Tag Archives: mental health

My First Podcast

My first podcast has been released by Nurse & Midwife Support to coincide with RUOK Day. 

It’s about suicide and nurses and mental health and social media and stuff.

You can access it by clicking here or on the picture below.

Many thanks to Mark Aitken at Nurse & Midwife Support for interviewing me back on 10th October 2019 (World Mental Health Day) for this podcast.

For those who don’t listen to podcasts, below is a copy of the transcript that I have pirated from this webpage:

Mark Aitken: I’m at the Australian College of Mental Health Nurses 45th International Conference in Sydney. My guest today is Paul McNamara: Clinical Nurse Consultant, Consultation Liaison Psychiatry Service at Cairns and Hinterland Hospital and Health Service. Welcome, and hello Paul!

Paul McNamara: G’day Mark, thanks for having me.

MA: It’s great to have you here today Paul. Today, we will discuss suicide and support for nurses, midwives and students at risk of suicide and following the death by suicide of a colleague. Paul, as you report in your blog on your website (meta4RN.com which I’ll get you to talk about shortly) you cite a retrospective study into suicide in Australia from 2001 to 2012 that uncovered these alarming four findings:

  1. Female medical professionals are 128% more likely to suicide than females in other occupations.
  2. Female nurses and midwives are 192% more likely to suicide than females in other occupations.
  3. Male nurses and midwives are 52% more likely to suicide than males in other occupations.
  4. Male nurses and midwives are 196% more likely to suicide than their female colleagues.

They’re incredible statistics. Quite disturbing I think, Paul. Would you please tell our listeners a bit more about that? But also, your role and meta4rn.com and why you wrote the blog about suicide that you’ve titled Nurses, Midwives, Medical Practitioners: Suicide and Stigma.

PM: Sure. The hospital that I work in, I’ve been there off and on for nearly 20 years now. Back in the early 2000’s three of the nurses who worked there died by suicide. That was a bit of a shock to us all. It happened within a fairly short amount of time, about 18 months I think it was. It felt like knock, after knock, after knock. A lot of us, myself included, were standing around looking at each other. Looking at our colleagues on the nursing team and thinking, “Oh Christ, what could we have done better? What could we have done differently?” That’s really stuck with me. Then with my role, I work as a mental health nurse in the general hospital. Not everyday day of the week, but certainly every week of my working life I will see people who have attempted to take their own lives and have survived it and been admitted (medically or surgically) to be patched up. While that’s happening, I’m providing the mental health input.

I guess that suicide is just an everyday part of my working life. A bit more than I would like, sometimes, to be honest. When it effects my colleagues, that gives it an extra resonance. It was with those thoughts bouncing around my head when I saw that paper come out with that data. That was published in November 2016, it was written by a pretty impressive bunch of people. They were all doctors on the team. I think one of them was a PhD doctor, not a medical doctor, but the rest of them were medical doctors from various specialties. The bits of that story that were picked up by the mainstream media were about the escalated risk to doctors of suicide. The mainstream media didn’t really pick up on the escalated risks to nurses and midwives, which were actually a bit higher than the risks for female doctors. Interestingly, male doctors don’t kill themselves at a greater rate than blokes in other professions. So, it was very much about nurses and midwives. As we know, most nurses and midwives are females. The whole thing has just got a bit of a resonance for me. It worries me. I guess the title that I gave it, it was speculative. I wonder about the stigma around suicide as we (nurses and midwives) get exposed to suicide stuff so much. I wonder whether we stigmatise ourselves around that. That was what the blog post was all about.

MA: Thanks Paul, I think you make some really interesting points there. Would you tell our listeners a bit about meta4rn.com? People will obviously want to access this blog once they listen to this podcast. I think it’s a really important blog, so what is it and why did you start it?

PM: This could be the cleverest thing here today Mark..

-Laughs-

MA: Apart from us.

PM: That’s right. Meta4rn.com is a homophone, it’s a bit of a play on words. It can be read two ways: metaphor, as in using an analogy to get a point across. A lot of education happens that way, where we use metaphors. I think particularly amongst nurses and midwives, you’ll be at a nursing station saying, “You do it this way because it’s a bit like a…” We use that kind of language a lot. We use metaphors a lot, and I threw on RN at the end because that’s what I am, an RN. Another way to break down that name is meta, which is like if we were having a conversation about another conversation. That would be a meta conversation. A lot of the stuff I talk about on the blog is a conversation about nursing conversations. That was where the idea for the name came from. Every now and again, I feel a bit self-conscious about it because it is a little bit wanky.

I came about setting up that blog because at the time I was working in perinatal mental health. By definition, my patients were women aged somewhere between 15 and 45. That demographic had the best and quickest uptake of social media and smartphones. This is going back to 2009/2010 when I first started mucking around in that space. If you remember back to then, iPhones were still a relatively new idea. I think they had been on the market in Australia for a year and a half, two years. It was women within that age bracket who were buying them first using social media the most. I was saying to the organisation that I was working for at the time that we, as perinatal mental health, should be getting in that space where the women are. But it was a government organisation, bureaucracies are a little bit sluggish. They didn’t really want to act on that, so I left the organisation behind and just set it up representing myself as a nurse (not the organisation). But I put myself up on social media in that space. Initially, because I was still working in perinatal mental health, it had a focus around that. But the funding for that role disappeared, so my focus has become much broader since then.

MA: It certainly has grown, as has your following. You’ve got a lot of subscribers to your website and I get regular emails and information.

PM: Yes.

MA: If people want to subscribe they can just google meta4rn and they can become a subscriber to your site and get access to some of the great information on your blog?

PM: Yes, and look, only if you want to. It won’t be too spamy, I tend to write about one blog post a month now. So, you can do that. If you don’t want to subscribe, if you’re like me you’re probably sick to death of too many emails. Just have a look around and see if there’s anything of interest for you.

MA: Navigate it via the website?

PM: Yes.

MA: You’re an excellent speaker about the importance of nurses and midwives blogging, or being active on social media. Indeed, Paul and I are at the 45th International Mental Health Nurses Conference in Sydney. We have been here since the beginning of this week. We’re recording this podcast on the 10th of October which many of you will know is World Mental Health Day. So, happy World Mental Health Day to you all! May you commit to your own mental health self-care and support. Paul, I think that’s vital. You gave a great session yesterday about nurses and social media. Could you talk a bit more about that please?

PM: The session was 45 minutes long so I definitely won’t give you that much information. But look, the short story is that we (as nurses and midwives) now have access to telling our stories and more access to the public conversation than what we have ever had before. I used some data to back this up, so it’s not just a dopey opinion. But I think maybe if we went back 10 years in time it would be frustrating to hear mainstream media talking about nursing issues without actually talking to any nurses. That still happens now, of course. But, from my point of view, I think that rather than getting frustrated about the mainstream media why don’t we take control of what we do have? This is things like social media; Twitter, blogs in particular, YouTube, Facebook. Make it separate from your personal accounts. I find Instagram a little bit harder to use in a professional sense, but I’m playing with it. I’m probably the wrong demographic to really be good at Instagram. All of these social media platforms are free to access and give us the opportunity to get our voice out there and join in on those conversations. People get to hear from us now, whether they want to or not. I think that’s a really important power. I think that we’d be foolish to ignore it.

