Impact News

Responding to Violence, Suicide, Psychosis and Trauma

2. Violence – Terror in the Mind

woman blurred head

So talking about the “Short, Fast Story” …

I was saying that violence is overwhelmingly a psychological affair so let me clarify what I mean. Violence is an act of aggression and yet it has relatively little to do with pain, injury or even force. We might stub our toe, fall off a bike, scald ourselves, be on the receiving end of fierce rugby tackle, or bash our head on a low doorway. The pain goes, the injury heals, we get on with our lives and forget all about it. Compare this with someone coming up to you and poking you in the chest, or spitting in your face. No real pain, injury or force – and yet you might be troubled by this for a long time.

Now let’s think about force a little more. Many of us feel that we would be at an immediate disadvantage because we are not particularly big or strong. Yet size and strength turn out not to be particularly significant – at least not in the way you expect. My best friend at school was huge – and well built – and yet he got bullied relentlessly by kids who were even smaller than me. I would tell him, “Rich, if not for you, for me, next time they do that to you – just sit on them” but he wouldn’t – his size and strength were his enemies, not his friends. Indeed when I consider some of the scariest people I have encountered, a lot of them have been remarkably small – but still scary!

Okay, many of us still say we are scared by violence – and yet the truth is that violence isn’t particularly scary and sometimes isn’t scary at all! What is scary is the fear of violence – the dreadful anticipation of what might happen as your sympathetic nervous system prepares you for the worst. When the violence takes place there are a whole host of emergency psychological processes that can take over – emotions can be de-activated, time can expand or collapse, dissociative processes engaged and the whole experience can feel unreal. After, of course, there is the trauma – the shattered belief system, the constant ruminations, the nightmares and flashbacks, disturbed arousal, avoidance and the feeling of pervasive danger. The violence itself is the least troublesome part.

The reason we fear violence is because it throws us (psychologically) into the “unknown.” Reason, understanding, reflection and problem-solving – the bed fellows of much of our professional practice – leave the room. Instead of reflecting, we are called on to react – faster than we can think, with little margin for error and possibly catastrophic consequences. We are lost, on our own and without a map.

Well that is where I come in (www.dangerousbehaviour.com ).

In the next posting I will begin to lay down the theoretical foundations to a new approach to understanding and responding to violence – or if you are impatient you could always buy my book! (www.facingdanger.com).

Finally if you want to learn about violence through a fringe theatre style training workshop, Mosaic Training are putting on “Difficult, Disturbing & Dangerous Behaviour” in London on 27th November. Click here for details.

Filed under: Impact Training, Other Mental Health, Uncategorized, Violence, , , , ,

Dangerous Behaviour Workshop in London, 27.11.15

Dangerous Behaviour

Difficult, Disturbing and Dangerous Behaviour” is a dramatic workshop that is usually only delivered as an in-house, bespoke training experience delivered on commission to organisations for delivery to their own staff. This can be frustrating for staff who wish to attend as individuals. However, for the only time this year Mosaic Training are staging this course for only £69.95/person in London on 27th November. It is anticipated that this workshop will sell out quickly so if you are interested please click here for the details.

Filed under: Uncategorized, , , , , , ,

Suicide – a casual affair?

ken070912.001.003.FAIRFAX.melb.s/age news  CRYING.photograph by ken irwin  shows  generic single eye crying SPECIAL 111

ken070912.001.003.FAIRFAX.melb.s/age news CRYING.photograph by ken irwin shows generic single eye crying SPECIAL 111

Some while ago I was delivering a training course on “dangerous behaviour” to a housing association when a man popped his head around the door and enquired as to whether this was the “Ladder Awareness Training.” I have to confess, to my shame, I could not prevent myself from bursting out into laughter. Could there really be such a thing as a workshop for grown ups on how to use a ladder? Yet I was the one being silly – an organisation should discharge its responsibility to ensure the safety of its staff and the public.

Now compare this to what we do about suicide. Suicide is the most common cause of death in men under the age of 35 (Five Years On, Department Of Health, 2005) and it’s estimated that around one million people will die by suicide worldwide each year – a lot more than die falling off a ladder! Incredibly, many mental health professionals receive NO training in understanding, assessing and responding to suicidal behaviour. I recently reviewed a M.Sc Forensic Psychology course and, even though the suicide rate in prison is reckoned to be 12 times that of the general public, suicide did not feature at all on the syllabus.

Often friends and family have to wait for a loved one to make an attempt on their life before they get any help – the silver lining should be that at last they will be in the safe and competent hands of the professionals. Except they are not. Acute mental health units often do little more than observe, restrict and medicate – they do not even effectively assess risk even though that is one of their primary roles.

