghosts.  You know they’re there, you just can’t see or hear them.  Traditional thinking is that they are dead inside however judging by the comments made on post it notes or feedback sheets there is in fact spirit.  However that spirit is in pain, feeling frustrated and not being valued.

I always think the purpose of these days is to exorcise feelings in something akin to a purge. So is it merely enough just to write them down or stick them on a wall?

The reason I think many of these well intentioned days fail is precisely due to this.  It all gets written down and not followed through.  Many assumptions are made about whose fault it is and life goes on the same.  It’s all a bit depressing.

So why not try something different and call these days what they really are: ‘Day of the Dead’ and no, I’m not being facetious.

The Mexicans believe that the day celebrates the cyclical nature of life in particular how new life can come from death.  Why not in these team building, management away days openly talk about the past but with one major difference – let ideas and life evolve and flourish.

I know some of you will be thinking ‘but we do that’ however I’m here to tell you it’s the exact opposite that happens. Why else do we keep having the same conversations if things are moving forward?

What we need to do is restore a little faith and breath renewed life into our workforce. Acknowledge the past but not stagnate in it.

Let the spirit of our NHS live…..

nhs, Uncategorized

You Got the Love

clcopeland

When I started writing these blogs it was with the intention of starting some conversations and understanding different perspectives.  Most of all I wanted them to be authentic.

This week I gave serious thought to resigning.

A perfect storm of events last week lead me to sit down and try to put into words why.

As I read it back the following day it made for painful reading.  Most of the issues centred around everyone else and how I was reacting to their behaviours and attitudes.  There was very little about the actual job of being a doctor.  A job I love.

When I’m under severe stress or pressure I withdraw. I go into a mental bunker and stay there while my brain conducts a sort of mental purge.  All kinds of garbage can come spewing out.  Most of it is a series of imaginary conversations all of which are in fact rooted in reality.  Things I wished I’d said, what that person would’ve said if I had.  A whole lot of nonsense really.  However it’s this nonsense that depletes my energy and causes unnecessary friction.  It had also brought me to the conclusion that I no longer wanted to work as a doctor.

For those of you reading this who have never experienced it I genuinely admire you.  I do believe though that the vast majority are not so blessed.

My mental health is such that I can recognise the signs and choose to retreat.  I need to let my mind do it’s thing but at the same time try not to pay attention to it.

During these times I rely on practicing mindfulness (Headspace) so I can literally watch the thoughts float in and out my mind.  At the point I have to stop concentrating and ‘let my mind do whatever it wants to do’ I never cease to be amazed that it does nothing. Nadda.  No thoughts at all.  This amuses me no end given the constant chatter of it at any other time.

I also listen to podcasts. Shortly after listening to one such podcast I had something of an epiphany (or mini psychotic moment depending on your perspective).  I listened to an interview with Don Miguel Ruiz.  He wrote the book ‘The Four Agreements’.  I’m not one for airy fairy self help stuff but this book has made a significant impact on me.

The four agreements are simple:

1. Be impeccable with your word

2. Don’t take anything personally

3. Don’t make assumptions

4. Always do your best

Hearing him speak and then reading the book has really forced me to stop and take a proper hard look at my own perception of the world and how it’s so dependent on the opinions of others.  My preferred poison of choice – the one telling me I’m not really good enough.

What I have found in the space of a week is that like mindfulness, when you put a stop to the white noise you are left with something of a void.  I’m not sure what to make of it just yet other than it’s very quiet. If I’m being entirely honest the silence is taking some getting used to but it does feel good.

I also can’t say with certainty how it will ultimately impact not just my professional but also my personal life.  I do feel like there has been something of a seismic change in my outlook.  I also believe it stopped me from giving up on something I love.  And that can only be a good thing……

 

 

Leadership, nhs, Uncategorized

Everything is awesome

clcopeland

I have always considered myself a positive and naturally optimistic person but several events this week sought to test that.  To be fair some were truly awful. However there were some things that, in my opinion, restored an equilibrium.

The first was the news story about mental health as championed by William, Harry and Kate:

https://www.theguardian.com/society/2017/apr/17/prince-harry-grief-revelations-praise-mental-health-experts

I quite liked the honesty with which they talked about the British ‘stiff upper lip’ culture. This is such a ridiculous notion when faced with the tragedy of losing your mum at such a young age.  There is no silver lining or looking on the bright side.  It’s just bloody awful and should be treated as such.  That said I do think how they have channelled it into something good is remarkable.

https://www.headstogether.org.uk/about-heads-together/

They are not the only people who are able to do such things.  Look around and you’ll see people from all walks of life trying to create something good from terrible circumstances. It could be running a marathon for charity or volunteering.

