Additional complications Demanding relatives/other advocates \200 Assess the patient on their own initially, but allow those attending with the patient to ha ve their say (this may clarify the \200\230why now \200\231 question, particularly if it i nvolves the breakdown of usual social supports). Ask the patient for their consent to discu ss the outcome of your consultation with those accompanying them (to avoid misunderstanding s and improve compliance with the proposed treatment plan). Patient \200\230raising the stakes \200\231 \200 If a patient is dissatis \201 ed with the outcome of your consultation, they may try a num ber of ways to change your mind (see b p. 994); they may even explicitly say: \200\230What do I have to do to convince you? \200\231 before resorting to other manipulative behaviors . This type of response only serves to con \201 rm any suspicions of attempted manipulatio n and should be recorded as such in the notes (verbatim if possible). Stick to your origina l management plan, and if the behavior becomes passively, verbally, or physically aggressiv e, clearly inform them that unless they desist, you will have no other option than to have them removed (by the police, if necessary). Equally, any threats of violence towards indivi duals present during the interview or elsewhere should be dealed with seriously and the pol ice (and the individual concerned) should be informed \200\224patient 24_Semple_Chap24.indd 996 12/7/2012 5:42:56 PM THE MANIPULATIVE PATIENT 2 997 con \201 dentiality does not take precedence over ensuring the safety of others. Suspected factitious illness \200 Try to obtain corroboration of the patient \200\231s story (or con \201 rmation of your su spicions) from third-party sources (e.g. GP, relative, previous notes, including other hosp itals they claim to have been seen at). If your suspicions are con \201 rmed, directly fee d this information back to the patient, and clearly inform them of what course of action yo u plan to take (e.g. recording this in their notes, informing other agencies, etc.). Do not feel \200\230defeated \200\231 if you decide to admit them to hospital. Record your suspi cions in the notes and inform the psychiatric team that the reason for admission is to asse ss how clinically signi \201 cant the reported symptoms are (it will soon become clear in a ward environment and it may take time to obtain third-party sources). Patient threatening suicide by telephone \200 \200 b p. 984). Keep the person talking (see Try to elicit useful information (name, where they are calling from, what they plan to do, risk to anyone else). If you judge the patient to b e at high risk of suicide, encourage them to come to hospital \200\224if they refuse or are unable to do so, organize for emergency services to go to their location and bring them to hospital. If the patient refuses to give you any information, inform the police who may ha ve other means to determine the source of the call and respond. Always document phone calls in the same way as you would any other patient contact (see Closure). Closure \200 Clearly document your assessment, any discussion with senior colleagues, the outcome, and a ny treatment plan. Record the agreement/disagreement of the patient and any other persons a ttending with them. If appropriate, provide the patient with written information (e.g. appo intment details, other contact numbers) to ensure clear communication. Ensure that you have informed any other necessary parties (e.g. keyworkers/psychiatric team already involved wi th the patient, source of referral \200\224which may be the GP, other carers, social worker s, etc.). If the assessment occurs out of hours, make arrangements for information to be pa ssed on to the relevant parties in the morning (ideally try to do this yourself). If you ha ve suggested outpatient follow-up for a new patient, make sure you have a means of contacti ng the patient, to allow the relevant service to make arrangements to see them as planned. If you think it is likely the patient will re-present to other services, inform them of you r contact with the patient and the outcome of your assessment. 