Harassment: From the BBC to the GMC

October, 6, 2014 | 6 Comments


  1. I don’t think the bureaucrats are mad, just ruthless and corrupt. In the Emperor’s New Clothes the courtiers are not really mad or delusional they just know what to say. Is the Emperor himself mad? The Emperor’s problem is that people just tell him what he would like to hear, so he ends up stupider than a small child. People need personal myths in order to preserve themselves. Generally speaking the Emperor needs to believe that his being Emperor is of universal benefit, and everything must be done to disguise the fact that it isn’t.

    Of course, with the GMC there are no rules at all and they will find things if it suits them – and if they can get away with it – which are plainly impossible. Some of it might get cleared up to no practical purpose in the High Court years down the line. This stuff is awful, and so familiar.

  2. I think there is a new element in this– that takes us into territory not covered by fables and myths–

    Friday– in a leading U.S. Newspaper, the CEO of a ‘family/corporate health care system’ makes a plea for the creation of “a cabinet level agency” that will step up to the plate with adequate funding to support — what he calls “a behavioral health emergency”. Just so happens, his ‘health care organization’ has taken proper account of the crisis and has sprung into action:
    “… we needed to centralize and coordinate behavior health into a specialized *autonomous and empowered team* (my *’s) whose goal is to TAKE A HOLISTIC, LONGITUDINAL VIEW OF THESE PATIENTS.”

    This is a CEO asking for ‘government’ to respond to his assessment of crisis and his ‘word’ that his organization is probably the most deserving of this new source of funding.

    I am caught in this health systems struggle to fund behavioral health. I know that the CEO has no direct input from frontline staff , struggling to deal with poorly staffed units– now overrun with inexperienced ‘cheap labor’. and systems problems that are continually ignored.

    I know that department/nursing/unit management is truly autonomously operating outside the guidelines for patient safety set forth by local regulatory/licensing agencies AND violating even minimal guidelines for resolving reported incidents on the units set forth in the contract with our nursing union.

    Should be obvious. This is the set up for management to dispose of anyone who can expose THEM.

    This is not a tale of the weaknesses and flaws. inherent in human nature. It is a deliberate enacting of the very antithesis of what it means to be *human*,that is; the willful disengagement from any attempt at *rational* inquiry!

    Persecution and exploitation of vulnerable people is not an ‘oops, sorry’ situation. Intent matters and premeditation evokes the most severe punishment for murder.No wonder the cover ups are becoming the major focus of management, administration, regulatory agencies— even government??

    And while the CEO of a leading American health care organization is telling the public he hopes to deal with the marginalization suffered by the mentally ill and drug addicted members of society by forcing the government to create a separate agency that will fund his *team’s* holistic approach to *these patients*– I think he is merely banking on government responding to the need to warehouse the *dregs* of society.

    WHO amongst us knows how little consideration has been paid to the safety, well being– even the health of the patients locked up on *behavioral health wards*?Pretty much a no-brainer– right?? Seek out the frontline staff, patients, families– right?
    WHO wouldn’t employ such a simple, direct, caring approach??

  3. Thank you Sinead for the fight you’re putting up — and letting us know about it! I heard about the for-profit “Steward Healthcare” chain a few years ago when the Nurses Union went to Wall Street to protest their buyout of a nonprofit Catholic hospital group. Steward is owned by a private-equity fund called Cerberus Capital Management. (Yep, Cerberus, the three-headed hound who in Greek mythology guarded the entrance to Hell. He’s a very fitting mascot for the Fund.)

    Now it looks like they’re heavily investing in psych facilities to supply what they think the insurers selling policies under the Affordable Care Act will want: psych care that’s streamlined, low cost and standardized in every detail. They’re hoping to cozy up to the Medicaid program for the poor as well. This Business Week article gives a pretty good breakdown:


    The fight you’re waging is really the same one David Healy’s been trying to push forward on this blog — and the one he & his colleagues are facing now in North Wales. This model means replacing care for human patients with “algorithms” — and in particular, replacing people with pills. That’s true across the board in health care, but nowhere more than in psychiatry.

