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55. Brain

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Understanding brain pain

Introduction

It’s not one of the more glamorous looking parts of our innards. Woody Allen famously remarked that his brain is his second favourite organ. Being an inpatient is, for many, an excellent opportunity to learn more about their brain and its relationship with their mental illness. We find it surprising that the brain is rarely mentioned to patients. Our best guess is that it’s a combination of an excessive backlash against the medical model of psychiatry and a concern that because the brain is a particularly complicated and under-researched piece of kit it will be too bewildering for patients to grasp.

Our view is that it’s almost impossible to get to grips with living with a mental illness without at least a basic understanding of how the brain is involved. (How tricky and futile would it be to talk to someone’s about their cardiovascular condition without mentioning the heart or about their epilepsy omitting the good old brain.) And our hunch is that if the brain is openly talked about, this will contribute to reducing the stigma of mental illness. Let’s big it up for Rethink Mental Illness, then, for their excellent (albeit somewhat gooey) new campaign logo:

Happily, the brain is starting to gain some mainstream and trendy recognition. There are online and high street brain gyms, mind fitness studios and emotional intelligence masterclasses where people can do anything from develop their memory skills to go to a seminar on how to face death. Below are some ideas for giving inpatients access to knowledge of the brain.

Ideas for getting the brain onto the ward

Topics

  • Patients’ illnesses, causes, symptoms, treatment options, recovery
  • Drink and drugs (prescribed and street)
  • Difficult emotions (which may not be part of the illness but may still be problematic for individuals) – anger, anxiety etc
  • Social factors and situations
  • The 5 pillars of brain health
  • Exercise
  • Nutrition
  • stress management
  • socialization
  • mental stimulation

How and when

  • Med ed sessions, aka the alarmingly named ‘psychoeducation’. The naming bar having been set that low, almost anything is better but we like brain train, mind gym, mind matters, heads up and so on.
  • Pharmacist visits and consultations enabling patients to:
  • Learn about the purpose of their medication, its side-effects, how to cope with the side-effects, the consequences of not taking it as prescribed or at all.
  • Ask questions about their medication or simply air their feelings about it
  • Discuss strategies for remembering to take the right doses at the right times
  • Learn about other aspects of medication, eg the effects of combining it with homeopathic treatments or with drink/street drugs; safe storage etc
  • Consultant appointments 
  • 1:1 meetings with key-worker 
  • Therapy!! Psychologists – and psychiatrists!
  • Physical exercise 
  • Stress management 
  • Good sleep at night 
  • Physical health 
  • Brain games which patients can do solo or with others – puzzles, word games, Wii thinking games, quizzes etc. Scrabble certainly does good business on inpatient wards! And Idea #13 Bingo and jigsaws includes evidence of the cognitive and emotional benefits of these and similar activities.
  • Reminiscence groups and approaches 

The Brain Gym

Here are some mind fitness ideas you might like to share with patients and other staff.

  • Exercise your brain by doing challenging activities, such as puzzles, reading, playing music, making art, playing art and making music
  • Give yourself a double-workout by stimulating your brain and senses with tastes, textures, smells, sounds and sights that are new for you
  • Take a different route to work, or move some home furniture to new positions. Our brains get so familiar with our daily routines that they can go onto auto-pilot and we’ll still get by. It stretches the brain to have to keep alert to new layouts.
  • Talking is good! (Including the listening part of conversations.) As well as finding out your neighbour’s view on the latest blockbuster movie, you can learn how much the star was (over)paid.
  • And connecting with people is even better for your brain and your life if you get into ‘mentalising’, or being mind-aware. We’re mind-aware when we get really tuned into what’s going on in our heads and what’s going on in other people’s.
  • Let your brain relax, or ‘wander’. (Obviously not when you’re driving, answering the £50,000 question on Who Wants to be a Millionaire or negotiating hospital leave with your consultant).

Ward examples

  • Workbooks that are diagnosis-specific including understanding the diagnosis, managing symptoms and medication, and stress management are provided to patients.
  • Provide psychoeducation in partnership with local carers’ groups.
  • Employing psychology graduates as HCAs
  • One of our psychologists is doing group analysis training
  • Clinical psychologist runs drop-in consultations for staff. Nursing staff trained in psychotherapy and ‘alternative’ therapies eg aromatherapy
  • Medication rounds. Quiet room with easy chair, patients come in one at a time. Chance to talk to patient at start of day.
  • Pharmacist visits wards daily + attends ward rounds.
  • pharmacist participates in the Monday review meeting.
  • Weekly drop-in medication clinic
  • Clozapine clinic provides information, support and advice.
  • The OT displays brain teasers on a board each week. Patients can ask her for the answers if they wish.
  • Cultural Activities (eg music) sessions include the participation of the pharmacist
  • There’s a new full-time pharmacy role and the pharmacist will start coming to reviews and holding walk-in session for patients.

Patient examples

  • The ward has self-help booklets and leaflets on the ward about mental health conditions and ways of coping. Good to change your focus with these.
  • Everything I thought and felt was scary and bizarre and unmanageable but learning about my condition and how the whole process works has made me feel like I have a say in what is happening in my own mind
  • My psychiatrist gave me information about my diagnosis, it was like a light bulb moment and it really helped me understand myself.
  • I never understood my own thoughts and that frustrated me. So I just started grouping them into colours and marking a chart for each one. I found patterns and triggers and now I feel so much more in-control of my own mind
  • The ward has groups and leaflets about mental illness. I have learnt a lot about my illness and it’s good to know I’m not on my own.
  • I didn’t get a diagnosis but my doctor helped explain why I feel like I do. A diagnosis probably would have been unhelpful and I think my doctor was sensitive to that.
  • The last thing I wanted, in fact the last thing on my mind when I first got admitted was a diagnosis. But you know what, now I have one I know why I am like I am. It puts your mind at rest and lets you get the right help.
  • Getting a diagnosis was really important to me. The way my life has been made so much more sense and I am determined to do as much as I can to get better and lead a regular life.

Categories: Involvement, Wardipedia
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You might be wondering – what difference does Star Wards actually make to mental health wards? It’s a question we continuously ask ourselves, to make sure that we are having a positive impact. Well, we have over 800 wards signed up to receive our resources and, in the past, we have had Star Wards independently evaluated. A micro-summary of what our users have said is that wards who tried Star Wards ideas had:

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