24_Semple_Chap24.indd 997 12/7/2012 5:42:56 PM CHAPTER 24 Dif \201 cult and urgent situations 998 Issues of child protection The treating doctor has a responsibility to consider the welfare not only of their patient, but also of the patient \200\231s dependants (in most cases, th eir children). Where there are concerns relating to the welfare of children, this responsib ility may be discharged both through actions you take your- self (e.g. admitting the patien t to hospital), and through involvement of appropriate statutory agencies (e.g. child and f amily social services). Each case should be individually assessed; however, a number of sce narios can be recognized: \200 Necessary absence When a patient is brought into hospital (e.g. for emergency assessment) t he admitting doctor should clarify whether they have dependent children, and if so, what ar rangements have been made for their care. If these are unsatisfactory, or are disconcerting ly vague (e.g. \200\230with a friend \200\231), child and family social services should be consulted. Neglect of childcare responsibilities result of mental disorder, patients \200 \231 ability to provide the appropriate level of physical or emotional care may be impaired . This may relate to functional impairments (e.g. poor memory), continuing symptomatology ( and medication side-effects), or dependence on drugs or alcohol. Having a mental disorder d oes not preclude being a parent \200\224what is important is that individual patients recei ve appropriate assessment to ascertain the type of additional support they may need and the level of monitoring required. Risk of positive harm to child to the child by acts of commi ssion, rather than omission. These include: Psychotic disorders in which the patient holds abnormal beliefs \200 about their child. Severe depressive disorder with suicidal ideas, which involve killing the child (usually for altruistic reasons). Drug misuse where there a re drugs or drug paraphernalia left carelessly in the child \200\231s environment. In some circumstances, as a Certain disorders carry the risk of harm In these cases, a joint approach should be adopted involving mental health (optimizing the patient \200\231s management) and social services (addressing issues of child protection an d welfare). 24_Semple_Chap24.indd 998 12/7/2012 5:42:56 PM This page intentionally left blank CHAPTER 24 Dif \201 cult and urgent situations 1000 Patients acting against medical advice 1: guiding principles In certain situations, doctors are faced with deciding whether or not to act against a patient \200\231s stated wishes. T his most commonly occurs when: \200 \200 A patient does not consent to a particular treatment plan. A patient wishes to leave hospit al, despite medical advice that this is not in their best interests. Some common clinical s cenarios are discussed in Box 24.3 (see b p. 1002). Fundamental principles \200 An adult has the right to refuse treatment or to leave hospital should they wish. Doctors h ave a responsibility to discuss what they are proposing with the patient fully, to ensure t hat the patient is informed of the options, risks, and the preferred management (but not to enforce or coerce). Special circumstances In some circumstances, doctors have the power to act without the pati ent \200\231s consent or override a patient \200\231s expressed wishes when: \200 Consent cannot be obtained in an may be given under common law (b p. 974). capacity is eith er temporarily or permanently impaired (b A patient \200\231s p. 970) and they are unable t o give informed consent. The responsible doctor should act in the patient \200\231s best in terest (b p. 874) \200\224consider treatment using incapacity legislation (b pp. 876 \200 \2239). They are suffering from a mental disorder and their capacity to take decisions is i mpaired. Use of the MHA may be necessary to ensure their own (or other persons \200\231) sa fety. emergency situation and treatment Points to note \200 When a this should be recorded clearly in the notes (with the reasons given by the patient) . If this involves discharge from hospital, a \200\230discharge against medical advice \200\231 form may be useful (as a written record of the patient \200\231s decision), even t hough such forms have no special legal status. In emergency situations, the de \201 nition of \200\230mental disorder \200\231 is that of a layperson, not whether ICD-10 or DSM-IV criteria are satis \201 ed. Incapacity legislation does not allow for detention in hospita l; equally detention under the MHA does not allow for compulsory treatment of physical diso rders. Always consider the balance of risks: ask yourself \200\230what am I more likely to be