I’m not suggesting for a moment that each and every nurse, midwife or student listening to this podcast should go out and create a social media portfolio. That’s not going to be everybody’s cup of tea. But there were some people who were wondering about it, and I would encourage you to explore that space. Nurse Uncut, the NSW Australian Nurse and Midwifery Foundation companion website, they’ve got a blog role there that includes some great examples of nurses and midwives who have got blogs out there. Some of them are really really good, many of them are much better than mine in terms of the way that they look and the clarity of information that they present. But I think that if you’re thinking of having a go, have a go. My only suggestion or caution around that, as a mental health nurse so of course we’re big on boundaries, if you are going to go and do that be really intentional about setting up a professional social media portfolio quite separate to your personal stuff. So, my holiday snaps and what have you, to show off to family and friends are not under my own name. You wouldn’t be able to stumble across them easily, but if you were to Google Paul McNamara mental health nurse or Paul McNamara Cairns you will get bombarded with stuff that I want you to see. I’m mindful that some of my patients, colleagues and bosses will search for me on Google. Usually not with sinister intent, but more out of curiosity. I want to be in charge of what they see, and that’s what that’s all about.

MA: Thanks Paul, I think that’s really useful information. It’s a bit outside of our key or core topic today but it’s still some very useful information for nurses and midwives. Also, I would add that there’s some very useful information on using social media and blogging effectively. But also, in relation to your regulatory requirements on the Nursing and Midwifery Board of Australia website. So, if you’re kind of worried about how you’re presenting yourself, check those out first to make sure that you’re considering the regulatory requirements of your registration.

PM: And, look, I feel like those are fairly common sense guidelines. The short version is: don’t be a dick, and you’ll be fine.

MA: Good point Paul. Paul, you and I have been speaking about suicide and our concern for the profession, for nurses and midwives in relation to this since we first spoke at the beginning of Nurse & Midwife Support in 2017. In fact, you contacted me and raised your concern in relation to this issue. Indeed, the effect that the suicide of several colleagues at your health service had on you and other members of the team. Would you please share with our listeners why you think this issue is important for us to discuss? In relation to nurses and midwives? Indeed, getting it out into the open.

PM: I was really thrilled when Nurse & Midwife Support launched. I don’t know whether it’s a coincidence that that launch in March 2017 coincided with that paper I was talking about, which was published in November 2016. It was probably too short a lead time to have caused an effect, but the timing was great anyway. The advantage that Nurse & Midwife Support have over the Employee Assistance Programs or going off to see your GP is that it’s specifically targeted to nurses and midwives. It’s 24 hours a day, 7 days a week, which reflects the shift working nature of our jobs. For many and probably most of us anyway. Having that great degree of flexibility is really important.

A downside is probably that it’s all phone based. For a lot of us, at a time of emotional distress we’d really appreciate that face to face contact. But this is a good first step and I’m really pleased that it’s there. I’m the mental health guy who wanders around the general hospital, and I hear mixed reports about peoples experience with the Employee Assistance Program. Some people have had a terrific service, but not all. Particularly, if people are carrying concerns that they think may jeopardize their employment or their registration, accessing support via your workplace is scary. Being able to go beyond the workplace, far far away down to the other end of the telephone has that advantage around that. So, if the way that you manage your stress is that you’re really hitting the booze or doing something that might get you judged poorly in your workplace, I think it’s a great advantage to have somebody far away from the workplace that you can have that conversation with. So, if you do need to go back to your workplace and discuss that part of the issue, you may be able to go back with an at least partially formed solution. I think that that’s the great advantage.

MA: Thanks Paul. Just to clarify for our listeners, Nurse & Midwife Support provides brief intervention counselling and referral pathways. If you phone our service and you need face to face counselling, as Paul suggests, then we’re able to give you some referral options so that you can access that service. But I think in the first instance, it’s often really useful to phone a service like Nurse &Midwife Support, talk through the issue and get some options in terms of where you may go next. Paul, you state in your blog that suicide is a complex matter, that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who are feeling suicidal. The data that you cite, and the research suggests that health professionals have an actual or perceived barrier to accessing these existing supports. You posed the question, I wonder what that barrier is? Paul, what is the barrier?

PM: I need to really clarify that I don’t know, that’s probably something for another team of researchers to explore. I can’t pretend that I know for sure but I imagine, through conversations with colleagues, that one of the barriers is about embarrassment. Shame. Nurses and midwives tend to be empathetic creatures, but because we’re so immersed in other people’s traumas we sometimes put up barriers which sometimes include some really irreverent defences. Like, if someone comes in after a suicide attempt, I have heard people say, “Why don’t they do it the proper way?” Stuff like that. When we say stuff like that, in front of each other, it doesn’t really give us permission to disclose that we’re at that point or getting close to being at that point. So, I think that sometimes the defences that we use so that we can go back to our job from day to day may accidentally stigmatize accessing support for each other. That’s what I was really trying to argue in that blog post. That we should just be a little bit careful about the ways in which we talk about suicide, for our patients and/or vulnerable colleagues. Let’s reach out to our colleagues, give permission and actually encourage them to come out and say that it’s ok to put up your hand if you’re going through a really rough spot. It would be foolish to pretend that that alone would make a big difference, but it would help.

MA: Thanks Paul. Do you think that there is a specific stressor, or there are stressors that prompt nurses to commit suicide rather than seeking help?

PM: Again, I’ll throw in the disclaimer that I won’t pretend to have all of the answers. But think about us, as nurses and midwives, and think about our psychopathology. We’ve probably got more empathy than the general man in the street. We’ve been attracted to do a job which almost in essence means that we’ve got to put the needs of others before our own needs. Anyone whose held their bladder for an 8-hour shift would recognise that. While you’re running around putting in catheters for other people, it’s not unusual for us to put the needs of others before us. I wonder whether that’s a part of the reason that nurses and midwives are overrepresented in suicide data, we’re not good at putting ourselves and our own needs first. Throw in on top of that, many of us do shift work so being sleep deprived makes us more emotionally vulnerable. We get exposed to other peoples’ trauma face to face. We’re up close and personal with our patients physical and emotional traumas. We’re the people who go behind the curtain and get exposed to those really raw emotions. For us to pretend that that’s not going to have a knock-on effect, would be a little bit foolish.

MA: Thanks Paul. On this day, World Mental Health Day, the 10th of October, we obviously place the spotlight on mental health. Do you think that there’s a lot of untreated mental health amongst nurses and midwives? Or indeed, untreated mental illnesses amongst nurses and midwives?

