Yellow socks and handstands: Dr Peter J Gordon (reblog)

Hole Ousia

There is a lot of effort in NHS Scotland to raise awareness amongst healthcare staff about delirium, using statements like this:


Delirium is a very complex state and it is a shame that awareness is not always accompanied by understanding of this complexity. This is not surprising as delirium is poorly understood. It remains unclear to what extent delirium is itself a risk factor for mortality, rather than simply reflecting a multi-morbid state where each condition carries its own risks:

yellow socks and handstands

[the above is an excerpt from Inside Health last week]

The following slides come from recent awareness-raising events in NHS Scotland:

Resource into OPACTHINK delirium across scotland

These “busy slides” perhaps do reflect some appreciation of the complexity of delirium. What appears to be lacking is meaningful and informed involvement of patients:

Informed choice

Margaret McCartney stated in this:

Rather than submission

In her book “The Patient Paradox” Margaret McCartney said:


All awareness campaigns can suffer from the difficulty of communicating…

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Streatham Jobcentre Besieged By Protesters Demanding No Forced Treatment (reblog)

the void

no-forced-treatmentAround 100 people marched on Streatham Jobcentre today in a fantastic start to the fight against forced psychological treatments for unemployed, sick and disabled claimants.

Protesters gathered in Streatham Memorial Gardens with many carrying banners showing the growing anger at the collaboration of mental health workers and charities with the DWP’s workfare and benefit sanctions regime.  At just after 2pm the protest took to the streets, taking over the busy road before fnally arriving outside the Jobcentre which now also contains much of Lambeth’s mental health services.

The ever present G4S security guards blocked campaigners from entering the Jobcentre, with one member of staff informing the amused crowd that there were no jobs available today.  What bungling Jobcentre workers didn’t realise is that several people were already inside the building where they proceeded to disrupt the opening party of the so-called Living Well Network Hub and hung a banner out…

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‘Compulsory well-being: An interview with Will Davies’ @mindhacksblog [reblog]

Mind Hacks

The UK government’s use of psychology has suddenly become controversial. They have promised to put psychologists into job centres “to provide integrated employment and mental health support to claimants with common mental health conditions” but with the potential threat of having assistance removed if people do not attend treatment.

It has been criticised as ‘treating unemployment as a mental problem’ or an attempt to ‘psychologically reprogramme the unemployed’ and has triggered an upcoming march on a London job centre.

Will Davies is a political scientist and the author of the new bookThe Happiness Industry that looks at the history and practice of positive psychology as government and ‘well-being’ as a way of managing people.

We caught up with him to get some background on the recent controversy.

Is this use of psychology in social policy a quick fix or part of a broader trend?

There is a long history…

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Re-labelling (and a bit): Dr Peter J Gordon [reblog]

Hole Ousia

I read this book recently [below].

I am approaching fifty. With age-related sight changes I find that my arms need to be longer!. So if I have misread “and a bit”  please do forgive me:

Now we are sixty and a bit

This book reminded my of a protocol issued by an NHS Board that I once worked for:

4 april 2014 all over 65 MUST

As a doctor who tries his best to follow evidence-based medicine, I argued against this dictat. I found that, neither my NHS Board nor indeed that NHS Scotland shared my concerns:

Brian Robson

With the recent publication of the Care Standards for Older People, the Chair of Healthcare Improvement Scotland confirmed:


It would appear to me that this “screening instrument” has been re-labelled.

The 4AT has been developed and promoted as:


Recently the 4AT has recently been re-labelled as:

4AT validated UK Gov

The authors  4AT describe its key features:

(1) “brevity” (takes less than 2 minutes”), and

(2) that…

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Dr Peter J Gordon: Promises to listen to our elders [reblog]

Hole Ousia

The “Care Standards for Older people in Hospital”, which replace the previous 13 year old standards, were published this month.


As a doctor working in NHS Scotland whose work for twenty years has been dedicated to our elders, I submitted feedback on the initial draft. I started out by saying:


With the recent  publication of Standards I wrote to the Chair of Healthcare Improvement Scotland commending the publication of the Standards and asking for clarification on the involvement of “older people” in the development of these NHS Scotland standards.


