Never give up on someone ...

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

Never give up on someone with Mental Illness – 

when 'I' is replaced with -
'We'  'illness' becomes 'Wellness'

Thanks to colleague Julie Draper - apparently this is doing the rounds on Facebook and elsewhere.

Care pathways: 15 minutes on Monday - how far is that?

On Monday I have a quick visit for 15 minute slot on care pathways at an interprofessional study day for 2nd and 3rd year students.

After the short presentation I'll ask the question of what difference the students can make to the patient's care pathway. There may be value in continuing the 'journey' metaphor?

They can ensure the care pathway is well-documented (otherwise it doesn't exist, and travel on it never happened) they can check it is accessible (an achievable goal) and that it does not trip anyone up (we don't do - iatrogenic).

There are further tests: is it navigable, tried and tested, a safe (evidenced-based) route? As the student's contemplate a major step in their health career, we really need them to focus on the health career of the persons in their care.

[ There won't be time for this: but do we need to wait until the 'end' for the outcome and capturing that (feedback). Or can do we this verbally, incrementally (positive impact on quality)? ]

I could ask them all to stand and make like sign-posts, but for the risk of poked eyes. It's true though, sign-posting is an important job, but how we do that is another post (the value of self-discovery as learning).

Once medically fit the key thing should be checking the person's (not viewing them totally as patient) wayfaring skills.

OK, who took my care pathway?

Can they read the map (are they health literate)? Can they find a map? Do they have a stay-well, recovery and well-being ... compass (a conceptual framework, an app, care plan)? If there literally is no self-care pathway under the patient at present, then the student can help them and their carer if necessary to find or create this compass - across the required care domains.

THEN this person (potential future patient) can avoid having to step off their self-care pathway and onto the health care pathway. You see there's a risk and a cost in that particular transfer.




Image source: http://www.farlandgroup.com/customer-journey-mapping/

Alcohol: Messages in bottles, domains and anagrams

The perennial health news item that is alcohol has bubbled and overflowed this week. In 1987-88 I visited several nearby alcohol services in Blackburn, Preston and Salford with a questionnaire to compare and contrast with Chorley which at the time had no dedicated alcohol services. There was Alcoholics Anonymous AA and Al-Anon, but nothing specific through health beyond community psychiatric nurses. The project was for the CPN(Cert.).

Back then I remember a Consultant Psychiatrist saying that the level of alcohol consumption is directly related to cost. The literature I read also drew attention to historical comparisons. I think it was Alcohol Concern who supported this view and called for urgent action. Of course all that was some 24 years ago. Incredible that there is some movement in 2012. In 2007 the taxi driver from Elounda to Heraklion airport described the movement and horizontal stasis that adorns the pavements (and spills onto the roads) of Malia as we zipped by. The Brits do have a problem. A Consultant physician highlighted this from a hospital ward on BBC Radio 4 news today.

Don't get me wrong: I like an occasional drink but my enjoyment of alcohol has been tempered over the years by several experiences:

• An early party aged 15 (and at a church social club) preloading was already in vogue. No sooner were a group of us sat at a table than someone threw up on the table. It was alcohol.
• Biology and human biology lessons helped instil the impacts of alcohol.
• Having to say 'goodbye' to clients with a drink problem, duly referred by their GP. I cannot support them in their drinking after several attempts to effect change.
• Appreciating the link between drink and risk behaviours.
• Working with people whose 'ill-health career' has seen them having to live with, but not themselves recognise Korsakoff's syndrome.
• Seeing people over three decades who cannot be supported in the community with their family, relatively young for residential care, but given a lack of specialised facilities - there they frequently are.

Hopefully the policy turn will have a positive impact extending beyond news headlines:

Minimum alcohol price planned for England and Wales
http://www.bbc.co.uk/news/uk-17482035

Alcohol pricing: politics under the influence 
http://www.guardian.co.uk/commentisfree/2012/mar/23/alcohol-pricing-politics-under-influence?newsfeed=true

With the prospect of an alcohol and a new NHS information strategy in England you hope that some dots can be joined. Here are a few:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Motivation    Psychological effects Attitudes to risk         Predisposition Personality     Education    Vulnerability	Data     Evidence      Public health Physical effects    Dual diagnosis Research       Violence - statistics
Social contradictons and attitudes - 'image' Upbringing       Cultural attitudes  Marketing          Media	Cost per unit      Services        Funding   Cost to health budget      Reporting Policy   Lobbying   Taxes   Commissioning

Beer label c/o http://www.beerlabelizer.com/

'Real Stout' = 'Sale Tutor'