A woman, following a suicide attempt, is admitted to hospital on a Section 2 of the Mental Health Act. A nurse asks some questions to help ascertain whether she really wished to die (she does). During her time in the acute mental health unit no further formal assessment of suicide risk is made and as she declines medication no treatment is offered. Her suicide attempt is viewed as a response to “situational stress” and yet no-one investigates whether her situation was getting better or worse while in hospital (it was getting a whole lot worse). None-the-less, the psychiatrist says she looked happier and told him she wouldn’t hurt herself (an unexplained improvement is an indicator of acute suicide risk and 50% of in-patients dissemble prior to taking their lives) – so takes he her off the Section and allows her leave. She doesn’t return on time and eventually she is found by a helicopter rescue team by a railway track. Still there is no re-assessment of suicide risk and she is allowed to continue taking leave from the ward – despite the the fact that best predictor of future behaviour is past behaviour and it is well-known that suicide risk varies enormously over time. She starts making a list of her possessions (putting things in order?) and tells friends and family not to visit (another indicator of suicide risk), but does check that they are coping with her dog. Prior to the current crisis she had always said that the one reason she would never kill herself was her dog – and yet during her whole time on the ward she never once asked to see him (the primary protective factor). The following day she had an important appointment and yet 15 minutes before she was allowed to leave the ward – no-one asked why. She failed to return on time and only did so after frantic calls from her mother. Still there was no re-appraisal of the situation. Later that evening she again asked to leave the ward and was again allowed to do so. This time she didn’t return …

The point is that less training and less skill was applied to keeping this woman alive than was offered to the man hoping to use his ladder. Why?

You might also be interested to read this Poor mental care blamed as mother burns herself to death. Whatever this is about its not lack of resources.

Filed under: Other Mental Health, self-harm, Suicide, Uncategorized, , , ,

“Outsiders”

A new “fringe theatre style” workshop by Dr Iain Bourne using drama and narration to explore the world of personality disorders. Full details to follow – in the meantime send an email enquiry to Iain

The term “Personality Disorder” has infiltrated common parlance and is often used with great laxity in professional circles to refer to “bothersome people like that.” To do so, however, not only displays a lack of knowledge but is discriminatory and prejudicial. Even those with a more informed understanding of the concept often struggle to articulate the difference between personality disorder and mental illness.

A simple comparison may help. Many consider Obsessive-compulsive Personality Disorder (OCPD) to be a less serious form of Obsessive-Compulsive Disorder (OCD) – when in many ways they are polar opposites. People with OCPD tend to be unemotional and detached with a strong liking for order and precision in their life, are fussy, inflexible and strongly dislike change – and that is the way they prefer to be! People with OCD have a distinct mental illness with a clear neurological component in which their life, against their will, is overrun by unwanted and often distasteful intrusive thoughts and an inability to refrain from rituals and checking behaviour that they acknowledge as pointless and irrational. People with OCD are often very emotional, acutely aware of their disorder and desperate to change. Similar differences are seen in other conditions such as schizophrenia vs schizotypal personality disorder.

Actually when most people refer to “PD” they are not usually referring to OCPD but either Borderline Personality Disorder – a very real and distressing condition – or Antisocial Personality – a much vaguer condition that attempts to medicalise the criminal mind.

Both conditions are explored in “Outsiders” alongside other PDs to:

* Aid our understanding of the condition from the service user’s perspective
* Address our own biases and prejudices
* Feel more confident in challenging other professionals whose use of the term may be discriminatory
* Identify targeted strategies to assist service users in developing more fulfilled lives

Filed under: Impact Training, Other Mental Health, Uncategorized, , , , , ,

Violence in Social Work

Senior people in the Social Work and Social care comment on their own experiences of violence.

http://www.communitycare.co.uk/blogs/social-work-blog/2013/08/tackling-violence-against-social-care-staff-i-wish-there-was-a-simple-answer/?cmpid=NLC|SC|SCDDB-20130822

Filed under: Uncategorized, , ,

Managing Dangerous Psychotic Behaviour – On YouTube

Iain Bourne discusses the principles underpinning Psychosis Containment Skills – or the interactive, face-face professional skills used in responding to immediately dangerous  psychotic behaviour. Features include the relationship between psychosis and violence; dysphoric vs reactive drivers; how to spot whether the psychosis is driving the behaviour; the differential role of hallucinations, delusions and paranoia; the involvement of persecutory and command auditory hallucinations; the psychotic vs non-psychotic world; changes in the sensory filtering system; personal space and catastrophic reactions.

Filed under: Uncategorized, , , , , , , , , , , ,

YouTube Video for “Facing Danger in the Helping Professions”

 

Filed under: Uncategorized

Suicide Rates Rise in UK

According to the Office of National Statistics the suicide rate for men aged 45-59 in the UK is now the highest since 1986. Against a trend over the past two decades that has seen suicide rates gradually falling, suicide rates are now rising again for both men and women wih highest suicide rates being among men aged 30-44. According to stephen Platt at Edinburgh University disadvantages midlle aged men face a perfect storm of “unemployment, deprivation, social isolation, changing definitions of what it is to be a man, alcohol misuse, labour market and demographic changes that have had a dramatic effect on their work, relationships and very identity.” Next month the government will award research contracts worth £1.5m to develop new initiatives as part of a “refreshed” suicide prevention strategy.

Filed under: Uncategorized, , , , ,

Bipolar disorder, creativity & writers

here is an interesting study from Sweden investigating the link between mental illness and creativity:

http://www.nhs.uk/news/2012/10October/Pages/the-price-of-genius%E2%80%93creativity-linked-to-mental-illness.aspx

 

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Razor’s Edge: Suicide & Self-harm Workshop in Nottingham

Nottingham HLG are putting on an open access workshop delivered by Dr Iain Bourne on 27th November 2012. For further information and booking details visit:

http://www.hlg.org.uk/training/quarterly-training-schedule

If you would like this course to be delivered in-house visit www.dangerousbehaviour.com or email impact@dangerousbehaviour.com

Filed under: Impact Training, self-harm, Suicide, Uncategorized, , , , , , , ,