Stayin’ ‘Appy – Mental Health Apps

In the wake of Mental Health Awareness Week last month, I have been astonished by the amount and variety of downloadable apps designed to help people with mental health challenges.

Whilst these are obviously not a substitute for appropriate counselling and therapy, they may have a role in supporting and aiding conventional therapies and I note that the NHS information pages list a number.

I set out links to a few below but there many more available and some offer direct counselling support on a secure and confidential basis.


SilverCloud

A step-by-step online course to help you manage stress, anxiety and depression.


Feeling Good: positive mindset

Helps relax your body and mind and build your confidence using audio-tracks


Ieso

Strike up a dialogue with mental health therapists using instant messaging. Confidential and secure.


MeeTwo

discussion forum for teenagers and young people on day-to-day issues.


My Possible Self: The Mental Health App

An app that helps you manage fear, anxiety and stress and get to grips with unhelpful thinking


Sleepstation

 Connect with a team of sleep experts to help you fall asleep or stay asleep through the night

Stress & Anxiety Companion

Breathing exercises, relaxing music and games to help calm your mind and change negative thoughts

Thrive: Feel Stress Free


Use games to track your mood and teach yourself methods to take control of stress and anxiety

Be Mindful

An online course to help reduce stress and anxiety using mindfulness-based cognitive therapy


Beat Panic

Overcome panic attacks and anxiety wherever you happen to be

 

BlueIce

This app helps young people manage their emotions and reduce urges to self-harm


Calm Harm

Reduce urges to self-harm and manage emotions in a more positive way

 


Catch It

Learn to manage negative thoughts and look at problems differently


Chill Panda

 

Use breathing techniques to help you relax more, worry less and feel better

 

Cove

 

Create music to reflect emotions like joy, sadness and anger to help express how you feel

Gabriel Sherliker

NHS Medicines Shortages: Due to Brexit?

Gabriel Sherliker- Medicines

So here down in leafy Hampshire there are reputed shortages of certain medicines and generally there are undeniably shortages of some drugs in hospital dispensaries across the UK.

Some people are worried by this, including insulin-dependent privateers who are reputedly stock-piling insulin by over-stating their requirement, blagging it out of GP’s, or buying it on the direct online markets.

Question: Is this due to Brexit?

So juxtapose two facts: (1) the UK has not left, nor come anywhere close to leaving, the EU yet and (2) the first duty of any Government is to protect its citizens, especially the old, ill and infirm who are in urgent need of medical supplies.

Given that we haven’t ‘Brexited’ yet on any terms, no-deal, withdrawal agreement or otherwise, it is a bit rich to say that the current shortages are “due to Brexit”. Admittedly, there may be a nebulous Brexit effect, but it is rather difficult to say exactly what this might be.

Meanwhile, the number of drugs on the concession list has rocketed to almost 100 because generic prices are apparently roaring away. I wonder exactly who is playing who here? I note that in December 2018 the NHS included Tadalafil 5 mg on the concessions list and paid an extra quarter of a million for the 400,000 odd units supplied. So it is true, though perhaps a bit music-hall, to say that prices are not the only thing that are going up.

Then there are reports of pharma companies being asked to stock-pile certain drugs by the DHSC no-deal Brexit swat team under cover of NDA Agreements that PM Theresa May has herself referred to as ‘unethical’ whilst others say are ‘routine’. Again, the truth seems to be a foreign country in this area. But stock-piling by pharma companies, or private interests in anticipation of a profit and by the T1D brigade fearful of a drying up of insulin supply, will lead to a dearth of packets, tubes and phials on the dispensary shelf.

However, it is reported by The Pharmaceutical Journal, that perhaps the shortages are just due to across-the-board price increasesand Government’s slowness in reacting to them, one-off causes like suspension of manufacturing licences and the lack of any secondary legislation to control prices and supply.

The lack of any effective Government response may be due to the preoccupation with Brexit and the lack of any parliamentary time to deal with these issues, but then again secondary legislation does not really need any parliamentary time.

So, I am thinking that the medicine shortages are really not a great deal to do with Brexit but a lot to do with the Government’s failure to regulate prices and supply effectively.

The first duty of any Government is to protect its citizens. I suggest they get on with it.