PM: Yes, we’re overrepresented in those common mental health problems such as depression and anxiety. We’re more likely than our patients to experience depression and anxiety, and I’m guessing for some of those reasons that I was just talking about before. There is, yes.

MA: Do you think that a more widely utilised facility for clinical supervision for nurses and midwives would improve their mental health and wellbeing?

PM: It’s about the only thing that stopped me from going mad. I probably am still a bit mad, but my clinical supervision has been such an important part of my practice. In Queensland, anyway, clinical supervision has been available to any mental health nurse working in the public sector since 2009. Interestingly, in the guidelines before that which were implemented in 2003 in Queensland, nurses were explicitly excluded from it. The rationale for that was a really good one, which is that it would cost a lot of money. But, it’s really important. We do emotional labour. We need to make sure that we look after ourselves.

Clinical supervision, just for those who don’t know a whole lot about it, it’s a bit of a dopey name. The analogy I use is say, a lot of our listeners will hold a Bachelor of Nursing or a Bachelor of Midwifery. Some of our listeners may hold a masters in this space, but not many of us will actually be bachelors or be masters. So, the name doesn’t necessarily accurately reflect what’s going on now. Clinical supervision was named about 100 years ago by psychotherapists. They were addressing their patients, one on one, who were talking through their problems. If they didn’t feel 100% confident that they weren’t making mistakes with the way that their sessions were progressing, they could tap a trusted colleague on the shoulder and be able to discuss the case with them. The colleague was then able to give supervision and support, to minimize the risk of harm to the patient.

That’s where the name comes from, it’s a bit icky for nurses and midwives. We’ve come from a fairly bullying culture so the idea of supervision sounds like scrutiny. It’s not. It’s very much about support and I was really thrilled to see in April this year that the College of Nurses, the College of Midwives and College of Mental Health Nurses in Australia put out that joint statement saying that Clinical Supervision should be available to all nurses and midwives, not just mental health nurses. All nurses and midwives in Australia should be given that opportunity to reflect on their practice so they can care for themselves. It’s not a self-indulgent thing, as this will enable them to provide better care for their patients.

MA: Thanks Paul. Just to pick up that point you made, because I do hear this when I’m around the traps talking to nurses and midwives around the bullying culture in nursing. I know some of our listeners will be very interested in this.

PM: I’ll be fair dinkum with you about this Mark. I think as a bloke, I kind of have managed to stand apart from that. It’s a bit weird, we’ve got two men here talking about nursing and midwifery. I think 89% of general nurses are female and 99% of midwives are female. So, it’s weird that blokes are talking about this, and I think that as a man I’ve probably dodged most bullets around bullying. But I hear it from my colleagues. A lot of it isn’t necessarily intentional. It’s about what happens in our workplace, we’ve got this busy stuff going on in busy wards that are crisis driven. There’s always a crisis going on. When something that would normally be addressed with empathy, kindness and calmness. Being met with an invitation for tea in the staff room, I think nursing has a culture where it’s like, “I can see you’re upset, but let’s get on with it.” I think that that emotional neglect is probably the biggest source of bullying that I’m aware of. But I know that through my gender, I’ve got blind spots around bullying.

MA: Thanks Paul, and what are you doing to look after your own mental health? A part from clinical supervision?

PM: Well clinical supervision is number one. My wife Stella is also a nurse, so we speak the same sort of language. We kind of look after each other. We’re really good at going to restaurants and going on holidays. We make a point of doing those sorts of things, to give ourselves treats. We’re working to get a benefit out of our nursing work. A personal benefit. More recently, I’ve recommitted myself to being a bad tennis player and an awful guitar player. Bought myself a new tennis racket and a new guitar, and I’m determined to be a little less crap at both.

MA: Well I look forward to seeing you in a band soon Paul. Just one last question, do you have a cut through message that will support nurses and midwives to seek help? Who may be at risk of suicide?

PM: Yes, don’t leave it until it’s too late. I think we’re almost predisposed to go; “Oh she’ll be right, she’ll be right, she’ll be right.” Don’t leave it until it’s crisis point would be my idea. If you’re going through a bit of a rough patch, don’t be shy about picking up the phone to Nurse a& Midwife Support. If you’ve got a decent GP who you can have a yarn to, that would be the next best port of call. He or she can make a referral to a credited mental health professional such as myself or maybe a psychologist or someone who can provide that one on one emotional kind of support. Just prioritise your health. I’m playing a tricky little emotional blackmail on your listeners now, but even if you don’t want to do it for yourself, it would be really good for your patients if you’re not overwhelmed by depression and anxiety. If you’re a bit motivated by helping others, you can do that by helping yourself.

MA: Thanks Paul, great advice. Well I can’t believe we’ve come to the end of another podcast, we could talk about this all day! Thanks Paul, we’ve had some great conversations since we met in 2017. We’ve talked about Nurse &Midwife Support today; mental health, suicide and the barriers for nurses and midwives accessing support. We’ve talked about stigma, the research, we’ve provided some strategies for overcoming stigma and the elements to supporting nurses and midwives at risk of developing mental illness and suicide. Paul, do you have any final words of wisdom for our listeners?

PM: Wisdom? No. But look, good luck out there. We know it’s a difficult job. You deserve to be cared for.

MA: Thanks Paul. If you found this podcast useful, please share it with other nurses, midwives, graduates and students. Feel free to rate us on whatever platform you’re listening on. That will help to elevate us and for other people to actually find our podcasts. This is important, because your health matters. Look after yourselves and each other, we’ll have some information attached to this podcast that will provide you with access to Paul’s blog, his website and indeed some services that can support your health and wellbeing. Take care, and I’ll speak to you next time.

 

Three Links

The podcast and transcripts:
www.nmsupport.org.au/resources/podcasts/discussing-suicide-jon-tyler-paul-mcnamara

Suicide info:
www.nmsupport.org.au/mental-health/suicide

Nurses, midwives, medical practitioners, suicide and stigma
www.nmsupport.org.au/news/nurses-midwives-medical-practitioners-suicide-and-stigma

 

End

That’s it. Thanks again to Nurse & Midwifery Support – what a terrific back-up for me and my colleagues.

As always, your feedback is welcomed via the comments section below.

Paul McNamara, 10 September 2020

Short URL: meta4RN.com/podcast

 

Are there smartphone apps specifically for people who experience eating disorders?

Q: Are there smartphone apps specifically for people who experience eating disorders?
A: Yes. Three*
1. Rise Up + Recover www.recoverywarriors.com/app
2. Recovery Record – RR www.recoveryrecord.com
3. MindShift www.anxietycanada.com/resources/mindshift-cbt

Q: Is this the shortest blog post in the history of humans?
A: No. Please read on for elaboration, geeky stuff and a disclaimer (look for the red asterisk* below).