criticized (or sued) for? \200\231 Although the \201 nal decision in non-mentally ill , capable adults rests with them, in \200\230close-call \200\231 situations it is better t o err on the side of safety, and review again later. (Such situations should always be disc ussed with a senior colleague.) capable patient disagrees with a proposed course of action, Patient wanting to leave a psychiatric ward The duty psychiatrist is often called to psychi atric wards when patients wish to take their own discharge. Although not wanting to be in a 24_Semple_Chap24.indd 1000 12/7/2012 5:42:56 PM PATIENTS ACTING AGAINST MEDICAL ADVICE 1: GUIDING PRINCIPLES 1001 psychiatric ward may often seem the most rational response \200\224particularly when there are other more behaviourally disturbed patients in the same ward \200\224a pragmatic approa ch should be adopted (i.e. balancing the need for assessment/inpatient treatment against th e additional stress caused by admission). Follow the general principles detailed here, focu sing on man- aging risk and acting in the patient \200\231s \200\230best interests \200 \231. Note especially: \200 Deciding whether a patient is permitted to leave the ward wil l be informed by both an assessment of their current mental state and knowledge of any esta blished management plans. Often decisions regarding the course of action to take will have already been discussed by the responsible consultant with nursing staff. When there are con cerns, the default position is often reassessment at the time the patient is asking to leav e. When a patient does elect to leave against medical advice, record this clearly in the no tes with, at the very minimum, an agreement for a planned review (e.g. as an outpatient, by the GP) and the recommendation that, should the patient (or their relatives) feel the situ ation has become unsustainable at home, they should return to the hospital. 24_Semple_Chap24.indd 1001 12/7/2012 5:42:56 PM CHAPTER 24 Dif \201 cult and urgent situations 1002 Patients acting against medical advice 2: clinical scenarios Box 24.3 Some examples of clinical scenarios 52-yr-old 4 admitted with chest pain, who ough t to remain in the hos- pital for overnight telemetry, cardiac enzymes, and repeat ECG (in the morning), but does not wish to do so. He is not incapable and not suf- fering from a me ntal disorder. The decision rests with him (he has a right to refuse \200\224even if you think he is actin g foolishly). 22-yr-old 5 who admits to ingesting 56 aspirin, brought to GP by a con- cerne d friend, now refusing to get in an ambulance to go to hospital. Most people would agree that she is possibly suffering from a mental disor- der (suggested by her recent OD), hence there are grounds for use of MHA, with emergency treatment under c ommon law. 18-yr-old 5 admitted after a paracetamol overdose who needs further treatment, b ut wishes to leave. She has some depressive features and may possibly be under the in \202 uence of alcohol. There is suf \201 cient suspicion of mental disorder to detain under the MHA (perhaps more than in the previous scenario); treatment would be under common law. 34-yr-old 5 with long history of anorexia nervosa, current weight under 6st, with clear physical complications o f starvation (and biochemical abnormalities), refusing admission for medical management. Clear mental disorder, as well as \200\230risk to themselves \200\231 \200\224detain under the MHA; emergency treatment under common law. 53-yr-old 4 previously seen in A&E followin g a fall whilst intoxicated, brought back up to A&E 6 days later by spouse with \202 uctu ating level of consciousness (also has been drinking heavily) \200\224suspected extradural, but angrily refusing CT head. Capacity impaired both by alcohol and potentially serious underlying treata- ble physical d isorder. Necessary urgent investigation warranted as in patient \200\231s best interests \200\224with use of sedation (if necessary) under common law. 67-yr-old 4 with post-operati ve URTI who presents as confused, wish- ing to leave the ward because he is \200\230late f or his brother \200\231s wedding \200\231. There is a clear mental disorder and he ought to be detained under the MHA; treat under com mon law (sedate if necessary). 