Dr Gabriel Sherliker

Thoughts on the Anniversary of The Williams Review

As we approach the anniversary of the report by Professor Sir Normal Williams (published 11.06.2018) on the regulatory consequences of the application of the criminal law to the decisions and conduct of healthcare professionals, it is appropriate to take stock of its conclusions and the effect it may have on standards of medical care in the UK.

Following in the turbulent wake of the Bawa-Garba case, which involved the successful conviction of Dr Bawa-Garba for gross negligence manslaughter in November 2015, the Williams Report observed that “Though the legal bar for conviction for gross negligence manslaughter is high, investigations that have little prospect of conviction cause uncertainty and distress” and went on to conclude that professional guidance and a clearer understanding of the application of gross negligence manslaughter in the medical context “should lead to criminal investigations focussed on those rare cases where an individual’s performance is so “truly exceptionally bad” that it requires a criminal sanction”.

It is the task of The Marx Report to consider the appropriateness or otherwise of the application of a severe criminal sanction to the well-meaning conduct and decision-making of healthcare professionals.

The absurdities and unfairness of the current law are admirably canvassed by reporter and broadcaster Nick Ross in his Submission to Clare Marx

A criminal sanction usually requires proof an intention to commit the criminal act alleged and, in the healthcare context, it is surely only in the very rarest, aberrant circumstances where that will ever be the case.

What is plain from the Bawa-Garba facts is that medical-decision making does not take place in a vacuum but in the intense activity, measured chaos and inter-connectedness of the hospital environment where everyone is subject to a high level of dependency, not only on personal expertise and judgement, but also on colleagues, equipment and technological resource. In such a context, it cannot be the case that every mistake should lead to criminal proceedings even when the consequences of such mistake are tragic.

Professionals are called upon to make snap judgements all the time in the interests of the greater good, whether the professional concerned is a commander in the heat of battle, a paramedic arriving at the scene of a traumatic car pile-up, a lawyer reviewing evidence, a fire-fighter attending a blazing building, or, yes, even an over-worked, under-resourced doctor. These decisions may on occasion be wrong, the conduct open to debate or criticism, but the law has to inculcate a culture where the professional concerned has the courage to make the decision, and to do what they consider necessary or appropriate in any given set of circumstances, without fear of criminal prosecution. Such a climate of fear will not raise standards of medical care and medical outcomes but will act to lower them because the professionals concerned will reserve judgement and forebear to act for fear of criminal reprisals where such decisions and actions are critically necessary and the consequences of such fear will itself only lead to further public harm, criticism and prosecution.

The conviction of Dr Bawa-Garba is surprising given the number of factors, apart from her own conduct and decision-making, thatso obviously contributed directly and inexorably to the patient’s regrettable death.  The X-ray results were delayed for several hours due to a computer failure; her supervising consultant was not available until too late to be of any use; the registrar was away on a training day, there was no absentee staff cover; an agency nurse offered poor support: a parent wrongly administered inappropriate medication; Dr BawaGarba had only recently returned from maternity leave, was unfamiliar with the hospital, and had been given no induction training. Given the systemic failure of the hospital environment within which Dr Bawa-Garba was operating the wave of open-mouthed hostility from the medical profession, following her conviction for gross negligent manslaughter, is wholly unsurprising.

It cannot be right that an individual doctor should be prosecuted and convicted for conduct and decision-making where a death results from a whole series of administrative errors, a lack of resources and intervening, coincident events upon which the conduct and decision-making of the individual doctor concerned is wholly dependent. Here the duty of care that is breached is the duty of care that the entire service system is meant to provide and not simply that of the individual doctor.

It may be doubted whether the criminal law has any place in maintaining either an institutional, or an individual standard of care, but if the criminal law wishes to attribute blame in circumstances where a death results from a whole series of systemic errors and shortcomings, the manslaughter charge should be corporate, and not individual.

Systemic failures can only be remedied by systemic responsibility and systemic improvement.

If the objective is to preserve public safety and maintain care standards, rather than to punish a scape-goat, it should be remembered that the civil law of negligence is also available and again the imposition of damages, not blame, may be a better long-term mechanism for securing public safety and maintaining care standards than lone, arbitrary prosecutions under the criminal law.

It is to be hoped that law and policy will now change so that individual medical professionals will not be subject to arbitrary and serious criminal sanction where multiple other causes are equally, if not more, to blame.

Dr Gabriel Sherliker