Elaboration

Recently I was chatting with someone who experiences an eating disorder and was asked whether there were any apps specific to their circumstances. I was a bit busy at work, and only had time to to check-out Australia’s digital mental health hub Head To Health, and found nothing specific to eating disorders there. A few things pop-up on a google search, but when you’re a health professional you need to be careful about prescribing digital technologies. As articulated in editorials, letters, journal articles and blogs, health professionals have a responsibility to do no harm, and provide credible, evidence-based information if giving advice re apps, websites or other digital technologies.

Geeky Stuff

Fairburn and Rothwell (2015, p. 1038) took a systematic approach to clinical appraisal of eating disorder apps, and concluded, “The enthusiasm for apps outstrips the evidence supporting their use.” Ouch.

But that was way back in 2015, some people are still giving eating-disorder-specific app development a go, and digital therapeutics evolve quickly, so I thought it was worth doing a search of credible sources anyway.

After searching Head To Health, later (in my own time boss) I had a look at the Queensland Eating Disorder Service (QuEDS) resource page, the Butterfly Foundation website, and the Eating Disorders Victoria site and couldn’t find recommendations for apps. I then signed-up for ORCHA (“the world’s leading health app evaluation and advisor organisation“) and did a search there – that yielded poor results. Searching ORCHA for “eating disorder” was too broad and yielded a list of food/diet-related apps. Searching ORCHA for “anorexia nervosa” yielded two apps that had a green rating – one was a NHS/UK-only app, and when I clicked the other one on the App Store the top review spoke about their weight-loss. It might be a good app, but I’m afraid to share it here. That sort of thing would probably be laughed-off with an eye roll by someone who is living with an eating disorder and is in a good head space, but could really throw a spanner in the works for someone who isn’t in a good head space. The mortality rate of eating disorders is a worry, so primum non nocere.

Then I stumbled into the Centre for Eating and Dieting Disorder (CEDD) website and found a resource called “Navigating Your Way to Health” and, lo and behold, found this on page 33:

Using apps can be a handy way of helping you in your journey to recovery. We’ve listed some FREE apps here that might be useful. The following apps have been designed to help people with eating disorders to empower you to be in control of your recovery.
> Rise Up + Recover 
> Recovery Record – RR 
> recoveryBox 
> MindShift 

Disclaimer*

Although it was listed in the resource above, I left the recoveryBox app off my list at the top of the page because as at 09/08/20 (today) their website isn’t working. The app is still available on the App Store, but as the website is out of action, I’m guessing the app isn’t being updated any more. “Navigating Your Way To Health” was published in 2016 and, as noted above, digital therapeutics evolve quickly. It seems they devolve quickly too.

I’m pretty confident this is credible information as of right now, but who knows what reviews are underway or what apps are in development? Not me. For all I know there will be a fantastic Australian app co-produced by consumers/survivors, clinicians and academics tomorrow. I hope so. Just in case, check in on CEDD if you’re reading this after 09/08/20.

As noted in my recent blog post regarding the stepped care model (“One. Step. Beyond.” meta4RN.com/step) the concept of “one size fits all” doesn’t apply in mental health recovery. On the same theme, apps can be a useful addition to other strategies and useful for maintenance/relapse prevention. They should not be relied on alone if someone is experiencing significant symptoms of poor health.

I won’t pretend for a moment to have any special insight into what is a useful app for people who are experiencing an eating disorder, and don’t really have the time, skill-set or funding to undertake an independent review. I do trust the credibility of CEDD though, and if they say these apps are OK, who am I to say otherwise?

As originally noted in September 2012 (see number 13 here: meta4RN.com/about), the views and opinions I express here or on related social media portals do not represent the views of my employer. That really should be taken for granted, but anyway…

One last thing in this section: I don’t have any financial/other ties to any of the organisations or apps named above.

References

Daya, I., Hamilton, B. and Roper, C. (2020), Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. International Journal of Mental Health Nursing, 29(2): 299-31.
doi: 10.1111/inm.12653

Fairburn, C.G. and Rothwell, E.R. (2015) Apps and eating disorders: A systematic clinical appraisal. International Journal of Eating Disorders, 48: 1038-1046.
doi: 10.1002/eat.22398

Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943

Hunter Institute of Mental Health and the Centre for Eating and Dieting Disorders (2016). Navigating Your Way to Health: A brief guide to approaching the challenges, treatments and pathways to recovery from an eating disorder. NSW Ministry of Health.
via cedd.org.au/begin-recovery 

Neumayr, C, Voderholzer, U, Tregarthen, J, Schlegl, S. (2019) Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist‐guided smartphone app. International Journal of Eating Disorders, 52: 1191– 1201
doi: 10.1002/eat.23152

Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527

Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679

End

That’s it. Thanks for reading down this far 🙂

As always, you’re welcome to leave feedback in the comments section below.

Paul McNamara, 9 August 2020

Short URL meta4RN.com/app

 

Liaison in the Time of #COVID19

.

This page is an accompaniment to a brief presentation at the Inaugural ACMHN Consultation Liaison Special Interest Group online webinar via zoom – it is just a place to plonk things that I’ll talk about in case anyone wants to clarify anything for themselves.

So, here goes:

As noted on a previous blog post, Queensland’s population is much bigger than Australia’s smaller states/territories, but falls a long way short of Australia’s two largest states. 

 

Queensland’s population size compares better to New Zealand, Ireland, Norway and Singapore than other Australian states and territories.

 

All the data below is true as of 1 August 2020 (as you probably know, 1st of August = the Horses Birthday in Australia).

 

It is interesting to compare the number of Covid-19 cases across similar-sized populations. Obviously there are many differences between the populations too – not the least of which is land area – so I’m doubtful that a proper epidemiologist or public health professional would put much stock in this comparison. That disclaimer aside, it is noted that Queensland has a larger population than New Zealand – which is held-up as a shining-light of Covid-19 control – but, to date, has a lower incidence of Covid-19 positive people.

 

I’m not sharing the data about number of Covid-19 deaths as a macabre version of State of Origin or the Bledisloe Cup. It’s not a competition. It’s certainly not a game. Thousands of families across the world are in mourning. That said, isn’t it interesting how low Singapore’s death rate is compared to that of Ireland and, to a lesser extent, Norway? Both New Zealand and Queensland have been very fortunate to date in limiting the number of deaths.

 

Comparing the number of new cases of Covid-19 in the last 24 hours (as at 01/08/20) is also interesting.

 

Links to Data Sources
New Zealand
Ireland
Queensland
Norway
Singapore 

 

In the session there will be mention of the “Clean Hands. Clear Head.” strategy to embed anxiety-management into everyday clinical practice. More info about his via the blog post and video of the same name: meta4RN.com/head

 

Also in the session there will mention of “Positive Practice Environment (the other PPE)” Again, there is more info about this via a blog of the same name: meta4RN.com/PPE

 

Finally, here is a link to the Prezi that was used to make the video. My understanding is that all these pretty Prezis will stop working at the end of 2020 when everyone stops using flash (just letting you know in case you’re looking at this page in 2021).