23-yr-old 4 admitted with psychotic illness, who wants to go home to confront the neighbors whom he believes have conspired with the police to get him \200\230banged up in a nut hut \200\231. Clear mental disorder. Detain under MHA; emergency treatment if required under common law. 24_Semple_Chap24.indd 1002 12/7/2012 5:42:56 PM This page intentionally left blank CHAPTER 24 Dif \201 cult and urgent situations 1004 The mental health of doctors \200\230Quis custodiet ipsos custodes? \200\231 Who will watc h the watchmen? In general, doctors are in a pretty good state of health, with a lower prev a- lence of smoking, cardiovascular disease, cancer, and a longer life expect- ancy than th e general population. With respect to mental health, however, the situation is reversed \200\224with the incidence of most psychiatric disorders higher in doctors: \200 725% of doctors to have signi \201 cant depressive Surveys have found symptoms, with increased risk in: junior house of \201 cers/interns; ju nior doctors in O&G and psychiatry; radiologists, anesthetists, surgeons, and pediatricians . Suicide rates are high, with depression, alcohol, and drug misuse signi \201 cant contri butory factors. Specialties over-represented include anesthetics, GP, psychiatry, and emerg ency medicine. Problems of drug and alcohol dependence may affect as many as 1 in 15 doctor s in the UK. Why are doctors more likely to have mental health problems? Individual factors \200 Personality \200\224many of the qualities that make a \200\230good doctor \200\231 may als o increase the risk of psychiatric problems (e.g. obsessionality, perfectionism, being ambi tious, self-sacri \201 ce, high expectations of self, low tolerance of uncertainty, dif \201 culty expressing emotions). Ways of thinking/coping styles, e.g. being overly self-cri tical, denial, minimization, rationalization, drinking culture, need to appear competent ( \200\230no problems \200\231). Occupational factors \200 \200 \200 \200 \200 \200 Long and disruptive work hours. Exposure to traumatic events \200\224dealing with death, et hical dilemmas. Lack of support (particularly from senior colleagues). Competing needs of p atients and family. Increasing expectations with diminishing resources. Professional and ge ographic isolation. Barriers to seeking help Doctors are notoriously bad at seeking help for their own medical prob- lems \200\224particularly psychiatric problems \200\224often only presenting when a c risis arises. Reasons for this include: \200 Symptom concealment due to fears of hospitalization, loss of medical registration, exposure to stigmatization. Negative attitudes to psychiatry, psychiatrists, and people with psychi atric problems. Lack of insight being a feature of many psychiatric disorders. This may lead to delayed referral, misdiagnosis, and not receiving the ben- e \201 ts of e arly interventions. 24_Semple_Chap24.indd 1004 12/7/2012 5:42:57 PM THE MENTAL HEALTH OF DOCTORS 1005 What to do if you suspect a colleague has a problem You have a duty to take action (see Box 24.4), both in the interests of patient care and of your colleague \200\231s health (such actions are both ethically responsible and caring). Not to do so could both put patients at risk and potentially deny your colleague treatment which might prevent further deteriorati on in health and performance. Usually a staged approach works best: \200 Con \201 rm your suspicions through informal discussion with other colleagues. If a clear pattern of behavior is present, \201 rst consider discussing this observation with the co lleague in question. It is better if face-to-face discussion is conducted by someone of the same grade. If face-to-face discussion yields no results, speak to an impartial senior col league and/or seek further advice about local procedures (see Box 24.4). If the colleague i s YOU, remember: patients \201 rst and take pride in looking after their own health (see b p. 1006). responsible physicians put their Box 24.4 Duty to take action1,* You must protect patients from risk of harm posed by another col- league \200\231s conduct, performance or health. The safety of patients must come \201 rst at all times. If you ha ve concerns that a colleague may not be \201 t to practice, you must take appropriate ste ps without delay, so that the concerns are investigated and patients protected where necess ary. This means you must give an honest explanation of your concerns to an appropriate pers on from your employing or contracting body, and follow their procedures. If there are no appropriate local systems, or local systems do