• Starvation rations? 01 February 2016 | View comments

  • Friday lunchtime with ten medical students – a wonderful opportunity for reflecting on the state of our world. The student – modal age 22 years, gender split equal have come to Manchester and to Medicine from many places: Bolton, Stoke (or near Stoke), London (where there?), Brunei, Germany, Malaysia, Mauritius and more. Manchester? ‘The only place which would have me’ (a sort of modesty – in fact it was his first choice).’ It is good for Medicine’.

    Medicine? Interesting, challenging – but underlying all – and scarcely admitted without a nudge – A wish to use talent and time to help others.

    The Guardian newspaper has continued its articles about the NHS – and also found top news stories which feature healthcare: ‘Cuts blamed as mental health death toll soars’ was the front page headline on Tuesday.

    These are not deaths amongst old people but the clients of inpatient and community services for patients with serious mental health problems of working age. Numbers in contact with such services have increased, beds provided have fallen: 751 patients killed themselves 2014-15 compared with 595 2012-13. Deaths from all causes have risen from 1,413 to 1,713.

    So we thought a bit about why people with severe mental illnesses die young. Some deaths are violent and may be at their own hand. Others are of natural causes – linked to illnesses of poor diet, poor habits and being poor. And we rage for a while on the lack of employment amongst the people who are known to psychiatric impatient and community services. We remember that the mental hospitals appreciated the therapeutic value of work. It was all they had before ECT and neuroleptics. Neuroleptics, antidepressants and mood stabilisers fail to help people achieve their potential if they have no work.

    The final column of page 11 provides insights into the working week of an Old Age Psychiatrist. Citing only one patient a day Monday to Friday the diary covers a range of scenarios and vignettes. It is puzzling that four of the five patients are men. That hardly reflects the world we know. Alcohol dominates the lives of two, depression the lives of a further two and dementia finds a place only on Wednesday and in a dementia specialist care unit. It gave us a structure to cover the experiences of mental health amongst older people. The theme of the session was: ‘Getting to know you’- and we sang a few lines of the song, as one might in a Cognitive Stimulation Therapy session. The point is that it is useful to know about conditions – but to be really helpful we must find the person and make a connections and work with them in their world of past, present and future. There is so much which can be achieved with the application of long understood therapeutic practices. 

    Page one today tells us that Addenbrook’s Hospital is £60m overspent and St George’s Tooting approaches £46m debt. Jackie Crowther rants on Facebook that hospitals must change to be better relevant to ‘Elderly Folk’ and I rail: ‘get rid of ‘The Elderly’’ after Bernard Isaacs. We do want hospitals to be kind to older people and to people with dementia. But they, like people with other mental disorders, are people.

    We can get it right for people of all ages, gender, origins – at home, at work as well as in hospitals by making best use of what we know and what we have.

    That is the message for these young people setting out on careers which will equip them to help others

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