 

In Support of our Victorian Colleagues

 

End

That’s it. I hope some of this info is of interest. As always, you’re welcome to leave feedback via the comments section below.

Paul McNamara, 3 August 2020

Short URL: meta4RN.com/zoom

One. Step. Beyond.

Stories on the TV that speak of the mental health impacts of COVID-19/other issues nearly always end with words to the effect of, “And if this has raised any issues for you help is always available. Phone Lifeline on 13 11 14.”

In keeping with Mindframe media guidelines, it’s good that help-seeking information is included in these stories, but it doesn’t cater for the full spectrum of mental health problems.

Lifeline, for example, is a crisis support line, akin to lifesavers plucking people from the dangerous surf. It’s vital, but it’s not a “one size fits all” service (nor should we expect it to be).

Anyway, most of us would rather early intervention/prevention rather than crisis intervention. It’s better to learn how to swim than rely on someone saving you from drowning.

 

The Stepped Care Model of Mental Health

Self Portrait 26/04/20

The Stepped Care model aims to ensure that people have streamlined access to the right services for their needs over time, and as their needs change. There is more information about this available from more reputable sources than my blog, eg:  Northern Queensland Primary Health Network, Connect to Wellbeing, or your local public health network.

A short, amateurish, overview is this:

If you’re on the lowest (blue) step, you’re doing OK. Keep those healthy relationships and habits going.

If you’re on the second-lowest (green) step you probably should be more intentional about protecting your social and emotional wellbeing. Chat to people you love/trust, and see if any of the digital resources at Head To Health match where you’re at.

If you’re on the middle (yellow) step it’s definitely time to connect with someone. If you’re a Nurse or Midwife that could be NMSupport in the first instance,  if you’re in North Queensland you may consider contacting Connect to Wellbeing. Elsewhere you may need to google or go via healthdirect re equivalent services.

If you’re on the second-top (orange) step, don’t muck-about: make a double appointment to see your GP. S/he won’t necessarily reach straight for the prescription pad. The GP may discuss making a Mental Health Treatment Plan, which should include your goals  and – if you and your GP agree it’s worth a try – a referral to a specialist mental health professional.

If you’re on the top (red) step you will almost certainly want to make contact with your local mental health service. In Queensland phone 1300 64 2255 (1300 MH CALL). Outside of Queensland you should be able to track-down your local service via healthdirect.

One. Step. Beyond.

This blog post was inspired by chatting with hospital colleagues who were not familiar with the Stepped Care Model of Mental Health. Many thanks to these terrifically impressive people who are definitely NOT heroes: they’re just everyday compassionate, creative, funny, clever and skilled health professionals who – in a crisis – will go one step beyond to support the people who need it.

One last thing. If, like me, you have a foot one step beyond your usual step, perhaps the jaunty Madness (1979) song “One Step Beyond” will provide temporary distraction and cheer. 🙂

End

Thanks very much for visiting. As always your feedback is welcome in the comments section below.

Paul McNamara, 30 July 2020

Short URL meta4RN.com/step

Saint Dymphna and The Zombies – a mental health nurse’s perspective

On Friday 19 June 2020 I presented “Saint Dymphna and The Zombies – a mental health nurse’s perspective” at the James Cook University/Cairns Hospital Ground Rounds virtually (ie: via zoom).

The session was initially scheduled to coincide with the Feast Day of Saint Dymphna – 15 May. However, the COVID-19/coronavirus thing put paid to any semblance of crowd gatherings, so the Grand Rounds program was postponed. When the Grand Rounds resumed they were moved out of the auditorium, and (like many things in 2020) went online.

The session has been videoed, please feel free to watch the watch the presentation below.

This page also serves as a  collection point for the references and resources used in the presentation.

Saint Dymphna

Info and references re the amazing story of Saint Dymphna has been collated previously on two of my blog posts, here: meta4RN.com/amazing and here: meta4RN.com/dymphna. For the sake of completeness the list of references used is replicated below:

Catholic Online (n.d.) St. Dymphna. Retrieved from www.catholic.org/saints/saint.php?saint_id=222

Catholic Saints Info (2016, 27 July) Saint Dymphna. Retrieved from catholicsaints.info/saint-dymphna

de Botton, A. (2011, July) Alain de Botton: Atheism 2.0 [Video file] Retrieved from www.ted.com/talks/alain_de_botton_atheism_2_0

Franciscan Mission Associates. (n.d.) The Story of St. Dymphna. Retrieved from franciscanmissionassoc.org/prayer-requests/devotional-saints/st-dymphna/story/ 

Goldstein, J.L. & Godemont, M.M.L. (2003) The Legend and Lessons of Geel, Belgium: A 1500-Year-Old Legend, a 21st-Century Model. Community Mental Health Journal. 39: 441. doi: 10.1023/A:1025813003347

Ireland’s Eye (n.d.) Saint Dymphna. Retrieved from www.irelandseye.com/irish/people/saints/dympna.shtm

Jay, M. (2014, 9 January) The Geel question. Retrieved from aeon.co/essays/geel-where-the-mentally-ill-are-welcomed-home

Kirsch, J.P. (1909). St. Dymphna. In The Catholic Encyclopedia. New York: Robert Appleton Company. Retrieved from New Advent: www.newadvent.org/cathen/05221b.htm

Novena (n.d.) Feast of St. Dympna. Retrieved from novena.com/2013/05/15/feast-of-st-dymphna/

Openbaar Psychiatrisch Zorgcentrum (OPZ) – Geel website www.opzgeel.be/en/home/htm/intro.asp

Rabenstein, K.I. (1998) Saint of the day. Retrieved from www.saintpatrickdc.org/ss/0515.shtml

Wikipedia (2016, 21 September) Dymphna. Retrieved from en.wikipedia.org/wiki/Dymphna

The Zombies

Photo of zombie nurses source: Roberts, A. (2015, 9 March) Zombie nurses raise funds for international medical exchange, ABC Capricornia
www.abc.net.au/local/photos/2015/03/09/4193789.htm

Established in 2010, the Australian Health Professional Registration Agency (AHPRA) does not recognise any Nursing specialities [source], but recognises 23 specialities in Medicine and over 60 sub-specialities [source].  

Lakeman, R. and Molloy, L. (2018), Rise of the zombie institution, the failure of mental health nursing leadership, and mental health nursing as a zombie category. International Journal of Mental Health Nursing, Volume 27, Issue 3, pp. 1009-1014. doi.org/10.1111/inm.12408

Principal area of main job for Australian Nurses (top five):
1️⃣ Aged Care
2️⃣ Medical
3️⃣ Surgical
4️⃣ Peri-Operative
5️⃣ Mental Health
[Australian Institute of Health and Welfare (2016, June 9). Nursing and midwifery workforce 2015, web report: source]

There are over 22,000 nurses working in mental health settings in Australia [Australian Institute of Health and Welfare (2020, January 30). Mental health services in Australia, web report: source]. It is not known how many of them hold specific undergraduate or postgraduate qualifications in mental health. There are no mechanisms in place to prevent a nurse with no specialist mental health qualifications working in a specialist mental health setting.