not resolve the problem, and you are still concerned about the safety of patients, you should inform the relevant regul atory body. If you are not sure what to do, discuss your concerns with an impartial colleag ue or contact your defense body, a professional organization, or the GMC for advice. If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgment or performance could be affected by a condition o r its treatment, you must consult a suitably quali \201 ed colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patie nts. 1 General Medical Council (2006) Good medical practice, paragraphs 43,44 and 79. It is worth noting that doctors referred to the GMC because of mental health problems can c ontinue to practice, provided their problems are not judged to affect their professional ab ilities, and they are suitably supervised in an agreed treatment regime. 24_Semple_Chap24.indd 1005 12/7/2012 5:42:57 PM CHAPTER 24 Dif \201 cult and urgent situations 1006 Looking after your own mental health You have a duty to yourself and your patients to act p romptly if you feel there are early warning signs that your health may be affecting your pe rformance. Signs to watch out for \200 Dif \201 culties sleeping. \200 Becoming more impatient or irritable. \200 Dif \201 culties concentrating. \200 Being unable to make decisions. \200 Drinking or smoking more. \200 Not enjoying food as much. \200 Being unable to r elax or \200\230switch off \200\231. \200 Feeling tense (may manifest as somatic symptom s, e.g. recurrent headache, aches and pains, GI upset, feeling sweaty, dry mouth, tachycard ia). Developing good habits \200 Learn to relax relaxation, or simply setting aside time when you are not working to relax w ith a long bath, a quiet stroll, listening to music. It also means living life less frantic ally \200\224going to bed at a regular time and getting up 15 \200\22320min earlier to prev ent the feeling of \200\230always being in a rush \200\231. Take regular breaks at work fr om work). Even when work is busy, try to give yourself a 5 \200\22310min break every few ho urs. Escape the pager In the day and age of being always obtainable, it is a good idea to b e \200\230unobtainable \200\231 once or twice a week, to give yourself time to be alone an d re \202 ect. Exercise of stress. It will also keep you \201 t, helps prevent heart dis ease, and improve quality of sleep. Drugs Caffeine and alcohol should be used only in moder ation. Distraction which can be picked up or left easily can allow you to forget about your usual stresses. This might be a sport, a hobby, music, the movies, the theater, or books. The important point is that it is not work- related. This can involve learning methods of progressive This includes regular meal breaks (away There is no doubt that regular exercise helps reduce levels Tobacco and other recreational drugs are best avoided. Finding a pursuit that has no deadlines, no pressures, and Organizing your own medical care \200 \200 Register with a GP! Two-thirds of junior doctors have not done this. Allow yourself to bene \201 t from the same standards of care (including expert assessment, if this is felt to b e necessary) you would expect for your patients. If you are having dif \201 culties relate d to stress, anxiety, depression, or use of substances, consult your GP sooner rather than later. Be willing to take advice. In particular, do not rely on your own judgment of your a bility to continue working. 24_Semple_Chap24.indd 1006 12/7/2012 5:42:57 PM LOOKING AFTER YOUR OWN MENTAL HEALTH 1007 If your GP suggests speaking to a psychiatrist, and you feel uncomfortable with being seen locally, ask for an out-of-area consultation. Utilize other sources of help and advice \200 \224both informal (friends, family, self-help books) and formal (see Sources of support and advice.) Remember you are certainly not the \201 rst doctor to have encountered these so rts of dif \201 culties. Sources of support and advice \200 The independent service supported by the Royal Colleges, the Joint Consultants Committee, t he BMA, and other medical professional bodies. (Tel: 0870 21 0535). The The by illness thro ugh \200\230Doctors for doctors \200\231 (Tel: 020 7383 6739) and a free telephone counsel ing service (Tel: 0645 200 169). The Sick Doctors \200\231 Trust runs a 24-hr helpline for doctors with addiction problems. Callers are put in touch with the nearest member of the Ad dicted