Guest blog by Steph Beale-Cocks, (mental health service user at time of writing – now an Eating Disorder Clinician)
I have to be one of the worst people for taking meds. It doesn’t matter what it is I will either forget, not care, fear it, hide it, take too much, etc. – and for so many different reasons. Even when I almost lost my foot I still couldn’t take antibiotics, because I absolutely dread them. I had to have the crisis team come in three times a day to monitor me, and had to have them in liquid which also eased my fears. Only recently have I completed my first ever course of antibiotics – and I am relatively stable at the moment – so this policy is absolutely essential to get right.
I recently spoke to a charge nurse who said the biggest difference he ever saw to the positive sleep hygiene of his patients was when they all took their night meds at unique times. There is no point someone taking them only to be woken up by someone else who wasn’t tired. Zopiclone, for example, has a 10 min effect period where you are advised to be in the dark, still and silent – hard to do when other patients are bouncing off the walls!
Medicines and tablets are one of the factors of mental illness that you cannot get away from. They are not often the ‘cure’ but can give patients a much easier time and the stability to work on their illnesses. ‘Use of medicines was found to be approximately 98 to 100% for all types of wards except CAMHS [Child and Adolescent Mental Health Services]’ according to the Healthcare Commission. It is therefore something that is essential to get right. The Healthcare Commission also states that ‘effective management of medicines reduces lengths of stay and rates of readmission to hospital by 55 to 60%’.
Enabling patients to be confident enough to take responsibility for and comply to their administering of medication is a vital step towards sustainable recovery. The BST outlines some easy stages that a patient can work through with support with the goal of having little or no staff input for medicine management. This skill is one that will hopefully stay with the service user when they leave hospital. It will enable the individual to find out along the way where the problem areas are and how they can be tackled, with support, structure and guidance. Leaving hospital is often daunting and being able to have the stress of taking your medicines by yourself reduced can only be a good thing. It leaves one less thing to worry about and concentrate on and gives the patient a better chance of success on the ‘outside’ right from day one.
Taking medication can always throw up fears, doubts, anxieties, but with some simple steps the patient can gain a better understanding of what these may be about. I, for example, am fine with compliance to almost all of my tablets. But olanzapine and anti-biotics were always the exceptions. I hated the side-effects and grew more and more devious in how to avoid taking it whilst as an inpatient. Thinking back, if I had sat down with someone and told them exactly what the problem was and had a discussion on possible alternative viewpoints or even treatments I may have been able to avoid the whole ‘pill in the side of the cheek’ experience.
The Healthcare Commission says ‘there is still more to be done in this high priority area, for example, ensuring that people have access to a supply of medicines after discharge and increased opportunities for inpatients to manage their own medicines where appropriate’. I believe this is the way forward. If we don’t enable a person to try looking after their medications while in a highly supportive environment what chance have we got expecting them to do this ‘cold-turkey’ when discharged.
Having 91% of inpatients taking two or more medicines, some up to 21 different tablets, means that this is not a subject to be put on the backburner. This is something essential to overall care, and future development of mental health sufferers. I mean, I can’t even remember to take the washing out of the machine when it is done until about three days down the line and it all has to be re-spun – and I am a pretty self-reliable and functional person. Imagine if on top I was taking 21 different medications… an extreme example but not implausible. The simple suggestions such as compliance aids and continual assessment forms for how the person is progressing through the stages of self-medicating are ones that can make such a dramatic improvement to medication compliance and overall confidence.
With the suggestion that ‘medicines were a clear factor influencing the admission for one in every 33 people using services’ getting on top of this issue is vital. Now, if only they can make a compliance aid for my washing…!
This article was first published in ‘Star Wards – Second edition’ 2008