There are over 3,200 members of the Australian College of Mental Health Nurses [ACMHN 2017-2018 Annual Report: source]  – this equates to approx 14.5% of the nurses working in mental health settings. From my involvement with ACMHN, I am confident that nearly all members either hold or are  working towards a specialist qualification in mental health.

There are 1235 nurses who are credentialed (ie: peer reviewed and confirmed to have appropriate qualifications and experience, participation in clinical supervision, and contribution to the profession) by the Australian College of Mental Health Nurses [ACMHN 2019 Media Kit, source] – about 5.5% of the total.

58% of the nurses working in mental health settings are aged 45+, 33% are aged 55+ [Australian Institute of Health and Welfare (2020, January 30). Mental health services in Australia, web report: source].

Hildegard Peplau (1909-1999) is to Mental Health Nursing what Florence Nightingale (1820-1910) is to General Nursing [source].

End

Thanks for showing an interest in the presentation.

As always, your feedback is welcome in the comments section below.

Paul McNamara, 20 June 2020

Short URL: meta4RN.com/zombies

 

 

 

ieMR Liaison Psych Templates

A Quick Explanation

In the hospital that I work in we use ieMR. I’m a fan of ieMR, even though it has made the bad art of gingerbread women/men, genograms and other diagrams obsolete (more about that here: meta4RN.com/picture).

Car vs Bike Wounds: even an illustration that completely lacks artistic merit can convey a lot of information more effectively than a page full of text.

One of the reasons I like ieMR is that it accommodates auto-text/templates, which – in turn – assists clinicians to document with better consistency and more structure than they might have otherwise. When we have students on placement I used to send them MS Word versions of my ieMR templates, and assist them to get get them set-up on their ieMR account. That’s become a bit tricky to do since my hospital has shifted to Office365, so I am liberating the templates onto this blog page simply to circumnavigate that problem.

I’ve made it clear from the very beginning that this website does not represent the opinions of anyone else or any organisation (see number 13 here: meta4RN.com/about). So, just as a reminder, I’m putting the templates here because emailing them to students as word documents doesn’t work anymore. It’s not a recommendation for you. It’s not my employer’s idea. It’s fine if you don’t like the templates. It’s fine if you never use them yourself. I’m doing this simply for the convenience of me and the students I work with, that’s all.

Making ieMR auto-text/templates

To set-up ieMR auto-text/templates It’s easiest to get someone who knows how to sit with you for 2 minutes to show you. Really, about 2 minutes is all it takes.

In the absence of a helpful human there’s videos (eg: here) and PDFs (eg: here) to guide you. Or just google your question – some hospitals have their help info behind their firewall, but many do not.

That’s all the explanation I want to give. The prime purpose of this blog post is to share the content for easy copy and paste, so let’s get on with it…

Initial/Comprehensive Psychiatric Assessment

Review

Cognitive Screening results

End of Episode/Transfer of Care

End

That’s it. I’ve only just realised now that the formatting doesn’t carry across to ieMR. Bugger.

Please let me know via the comments section below if you know how to overcome that problem easily. BTW: as you can probably tell by this very basic-looking website, i’m not a coder or computer whiz. If there’s a fix it’ll need to be pretty straight forward for me to get it right :-).

Paul McNamara, 20 June 2019

Short URL: meta4RN.com/ieMR

Creative Commons Licence
This work is licensed under a Creative Commons Attribution-ShareAlike 2.5 Australia License.

How can we be integrated if nobody knows about us? #ACMHN2019

I’ve been asked to be one of the keynote speakers at the 45th International Mental Health Nursing Conference in Sydney, being held from 8th to 10th October 2019 (see the #ACMHN2019 hashtag on Twitter). To be an invited speaker at such a prestigious conference is a pretty big deal to me.

This blog page serves as a place to find my presentation quickly and easily [here], and as a place to collate and list references.

Click to go to Prezi

Bio (from www.acmhn2019.com/speakers)

Paul McNamara has been a nurse since 1988, a mental health nurse since 1993, a credentialed mental health nurse since 2006, and a fellow of ACMHN since 2008. He works as a consultation liaison CNC at Cairns Hospital. Paul also tinkers online quite a bit; he has a social media portfolio built around the homophone “meta4RN”, which can be read as either “metaphor RN” or “meta for RN”.   

Screengrab from the ACMHN2019.com website

More info about the conference here: www.ACMHN2019.com

References/Further Reading 

Altmetric Attention Score for Share or perish: Social media and the International Journal of Mental Health Nursing wiley.altmetric.com/details/62929297

Altmetric Attention Score for Do adult mental health services identify child abuse and neglect? A systematic review wiley.altmetric.com/details/23964454

Australian Health Practitioner Regulation Agency. (2014, March 17). Social media policy. Retrieved from www.ahpra.gov.au

Bec @notesforreview (2019, October 2). Because of Twitter I have – ^ academic/clinical knowledge – Learnt about current prof issues – Learnt from experts by experience – Gained new perspectives – Challenged biases – Made wonderful connections – Received & given support – Co-authored an article for ‘s magazine [Tweet]. https://twitter.com/notesforreview/status/1179344079609577472?s=21

Buus Lassen, Neils. (2019, September 11). in ‘Researchers: “We waste time and money writing articles none cares to read”‘, CBS Wire. Retrieved from cbswire.dk/researchers-we-waste-time-and-money-writing-articles-no-one-cares-to-read

Casella, E., Mills, J., & Usher, K. (2014). Social media and nursing practice: Changing the balance between the social and technical aspects of work. Collegian, 21(2), 121–126. www.collegianjournal.com/article/S1322-7696(14)00033-X/abstract

Facebook. (2015). Facebook logo. Retrieved from www.facebookbrand.com

Garfield, Stan. (2016, September 14). 90-9-1 Rule of Thumb: Fact or Fiction? www.linkedin.com/pulse/90-9-1-rule-thumb-fact-fiction-stan-garfield

Google. (2019). Map retrieved from www.google.com.au/maps/place/Cairns

#HealthUpNorth info www.health.qld.gov.au/cairns_hinterland/join-our-team/healthupnorth

#HealthUpNorth pics www.instagram.com/explore/tags/healthupnorth

Li, C. (2009). Foreword. In: S. Israel (Ed). Twitter Ville: How businesses can thrive in the new global neighborhoods. New York: Portfolio. books.google.com.au

Li, C. (2015). Charlene Li photo. Retrieved from www.charleneli.com/about-charlene/reviewer-resources/

Luddites I have known: meta4RN.com/luddites

McNamara, P. (2014). A Nurse’s Guide to Twitter. Retrieved from web.archive.org/web/20190607185707/https://www.ausmed.com.au/twitter-for-nurses