Physicians Program (APP), an independent and free service. The British Doctors and D entists Group is an af \201 liated organization, running support groups in local areas thr oughout the UK and Eire. For further information contact: Isis, 126 Weybourne Road, Farnham , Surrey, GU9 9HD (Tel: 020 7487 4445; Helpline: 01252 345163). National Counseling Service for Sick Doctors is a con \201 dential \200 Doctors \200\231 Support Network. (Tel: 07071 223 372). BMA offers free expert advice for m embers who may be affected 24_Semple_Chap24.indd 1007 12/7/2012 5:42:57 PM This page intentionally left blank 1009 Chapter 25 Useful resources Resources for patients 1010 Online clinical resources 1018 Online professional resources 10 22 25_Semple_Chap25.indd 1009 12/7/2012 5:39:57 PM CHAPTER 25 Useful resources 1010 Resources for patients Education of the patient and their relatives and carers is an import ant part of the management of mental disorders. Equally, contact with fellow sufferers can be an invaluable source of help and support to patients. This applies particularly if the d isorder is chronic or is only partially treatment- responsive. The following list of patien t organizations, websites, helpline numbers, and books is one which we have found useful in our clinical practice. You should familiarize yourself with the service provided by each r esource before recommending it to patients. You should also \201 nd out about local servi ces available in your area. General mental health problems The Samaritans M http://www.samaritans.org.uk jo@samaritans. org 08457 90 90 90 Con \201 dential emotional support for those experiencing feelings of distress, despair, o r thoughts of suicide. MIND M http://www.mind.org.uk 15 \200\22319 Broadway, London, E15 4BQ 0300 123 3393 (helpli ne) 020 8519 2122 (professional contact) Mental health charity which runs support networks, campaigns on behalf of sufferers from me ntal health problems, and provides information services. Royal College of Psychiatrists \200\224lea \202 ets and self-help advice M http://www.rcps ych.ac.uk/info Lea \202 ets Department, The Royal College of Psychiatrists, 17 Belgrave Sq uare, London, SW1X 8PG Wide range of information and self-help advice. SANE M http://www.sane.org.uk 1st Floor, Cityside House, 40 Adler Street, London, E1 1EE 08 45 767 8000 (helpline) 020 7375 1002 (professional contact) Mental health charity which campaigns on behalf of patients with mental illness, funds and carries out research, and provides information services. Affective disorders: patient organizations Association for Post Natal Illness M http://www. apni.org 145 Dawes Road, Fulham, London, SW6 7EB 020 7386 0868 Information and advice about postnatal depression. 25_Semple_Chap25.indd 1010 12/7/2012 5:39:57 PM RESOURCES FOR PATIENTS 1011 Beyond Blue M http://www.beyondblue.org.au Self-help and information about depression from the Australian National Depression Initiative. Manic Depression Fellowship (MDF) M http://www.mdf.org.uk 21 St George \200\231s Road, Lond on, SE1 6ES 020 7931 6480 Charity which provides information and support to those with bipolar disorder online and vi a local self-help groups. Books Copeland M and McKay M (1993) The depression workbook: a guide for liv- ing with depr ession and manic depression. Oakland: New Harbinger. Burns D (1981): The feeling good handb ook. London: Penguin. Butler G and Hope T (2007) Manage your mind: the mental \201 tness guide. Oxford: Oxford University Press. Westbrook D Managing depression. Oxford: Oxford Uni versity Press. From the Oxford Cognitive Therapy Center. Available at: M http://www. octc.c o.uk Greenberger D and Padesky CA (1995) Mind over mood. London: Guilford Press. Gilbert P (2009) Overcoming depression: a self-help guide using cognitive behavioral techniques. Lond on: Robinson. Bereavement: patient organizations Compassionate Friends M http://www.tcf.org.uk 08451 23 23 04 (Great Britain) 0288 77 88 016 (Northern Ireland) Befriending and support by and for bereaved parents. CRUSE Bereavement Care M http://www.cruselochaber.freeuk.com/canhelp.html Cruse House, 126 Sheen Road, Richmond, Surrey, TW9 1UR 0870 167 1677 (helpline) 020 8939 9530 (professional contact) Counseling and support for those who have experienced bereavement. CRUSE Bereavement Care Scotland M http://www.crusescotland.org.uk 3 Rutland Square, Edinbur gh, EH1 2AS 0845 600 2227 (helpline) 01738 444 178 (professional contact) Counseling and support for those who have experienced bereavement. 