There are parallels with our daily NHS life.  Recently I helped one of my trainees complete a near miss incident form. There was no harm and the patient and family were informed. The main thing from my perspective was to identify exactly what went wrong and more importantly how to make sure it doesn’t happen again.

The process of documenting failure is, by its nature, long, depressing and overwhelming negative.  There is no way to make it a positive experience for anyone. What you have to do though is pick everyone up and somehow turn it around. It’s a difficult one to balance as you want people to feel empowered to make a change but equally you’re trying not to diminish the mistake in the first place.

I believe we managed to achieve this balance.  A plan was made and over the next few weeks I am optimistic we will have something in place that ensures this particular incident will not be repeated.

Which then brought me to this quote that I saw the following day on my twitter feed (thank you @johnwalsh88): C91f2UvW0AAZKbu.jpg-large

This to me is much more reflective of who I am nowadays. I think it’s what we should all be to be honest. So with the glass half full I would argue that for every situation you hope for the best but plan for the worst.  To me that is about having plan A, B, C, D etc etc

This philosophy is reflected in a postcard I have on my wall at work that says ‘Failure is not an option’  It’s from the Apollo 13 mission. It makes me smile every time.  Now you may think I am deluded or living in denial but I agree with the statement. Failure is not an option.  You just haven’t found the option that works.  It is true of the NHS and in life that you will need to try out many different options until you find the one that works.

So on that note I go into another week with my eyes wide open, optimistic that it will be a good one. If it’s not, well, that’s just a chance to try out Plan B…

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nhs, Uncategorized

Everybody’s Talking (at me…)

clcopeland

blog-2-pic

I’m stuck. How to I get people to assess and document mental capacity?

This is something I have been struggling with for a few years now.  I know I’m not alone either.

In last weeks blog I alluded to the fact that part of the Older People in Acute Care inspection focused on mental capacity documentation.  I also spoke about how nursing staff were being held to account for it when it is medical staff who are responsible.

I also came across this tweet by the British Geriatrics Society (@GeriSoc):

‘Some pts in hospital for ages, have multiple procedures, before capacity finally questioned only because they want to go home! #bgsconf‘ 

This is a situation I have been witness to repeatedly.

How can we be striving for person centred care and yet the most fundamental aspect of this is not addressed?

It was therefore fortuitous that I was asked to present to our Clinical Governance Board on this topic.  So with the question twirling in my brain of how to improve it I started with some basic education.

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Does this person have capacity?  What about the others….?

Now the first thing I had to do was make an assumption that the people sat in the room had capacity.  That’s how we should approach the assessment of anyone we see in hospital, clinic or at home.  They should have a broad understanding of what is wrong with them, the treatment offered and what would happen if they refused treatment.  They also have to be able to communicate this decision and we should help facilitate this if they are unable.

I quickly ascertained that my audience was full of mentally competent people who were keen to hear what I had to say.

I moved onto what is meant by mental capacity.

Just because you can make bad choices it does not mean you lack mental capacity.  You just have to explore the reasoning behind why they believe what they do.

Mental capacity can also be fluid.  This is true in the case of the person with delirium. As the condition fluctuates there can be times when the person is lucid but at other times they can be confused and/or hallucinating.

Finally mental capacity is task specific.  This is of particular importance in the person with dementia.  They may be able to understand the need for treatment for a chest infection but lack insight regards their own safety at home.

So how can we maximise the decision making ability of the person?  Well first you have to have enough time to go through things, including time to re-assess where necessary.  You need peace and quiet.  The person should have every possible chance to use what capacity they do have. That means put their glasses on, check that hearing aids work, have written information available and allow family members or carers to be present.

Lastly I have spoken about mental capacity in relation to medical treatment.  There is a whole other aspect to it that encompasses decisions pertaining to financial and welfare matters.

With all this to consider is it any wonder that mental capacity is a complex and time consuming process?

So back to my question – how to engage people with it?  I personally think we need a much broader range of people trained in the assessment of mental capacity.  I think our nursing staff have much to offer in this area and I would welcome any thoughts or comments around this.

I also think we need to ensure that medical staff are properly educated.  It is a daunting topic but one that is relatively straight forward to understand if taught well.

Meantime I draw parallels with DNACPR discussions and documentation in terms of importance and the legal aspect.  We would not dream of having a conversation around treatment escalation/resuscitation and not document it.  Why do we not apply the same level of importance to a person’s mental capacity?

It makes no sense….!