How it all began.
In the 1953 Patient 'HM' had brain tissue in the temporal lobe of the brain surgically removed to relieve intractable epilepsy. It succeeded . It left him with no ability to remember who he had seen the day before or what they had talked about , although his chatting with them had held a conversation together that day
After the surgery, it quickly became apparent that he had lost the ability to form new declarative memories—ones involving facts and knowledge—though he retained his attentional and working memory capacity, as well as his intellectual abilities and personality.
The discovery that it was his hippocampus function that had been damaged, and that this had damaged his memory, led to a research frenzy into the study of memory firstly and extensively in rodent model, and eventually to Brain scanning procedures on the hippocampus of patients with schizophrenia.
HM died 2008. His brain was preserved.
This month were published pictures of finely sliced sections of the appropriate area of his brain so that the extent of the damage that led to memory management failure could be accurately addressed in actual tissue rather than indirectly through scanning.
In 2006 Clinical studies of the memory status of all patients with schizophrenia in a catchment were addressed by survey questionnaire which confirming in a subsequent study, found memory failure in 80% of subjectswith schizophrenia, leading to this hypothesis:- The Basis of Schizophrenia: hippocampal failure ... leading to cognitive impairment - for ever after - from the age of onset of the illness
Taking account of this disability in working memory span reduction, is a lead consideration for aftercare and rehabilitation.
|Back to Mental health Trust secondary specialist service Working Practices. Here is one answer : a Mental Health Trust Carer's Committee. It's Terms of Reference and Constitution
Next - a carer advisory leaflet You will know how difficult it can be for representative carers in an area get to know the working practices of Community Mental health Teams towards schizophrenia. ,p.'Confidentiality' you know , you may be their carer in some way but - 'they are adults 'now' - it's their choice', we have to respect it.
Helping carers provide their observations. What to have in place. What to do.
In January I cleared the Front Page to campaign for HTAS
Discussion is now going on between the Trust provider of service and the Commissioning body to provide an assurance of Standards that would meet HTAS.
The local Trust compared what HTAS visitor had to say about admission MHAct facilitiesa and functioning, compared with the subsequent visit of the Care Quality Commission making their assessment of the same Service. The CQC visit went further in its first Report needing a follow up Review to see that the unsatisfactory findings they had found were being addressed: unsatisfactory findings that HTAS had missed..
Here is another route for carers to exert influence by putting in their observations on local Services delivery
. Largely I think because they do follow up visits, and that there would be further reviews regularly.
Carers should - must - find out who is their local Care Quality Commission representative and prepare themselves to put their observations to them.
go to Front Page 2
|*** New !!!.|
The lessons from Inquiries after Homicide are not being learnt nationally.
One constant failure is that there is present in the Community, especially known to carers, information that the Mental Health team involved did not get hold of, had put in place no process for receiving it, so that clinical judgement was undermined. Often there was no regular team meeting at which the Consultant always attended so that his/her highest qualified experience, could hear about situations and give guidance to a full response from the team.
[The mandatory independent External Inquiry system is now increasingly handed over to private business run bodies.
Better to hand the Inquiry system governance over to the Care Quality Commission.
Whenever tragedies are Inquired into, the findings should be taken into account - with those others examined previously, at a national level, and the Reports with those lessons distributed to all Mental Healh Trusts, to sign off that they have read them. Police administrations, Child safety agencies: with the request that they read the Reports, and respond with what changes, if any, are put into place in their own departments. Otherwise the lessons remain in the local Area agencies, and elsewhere get filed away and forgotten.
Most counties now have 'places of safety' areas with a small number of 'beds' to which police can use Mental Health Act powers Section 135/136 to enter people that they think are behaving in a way that leads them to think there is mental illness. But who wll staff them? [ Police county services have been using 135/136 custody sections on around 500 people each year, unwillingly as custodial cells deemed unsuitable for proper care assessment needs.
A number of problems identified by CQC arise from a shortage of available mental health beds, or appropriate community alternatives, for patients in crisis.
Leading to Out of Area placements. Last year from Cornwall [ 500,000 ] ninety [ 90 ]
people were placed Out of Area; some faraway.
The Care Quality Commission has issued it's annual 2012-2013 today January 28 2014.
It's a damning Report and points to a collapse of provision of duty of care and to my mind to provision against CARER risk
. For me the best provision was and is for is a timely 28 day Observation Order [ sec 2 MHAct ] admission to give enough time for a review of illness degree, repair any lapsed treatment programme.
A series of failings in the way mental health services are being commissioned and run is damaging the care of patients detained under the Mental Health Act and undermining their rights, a January 28th report by the Care Quality Commission has found.
The CQC said improvements were "urgently needed" in NHS and social care services after its Monitoring the Mental Health Act 2012/13 report found evidence of substandard inpatient, crisis and out-of-hours care. NHS commissioners in many areas had also failed to meet their statutory duty under the Act to plan for cases of mental health patients requiring hospital admission as a matter of "special urgency", the report said.
There were 50,408 Mental Health Act detentions in 2012/13, the highest number on record. The number of people detained under the Act has risen 12% in the past five years, the CQC said.
A recent investigation by Community Care and BBC News found that over 1,700 mental health beds had been closed since April 2011, with bed pressures harming patients and staff care.