25_Semple_Chap25.indd 1011 12/7/2012 5:39:57 PM CHAPTER 25 Useful resources 1012 Children and parents: patient organizations Attention De \201 cit Disorder Information and Support Service (ADDISS) M http://www.addis s.co.uk 020 8952 2800 Information, training, and support for parents, sufferers, and professionals in the \201 elds of ADHD, and related learning and behavioral dif \201 culties. Childline M http://www.childline.org.uk 0800 1111 National helpline for young people in trouble or danger. Children 1st M http://www.children1st.org.uk 0131 446 2300 Helps families with children at risk of abuse. Education and Resources for Improving Childhood Continence (ERIC) M http://www.eric.org.uk 0845 370 8008 (helpline) Education and resources for improving childhood continence. Family Lives (formerly Parentline) M http://familylives.org.uk/ 0808 800 2222 (helpline) Charity offering help and support to parents. National Autistic Society M http://www.autism.org.uk/ 0845 070 4004 (helpline) Information, advice, and support for individuals with autism and their families. One Parent Families Scotland M http://www.opfs.org.uk 0800 018 5026 (helpline) Counseling, information, and self-help groups. Tourette Syndrome (UK) Association M http://www.tourettes-action.org.uk/ 0300 777 8427 (hel pline) A charity which offers advice and support to Tourette \200\231s sufferers and funds researc h into the condition. YoungMinds M http://www.youngminds.org.uk 102 \200\223108 Clerkenwell Road, London, EC1M 5S A 020 7336 8445 Charity providing advice and training and campaigning to improve the mental health of child ren and young people. 25_Semple_Chap25.indd 1012 12/7/2012 5:39:57 PM RESOURCES FOR PATIENTS 1013 Self-harm/borderline personality disorder: patient organizations BPD Resource Center M http ://bpdresourcecenter.org/ Extensive range of information and links to other resources for b orderline personality disorder. BPD World M http://www.bpdworld.org 4 King Street, Wake \201 eld WF1 2SQ Online information, support, and advice on borderline personality disor- der, self-harm, an d related issues. FirstSigns M http://www. \201 rstsigns.org.uk Information and support network for those wh o self-harm. National Self Harm Network M http://www.nshn.co.uk PO Box 7264, Nottingham NG1 6WJ Online support and self-help for people who self-harm. Books Schmidt U and Davidson K (2004) Life after self-harm: a guide to the future. New York : Brunner-Routledge. Kennerley H (2000) Overcoming childhood trauma. London: Robinson. Domestic abuse and violence: patient organizations Domestic Abuse Helpline M http://www.dom esticabuse.co.uk 0800 027 1234 Advice and information for people who have experienced or are experi- encing domestic abuse . Books McKay M and Rogers P (2009) The anger control workbook. Oakland: New Harbinger. Davie s W (2009) Overcoming anger and irritability. London: Robinson. Drug and alcohol problems: patient organizations Al-Anon M http://www.al-anonuk.org.uk 61 G reat Dover Street, London, SE1 4YF 020 7403 0888 (England and Wales) 0141 339 8884 (Scotlan d) 028 9068 2368 (Northern Ireland) 00353 1 873 2699 (Republic of Ireland) Helpline and meetings for families and friends of those with a drink problem. 25_Semple_Chap25.indd 1013 12/7/2012 5:39:57 PM CHAPTER 25 Useful resources 1014 Alcoholics Anonymous (AA) M http://www.alcoholics-anonymous.org.uk PO Box 1, Stonebow House , Stonebow, York YO1 7NJ 0845 769 7555 (national helpline) Alcohol Concern M http://www.alcoholconcern.org.uk 020 7928 7377 Range of information about alcohol problems. Drinkline 0800 917 8282 National, con \201 dential helpline for alcohol problems. Narcotics Anonymous M http://www.ukna.org UK Service Of \201 ce, 202 City Road, London, EC 1V 2PH 0300 999 1212 (helpline) 020 7251 4007 (professional contact) Group based self-help recovery programs based on the \200\23012 step \200\231 model. National Drugs Helpline M http://www.talktofrank.com Tel: 0800 77 66 00 Department of Health website with information and advice about drug problems. Books Fanning P and O \200\231Neil J (1996) The addiction workbook: step-by-step guide to q uitting alcohol and drugs. Oakland: New Harbinger. Dementia: patient organizations Alzheimer \200\231s Society (England, Wales, and Northern Ireland) M http://www.alzheimers. org.uk Gordon House, 10 Greencoat Place, London, SW1P 1PH 0845 300 0336 (helpline) 020 7306 0606 (professional contact) Local and telephone support services for those affected by dementia. Alzheimer Scotland \200\224Action on Dementia M http://www.alzscot.org 22 Drumsheugh Garden s, Edinburgh, EH3 7RN 0808 808 3000 (helpline) 0131 243 1453 (professional contact) Local and telephone support services for those affected by dementia. 