McNamara, P., & Meijome, X. M. (2015). Twitter Para Enfermeras (Spanish/Español).
Retrieved from web.archive.org/web/20151004183805/http://www.ausmed.com.au/es/twitter-para-enfermeras

McNamara, P. (2013) Behave online as you would in real life (letter to the editor), TQN: The Queensland Nurse, June 2013, Volume 32, Number 3, Page 4. meta4RN.com/TQN

McNamara, P. and Usher, K. (2019), Share or perish: Social media and the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing, 28(4), 960-970. doi:10.1111/inm.12600

Professional use of Twitter: meta4RN.com/poster

New South Wales Nurses and Midwives Association [nswnma]. (2014, July 30). Women now have unmediated access to public conversation via social media for 1st time in history @JaneCaro #NSWNMAconf14 #destroythejoint [Tweet].
Retrieved from twitter.com/nswnma/status/494313737575096321

Nurse and Midwife Blogroll www.nurseuncut.com.au/blog-roll

Salzmann‐Erikson, M. (2018), Mental health nurses’ use of Twitter for professional purposes during conference participation using #acmhn2016. International Journal of Mental Health Nursing, 27: 804-813. doi:10.1111/inm.12367

Thinking Health Communication? Think Mobile. meta4RN.com/mobile

Twitter. (2015). Twitter logo. Retrieved from about.twitter.com/press/brand-assets

Wall Media. (2015). Jane Caro photo. Retrieved from wallmedia.com.au/jane-caro/

Ward, Kylie. (2019, May 21). Nurses: the hidden healthcare professionals. The Sydney Morning Herald. Retrieved from www.smh.com.au/healthcare/nurses-the-hidden-healthcare-professionals-20190521-p51pq2.html

Wilson, R., Ranse, J., Cashin, A., & McNamara, P. (2014). Nurses and Twitter: The good, the bad, and the reluctant. Collegian, 21(2), 111–119. doi:10.1016/j.colegn.2013.09.003

WordPress. (2015). WordPress logo. Retrieved from wordpress.org/about/logos/

Wozniak, H., Uys, P., & Mahoney, M. J. (2012). Digital communication in a networked world. In J. Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communication in the health sciences (3rd ed., pp. 150–162). South Melbourne, Australia: Oxford University Press.

Ye Olde Yahoo CL Nurse eMail Network meta4RN.com/email

YouTube. (2015). YouTube logo. Retrieved from www.youtube.com/yt/brand/downloads.html

 

End 

Thanks for reading this far. You might be the only person who has. 🙂

As always, your feedback is welcome via the comments section below.

Paul McNamara, 4 October 2019

Short URL meta4RN.com/ACMHN2019

10 Delirium Misconceptions

This table/info extracted from Oldham et al (2018) is too handy not to share:

PDF version [easy to print]: 10DeliriumMisconceptions

Text version [just putting it here so that it’s searchable; hello google :-)]

1.
Misconception: This patient is oriented to person, place, and time. They’re not delirious.
Best Evidence: Delirium evaluation minimally requires assessing attention, orientation, memory, and the thought process, ideally at least once per nursing shift, to capture daily fluctuations in mental status.
2.
Misconception: Delirium always resolves.
Best Evidence: Especially in cognitively vulnerable patients, delirium may persist for days or even months after the proximal “causes” have been addressed.
3.
Misconception: We should expect frail, older patients to get confused at times, especially after receiving pain medication.
Best Evidence: Confusion in frail, older patients always requires further assessment.
4.
Misconception: The goal of a delirium work-up is to find the main cause of delirium.
Best Evidence: Delirium aetiology is typically multifactorial.
5.
Misconception: New-onset psychotic symptoms in late life likely represents primary mental illness.
Best Evidence: New delusions or hallucinations, particularly nonauditory, in middle age or later deserve evaluation for delirium or another medical cause.
6.
Misconception: Delirium in patients with dementia is less important because these patients are already confused at baseline.
Best Evidence: Patients with dementia deserve even closer monitoring for delirium because of their elevated delirium risk and because delirium superimposed on dementia indicates marked vulnerability.
7.
Misconception: Delirium treatment should include psychotropic medication.
Best Evidence: They are best used judiciously, if at all, for specific behaviours or symptoms rather than delirium itself.
8.
Misconception: The patient is delirious due to a psychiatric cause.
Best Evidence: Delirium always has a physiological cause.
9.
Misconception: It’s often best to let quiet patients rest.
Best Evidence: Hypoactive delirium is common and often under-recognized.
10.
Misconception: Patients become delirious just from being in the intensive care unit.
Best Evidence:  Delirium in the intensive care unit, as with delirium occurring in any setting, is caused by physiological and pharmacological insults.

Source/Reference

Oldham, M., Flanagan, N., Khan, A., Boukrina, O. & Marcantonio, E. (2018) Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. The Journal of Neuropsychiatry and Clinical Neurosciences, 30:1, 51-57.
doi.org/10.1176/appi.neuropsych.17030065

End

This is the least original blog post I’ve written. All I’ve done is transpose a table from this paper.

Why bother? So I can quickly and easily share it at work. I have conversations about this stuff a lot, especially misconceptions 1, 7 and 8. It’s handy to have an accessible and credible source to support these discussions.

That’s it. Visit the journal article yourself for elaboration about the misconceptions and evidence of delirium: doi.org/10.1176/appi.neuropsych.17030065

Paul McNamara, 18 April 2019

Short URL meta4RN.com/10Delirium

 

Self Care: Surviving emotionally taxing work environments

The nature of nursing will mean that we are likely to be are exposed to a range of challenges. It’s not unusual for nurses to witness aggression, feel unsafe, have first-hand exposure to other people’s tragedies, and to deal with the physical and emotional outcomes of trauma. This emotionally taxing environment can be pretty stressful. It’s something we should talk about.

I’m often asked to talk about this sort of stuff at inservice education sessions. This page is a 2019 update to support those sessions.

Printed handouts are so last century.

“Self care: Surviving emotionally taxing work environments” is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: prezi.com/skmu0lbnmkm5/first-thyself/#

I’m recycling and combining a lot of old ideas for the 2019 sessions. Self-plagiarism? Nah – it’s a groovy remix of some favourite old songs. Regular visitors to meta4RN.com may recognise the repetition, and be quite bored with me using the website as a place to store updated versions of old stuff. Sorry about that. I’ll pop-up a new and original post in coming days.

Here is the online presentation: Prezi

Here are the resources and references used in the presentation: (because I’m recycling old ideas this list is ridiculously self-referential).