In the Scotsman, the Chair of the the group developing the Standards, Dr Christine McAlpine stated that “we need to involve patients”:

Care Standards 12 June 2015a

In this article, Dr MacAlpine said:

Care Standards by Dr MacAlpine1

The Editor of the Scotsman summarised:

Care Standards in Scotsman - 9 June 2015b

Healthcare Improvement Scotland and Dr MacAlpine have stated the following:


[please note: my appreciation is that 1345 may not actually represent 1345 separate individual comments. I say…

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Hunter Watson Paper: Section 242 of Scottish Mental Health Act 2003: is it ECHR compatible?

Hunter Watson, Human Rights Campaigner, Aberdeen, in an Email sent to MSPs and fellow mental health campaigners on 20 June 2015:

“In the attached paper I point out that section 242 of the 2003 Act authorises the compulsory treatment of an adult with capacity. That is contrary to the advice of the Millan Committee, the committee that produced the report upon which the 2003 Act is based.

The paper also draws attention to the fact that a judgment of the European Court of Human Rights makes it clear that the Court assumed that an adult with capacity must not be subjected to compulsory treatment. That was made explicit in a recent judgment of the Supreme Court.

Further, a general comment made by UN Committee last year clearly demonstrates that it takes it for granted that persons with legal capacity have the right to refuse treatment. (Its only concern is that psychiatrists and others might be too ready to assume that people with a mental disorder lack capacity.)

There is a high probability that section 242 of the 2003 Act is not compatible with some Convention rights and hence, by virtue of section 29 of the Scotland Act, that the 2003 Act is not law. The Minister should not be permitted to evade making detailed responses to the points made in the attached paper by again claiming that he is confident that the 2003 Act, underpinned by the Millan principles, is compatible with the European Convention on Human Rights. The Minister should instead put in place without delay arrangements for conducting a wide review of the 2003 Act as requested by Richard Simpson and the General Assembly of the Church of Scotland.

I understand that the Scottish Parliament will be discussing the Mental Health (Scotland) Bill on Wednesday 24 June. I await with interest to find out whether the Minister accepts that there is a need for a wide review of the 2003 Act and also whether he is prepared to assure Parliament that the 2003 Act, amended by the Mental Health Bill to form the 2015 Act, is compatible with Convention rights. It would be wrong of him to offer Parliament any such assurance.”

Here is Hunter Watson’s 3 page paper on Section 242: hunter watson c242 one

hunter watson c242 two

hunter watson c242 three

Dr Peter J Gordon: Sign Guideline 98: Autism Spectrum Disorders [reblog]

Hole Ousia

I was recently asked by Autism Rights if SIGN Guideline 98 had records of financial interests for all those involved in developing this national guideline. The answer is no. Along with 38 other separate guidelines, all operational today in NHS Scotland,  no records of financial conflicts of interest are available. These were destroyed by SIGN.

SIGN 98 - no register of interest

I raised my concerns about this in a letter that was published in the BMJ on the 6th January 2014: SIGN should be transparent about competing interests in all current guidelines

SIGN guidelines have changed in approach to transparency since I wrote and all newly published guidelines now have declarations of interest included in “supporting material”.

These declarations are available on-line such as this one for SIGN Guideline 131: Management of Schizophrenia. It is interesting to compare this with the considerably more thorough approach to declarations of interest as contained in the equivalent NICE guideline

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Reforming the Narrative @MentalHealthCop [reblog]

Mental Health Cop

Yesterday, the Reform think tank published a (very modestly titled)report on policing”How To Run A Country: Crime and Policing”. It is one of various briefings they will be publishing ahead of the comprehensive spending review in autumn 2015 relating to various areas of public service.

This blog relates to just one brief section of the document on policing and mental health. To save you opening the file and finding the particular paragraphs, I have copied and pasted them here, from pages 9 and 10 —


“4.2.2 – Particular attention needs to be given to addressing the current inadequacies in dealing with people with mental health issues. As discussed above, the police service is increasingly responding to mental health related incidents as the service of last resort. This is placing unacceptable strain on police resources, but more importantly is damaging for those individuals suffering…

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