    As a psychiatric inpatient 30 years ago I got a fair number of pills — but I was also able to be hospitalized in a well-staffed unit with activities. Three times. It was far from perfect, but it kept me alive. Today almost no patient in my shoes would have that chance. I think it’s one big factor driving doctors to prescribe these paralyzing “cocktails” of five and six drugs, especially antipsychotics, to more & more patients. Drugging the patient to the gills begins to look like the only way to keep them safe — or at least keep your own ass covered, should they not be safe.

    Sure looks like Hades to me.

  4. Johanna, your experience as a patient on a well-staffed unit with activities supports my observations as an nurse, noting better outcomes for patients who are receiving treatment and care– also a reduction in the use of drugs, seclusion and restraint, when patients are in an environment that provides them with what I call, *signals of care*.

    If you then consider the compelling evidence for reducing the use of psychotropic drugs, it follows that the best care and treatment for patients on an inpatient psychiatric unit would center on staffing– quality and quantity.

    Here’s the *mystery*– How do we explain management practices that do not reflect care that is proven to be the best for the patients? Keeping in mind that there are managers with nursing background on the first tier of this group- advanced nursing degrees are usually required. These are the nurses one expects to be aware of *compelling evidence* for changing trends in patient care/safety. And, of course, we all should be able to expect that the psychiatrists are staying abreast of any specific dangers inherent in the treatments they prescribe. So, how do we come to grips with management practices that de-stabilize an inpatient psychiatric unit?

    Is there some reason why the majority of inpatient psychiatric units STILL subscribe to the philosophy that psych drugs ARE the treatment– the more, the better?

    Any for- profit behavioral health care *business* is certainly going to aim for the management practices that promote psych drugs as the main attraction. There is no profit to be gained from providing the care that will best meet the needs of the patients. AND, this needs to be addressed as *criminal*,[imo]– exploitation of a vulnerable population that the service providing business is harming — for financial gain. That is a crime.

    But, what if academic medical centers providing inpatient psychiatric services are no better in managing their units? What if the same philosophy of treatment =psych drugs prevails where we should be able to expect even greater vigilance over potential harmful practices? How do we begin to understand, what now amounts to, deliberate negligence of hard scientific evidence on the part of academic/teaching hospitals ?

    The big profits to be made in the business of behavioral health come from pharmaceutical companies. Period. No mystery there— and a *warehousing* approach to behavioral health care will definitely ensure that psych drugs will be the *proven* means for keeping the unit *safe*.

    I would imagine that an academic setting, beholding to financial contributions from pharmaceutical companies might actually be the model for an enterprising, business-minded doctor. Or so it seems in the case of the CEO of Steward Health Care.

  5. I was on the Nevada State Board of Psychological Examiners for 8 years (1990 to 1998). Our primary responsibility was protecting the public from incompetent or unscrupulous practitioners, a responsibility that is similar to what I imagine the GMC is charged with. We were earnest in carrying out our responsibilities but occasionally someone would file a frivolous or malicious complaint with the board following an undesirable legal outcome, for example in a child custody case. In such a case, the complainant was sometimes trying to use the Psychology Board to punish a professional in a disputed legal case, even though the practitioner had performed professionally and competently. We, as a board, were determined to not let ourselves be used to inappropriately extract revenge for an undesirable legal outcome when a professional behaved appropriately in a court of law. After reviewing all complaints carefully, the board would sometimes conclude that the complaint was not supported by the available evidence and therefore dismissed it. I hope the GMC will also not let itself be used by the pharmaceutical industry to punish legitimate industry critics with frivolous complaints. That would indeed be a tragedy. The GMC hopefully will realize that the goals of such critics and those of the GMC are aligned in protecting the public.

    David Antonuccio, Ph.D.
    Professor Emeritus of Psychiatry and Behavioral Sciences
    University of Nevada School of Medicine
    Reno, NV

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