Creative care for mental health patients

This post is the fourth in a series of posts reporting on the World Psychiatric Association (WPA) International Congress 2016, which I attended in Cape Town in November.

When Promise co-founder Dr Manaan Kar Ray was punched in the face in 2006 by a patient with whom he believed he had a good rapport, he found himself ashamed, mentally exhausted, and anxious about doing his job.

A second incident, in which a patient smashed a glass ashtray against a wall and chased him down the corridor, exacerbated his stress.

Today, years later, he has acknowledged the assault and the subsequent reflection provided him with a different frame of reference as to how mentally ill patients viewed the use of restraints in their treatment and whether, in their eyes, this constituted unprovoked violence.

Dr Kar Ray spoke at the WPA Congress. Together with Expert by Experience Sarah Rae, he created Promise, a proactive care initiative aimed at seeking out and embracing new ideas and, in the interests of patient-centred care, working to develop compassionate and creative alternatives for the care of patients with mental illness.

This was inspired by 2013 research that found huge variation in the use of restraint across England, with one centre reporting 38 incidents and another more than 3,000. There were also concerns about the face-down, or “prone” restraint method, plus related injuries, which numbered more than 1,000 in a single year.

Kar Ray, also a consultant psychiatrist at Fulbourn Hospital in Cambridge in the UK, pointed out that the use of mechanical constraints was commonplace in Europe and the developing world, and that he was sure “we can do better than this”.

“Our vision for Promise is to promote dignity by eliminating coercion in mental health. We need to have the courage to challenge the status quo, and not accept that because things have been this way for a long time, we should carry on this way,” he told delegates attending the congress.

Promise started with five founding members, are now thirty strong, and are constantly attracting more people keen on sharing and celebrating good practice. For caregivers, Kar Ray stressed that Promise’s message was clear: “We must contain the situation to keep patients and caregivers safe. But every time we lay hands on a patient is an opportunity for us to think whether there was something better we could have done upstream, ahead of the situation developing. If we can enhance the patient experience, maybe those situations don’t necessarily have to happen in the first place,” he said.

The Cape Town Promise Charter was signed following the session, and Kar Ray said this would help raise questions here, too, about whether restraint was indeed a necessity in the care of people who are mentally ill.

“Perhaps it’s not a necessary evil. Perhaps we are just stuck in the limitations of the past. And perhaps we need to shift out of that mindset, into a future full of possibilities,” he said.

The previous post in this series covered how psychiatrists can help break down the walls of racism and discrimination. My other reports from the WPA include an exposition of psychiatrists’ implicit contract with society, as well as African Union Commission Chair Nkosazana Dlamini-Zuma’s address at the opening ceremony of the WPA Congress, in which she called for international organisations to place more emphasis on mental health funding and activism.