The Six Monthly Check Up
Sorry. It’s a Groundhog Day post.
Steven has got his half yearly appointment with the psychiatrist on Thursday morning. I completely forgot the last one back in April. It’s a sign of how normal our life is now, and how free we are from professionals, that the last appointment didn’t register with me at all.
I don’t go to the appointments anymore. It’s partly since I got thrown out of the mental capacity assessment by the psychiatrist for “leading Steven” when I was trying to explain to the psychiatrist that Steven doesn’t understand the meaning of the word “better” in its comparative sense. Although, it’s not the same psychiatrist these days, my presence puts Steven at risk from them mis-interpreting him. When I’m around, Steven can always find something to talk about and I know that previous doctors have got intolerant as Steven starts discussing Sybil Fawlty’s wigs with me. So, I write a letter and leave the actual visit to the support workers.
Once again, that question comes up for me – why do people with learning disabilities get lumbered with a psychiatrist when they hit 18? Steven had a paediatrician until he was 16. The he went into that black hole for two years because children services end at 16 and adult services don’t start until 18. And then a month after Steven’s 18th birthday, we received an appointment letter to see a psychiatrist. 8 years on, I still don’t understand why.
I wrote my letter this morning. I mention how calm and settled Steven has been. I mention the massive breakthrough Steven made by finding the language and the insight to spot the triggers for his sensory overload. I ask whether it is time to stop all the anti psychotic medication. For the past six months, we’ve been in the final phase – .5mg once a day. That is so piddling, I’m not convinced it has any effect at all.
I know exactly what the psychiatrist’s post appointment report to the GP will say. Every single one for the last four years has said exactly the same thing. The first paragraph will comment on how nicely Steven is turned out and that his personal hygiene is good. The second paragraph will state that he cannot see any indicators of mental illness. The third and final paragraph will state that “it might be wise” to continue with the medication for the “time being” and to review in six months time. The cut and paste world of risperidone.
Needless to say, Steven cuts straight to the chase in his “why don’t you talk properly” way. I was preparing him for the visit earlier. He went away to think about and came back and asked:
“Steven Neary will talk to Dr T about…..?”
Steven doesn’t get why he has to go there. With the dentist, it’s very clear cut – “Dr F will look at Steven Neary’s teeth and talk about good brushing”.
With the GP, it’s less obvious because Steven’s history has shown him that the GP serves many different functions. The two that spring to Steven’s mind are: “Go and see Dr S and Dr S put a needle in Steven Neary’s arm”, and “Go and see Dr S and Dr S will talk to Steven about chicken pies and massive bellies”.
But he hasn’t got a clue what the psychiatrist will talk about. Probably because most of the language goes right over his head. He talks about “challenging behaviour” – Steven talks about “having my silly head on”.
It was in the psychiatrist’s office that one of my favourite conversations took place:
Psychiatrist: “Have you been out on your community programme this morning Steven?”
Steven: “No. Been swimming”.
One of the support workers talks about “The Gang”. In his eyes, it’s a gang that always has the threat of admittance to an ATU one clinical, bureaucratic decision away. The Gang, amongst others, consists of the psychiatrist and the challenging behaviour experts.
I’ve been putting out a call that instead of labelling people, “People with challenging behaviour”, we change that to “People in deep distress”. I know that might throw a hand grenade into The Gang and might push some inward reflection as to the part they are playing in the deep distress.
But probably not.
More than likely it will lead to a report that comments on the person’s “unkempt presentation”, overflowing logs of recorded challenging behaviour and the suggestion to keep taking the tablets and if nothing changes, “we can always try olanzapine”.
I won’t do an update post after Thursday’s appointment.
You’ve just read it.
From → Social Care