Australian College of Mental Health Nurses [www.acmhn.org], Australian College of Nursing [www.acn.edu.au], and Australian College of Midwives [www.midwives.org.au] (2019) Joint Position Statement: Clinical Supervision for Nurses + Midwives. Released online April 2019, PDF available via each organisation’s website, and here: ClinicalSupervisionJointPositionStatement

Basic Life Support Procedure
https://qheps.health.qld.gov.au/__data/assets/pdf_file/0030/607098/pro_basiclifesprt.pdf

Dymphna (re the patron saint of mental health nurses) meta4RN.com/amazing

Eales, Sandra. (2018). A focus on psychological safety helps teams thrive. InScope, No. 08., Summer 2018 edition, published by Queensland Nurses and Midwives Union on 13/12/18, pages 58-59. Eales2018

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Employee Assistance Service (via Queensland Health intranet)
qheps.health.qld.gov.au/hr/staff-health-wellbeing/counselling-support

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Queensland Health. (2009). Clinical Supervision Guidelines for Mental Health Services. PDF

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

That was bloody stressful! What’s next?
Web: meta4RN.com/bloody
QHEPS: https://qheps.health.qld.gov.au/__data/assets/pdf_file/0038/555779/That-was-bloody-stressful.pdf

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

It’s OK if you forget everything about today’s talk, just don’t forget that there is 24 hour support available via 1800 667 877 or https://nmsupport.org.au

End

Please have a play with the pretty Prezi: http://prezi.com/0ysapc6z9aqg

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare

 

 

Diagnostic Overshadowing

Consultation liaison psychiatry services (CLPS) are, typically, based in a general hospital setting to provide the dual services of mental health clinical assessment/treatment and clinician support/education. The clinical and education roles overlap – a lot.

A significant part of the CLPS job is undiagnosing mental illness. Undiagnosis is often correcting a misdiagnosis, and also serves to validate the emotions and experiences of people (Patfield, 2011; Lakeman & Emeleus, 2014). It is not unusual for CLPS to be asked to see somebody who is emotionally overwhelmed or dysregulated. Sometimes this is in the context of mental health problems often in the context of significant stress. Naturally, we do not want to ‘psychiatricise’ the human condition. Of course, you cry when you are sad, and of course you are anxious when, like Courtney Barnett in ‘Avant Gardener’, you are not that good at breathing in. Of course, you’re frustrated when you are in pain or do not understand what’s going on.

Validating understandable and proportionate emotions is important.

It is equally important to make sure that somebody who has experienced mental illness previously does not have every presentation to the hospital/outpatient clinic seen through that lens. That is called “diagnostic overshadowing”; which is a significant problem.
Diagnostic overshadowing is where physical symptoms are overlooked, dismissed or downplayed as a psychiatric/ psychosomatic symptom. It must be one of the most dangerous things that happen in hospitals.

The President of the Royal Australian and New Zealand College of Psychiatrists, Professor Malcolm Hopwood, said in May 2016, “I sometimes think that the worse thing a person can do for their physical health is to be diagnosed with a mental health disorder.” Prof Hopwood cited stigma and discrimination in the health sector as contributing problems to early mortality amongst people with mental health problems.

People, hospital clinical staff included, are often shocked when they find out that people diagnosed with mental illness die between 10 and 25 years younger than the general public. Although suicide is a contributing factor to high mortality rates amongst this part of the community, it is alarming to note that the overwhelming majority – 86% – of people with mental health problems who had a premature death did not die from suicide (Happell & Ewart, 2016).

About 60% of people who experience mental health problems experience chronic physical health problems too. Poor mental health is a major risk factor for poor physical health, and vice versa (Harris et al, 2018).

The lived experience

Diagnostic overshadowing happens outside of hospitals too. In the example below, understandable and proportionate human emotions were misinterpreted as psychopathology. The cascade of events that followed makes for a sobering read:

Eight years ago I was diagnosed with bipolar affective disorder (BPAD) and recovered enough to commence a PhD. Unable to obtain travel insurance for a conference due to my diagnosis, I disclosed the reason to my supervisor. Unfortunately, he began to see all stress (normal to a PhD student) as BPAD symptoms and decided I was incapable of completing the PhD and progressively began to discriminate against me. My mental health started to decline. I imagine this must have validated his belief that I was an unsuitable student.

I received some help from the university, with an advisor indicating that my supervisor was undermining my work. The advisor was promoted. Despite not knowing me, his replacement did not believe my account and disagreed with my psychiatrist’s assessment of my mental state. Other staff and graduate students joined the belief that I could not cope, alienating me from the entire department.

After almost 18 months of fighting, I was once again depressed and felt defeated. I left the degree and lost my scholarship. It was one of the hardest things I have done. After, I was unable to gain employment; overqualified for most positions, lacking experience for the rest, and no references. After five months of constant rejections and lingering grief from losing the PhD, my self-worth and coping ability were so diminished, I made a very serious suicide attempt. I was so distressed that I could not see another solution.

Seven months later and I still have no paid employment. I have been undertaking volunteer work to regain some meaning in my life and have set myself up for the long-term with a new field of study. However, this does not pay the bills, and living like this is taking its toll. Sometimes I do not know where my next meal will come from, I have lost friends because of their attitude towards mental illness, and have withdrawn from health-related activities because of a lack of finances. Most days I cope and can find meaning in what I do, some days are much harder.

Questions for Reflection

Assuming that you – the person reading this – is a health professional, we have some questions we would like you to reflect on.

Have I ever witnessed a person’s mental health history influence how their presenting complaint was investigated or treated?

How does my workplace prevent mental health stigmatising and diagnostic overshadowing?

What can I do to support good holistic patient care without falling into the trap of diagnostic overshadowing?

References

Happell, B. & Ewart, S. (2016). ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness. Australian Nursing and Midwifery Journal, 23(11), 47.

Harris, B. Duggan, M. Batterham, P. Bartlem, K. Clinton-McHarg, T. Dunbar, J. Fehily, C. Lawrence, D. Morgan, M. Rosenbaum, S. (2018). Australia’s mental health and physical health tracker: Background paper. Australian Health Policy Collaboration issues paper no. 2018-02, Melbourne, AHPC.

Lakeman, R. & Emeleus, M. (2014). Un-diagnosing mental illness in the process of helping. Psychotherapy in Australia, 21(1), 38-45.

Patfield, M. (2011). Undiagnosis: An Important New Role for Psychiatry. Australasian Psychiatry, 19(2), 107–109.

Seriously mentally ill ‘die younger’. (2016, May 10). SBS News. Retrieved from https://www.sbs.com.au/news/seriously-mentally-ill-die-younger

PDF version

A one page PDF version [suitable for printing] is available here: DiagnosticOvershadowing

Citation

McNamara, P. & Callahan, R. (2018). Diagnostic Overshadowing. News, Summer 2018 edition (published December 2018), Australian College of Mental Health Nurses, page 17.

End Notes

The article above is a tidied-up version of a blog post that Bec and I collaborated on in October 2018 (see meta4RN.com/shadoworiginal). This is not called self-plagiarising, it’s more like doing a studio version of a demo tape. 🙂

Many thanks to Sharina Smith for encouraging us to submit the article to ACMHN News.

Paul McNamara, 15 December 2018

Short URL meta4RN.com/shadow