25_Semple_Chap25.indd 1014 12/7/2012 5:39:57 PM RESOURCES FOR PATIENTS 1015 Eating disorders: patient organizations Beating Eating Disorders M http://www.b-eat.co.uk W ensum House, 103 Prince of Wales Road, Norwich NR1 1DW 0845 634 1414 (helpline) 0845 634 76 50 (under-18 helpline) Information and self-help for people with eating disorders. Overeate rs Anonymous M http://www.oa.org PO Box 19, Stretford, Manchester M32 9EB 07000 784985 (hel pline) 01236 825507 (local meeting information) Supportive fellowship for people with compu lsive overeating, following the 12-step program. Books Cooper P (1993) Bulimia nervosa and binge-eating. London: Robinson. Schmidt U and Treasure J (1993) Getting better bit(e) by bi t(e). London: Brunner-Routledge. Freeman C (2009) Overcoming anorexia nervosa. London: Robi nson. McCabe R (2004) The overcoming bulimia workbook. Oakland: New Harbinger. Gauntlett-Gi lbert J and Grace C (2005) Overcoming weight problems. London: Robinson. Learning disability: patient organizations Down \200\231s Syndrome Association M http://www .downs-syndrome.org.uk Langdon Down Center, 2a Langdon Park, Teddington, TW11 9PS 0845 230 0372 (helpline) Information, education, and training about Down \200\231s syndrome. Down \200\231s Syndrome Scotland M http://www.dsscotland.org.uk 158/160 Balgreen Road, Edinburgh , EH11 3AU 0131 313 4225 Advice, information, advocacy, and local group support for individ uals with Down \200\231s syndrome and their families. Fragile X Society M http://www.fragil ex.org.uk Rood End House, 6 Stortford Road, Great Dunmow, Essex, CM6 1DA 01371 875 100 Char ity offering information and supporting research. Mencap M http://www.mencap.org.uk 123 Gol den Lane, London, EC1Y 0RT 020 7454 0454 National charity offering housing support, educati on, and employment and local groups for individuals with learning disability. 25_Semple_Chap25.indd 1015 12/7/2012 5:39:57 PM CHAPTER 25 Useful resources 1016 Prader Willi Syndrome Association UK M http://pwsa.co.uk 125a London Road, Derby, DE1 2QQ 0 1332 365 676 Charity supporting sufferers and carers. Rett Syndrome Association UK M http://www.rettuk.org/ 113 Friern Barnet Road, London, N11 3 EU 01582 798 911 Charity offering information, advice, and practical help to people with Rett syndrome, thei r families, and carers. Neurotic disorders: patient organizations Anxiety UK M http://www.anxietyuk.org.uk/ 08444 7 75 774 Information and self-help guides on a range of anxiety disorders. OCD Action M http://www.ocdaction.org.uk 0845 390 6232 Information and advice for people suffering from OCD and related disorders. OCD-UK M http://www.ocduk.org 0870 126 9506 Information and self-help advice for people suffering from OCD. Panic Center M http://www.paniccenter.net Information and web-based self-help program for o vercoming panic attacks. Books Pollard A and Zuercher-White E (2003) Agoraphobia workbook. Oakland: New Harbinger. B ourne E (2011) Anxiety and phobia workbook. Oakland: New Harbinger. Kennerley H Managing an xiety: a user \200\231s manual. Oxford: Oxford University Press. From the Oxford Cognitive Therapy Center, 01865 223986. Available at: M http://www.octc.co.uk Westbrook D and Morriso n N Managing obsessive-compulsive disorder. Oxford: Oxford University Press. From the Oxfor d Cognitive Therapy Center, 01865 223986. Available at: M http://www.octc.co.uk Beck \201 eld D (2004) Master your panic and take back your life. USA: Impact. Davis M and Eshelman E R (2008) Relaxation and stress reduction workbook. Oakland: New Harbinger. Hyman B and Pedr ick C (2010) OCD workbook. Oakland: New Harbinger. Kennerley H (2009) Overcoming anxiety. L ondon: Robinson. 25_Semple_Chap25.indd 1016 12/7/2012 5:39:57 PM RESOURCES FOR PATIENTS 1017 Veale D and Willson R (2009) Overcoming obsessive compulsive disorder. London: Robinson. Si love D (1997) Overcoming panic. London: Robinson. Sanders D Overcoming phobias. Oxford: Oxf ord University Press. From the Oxford Cognitive Therapy Center, 01865 223986. Available at: M http:// www.octc.co.uk Butler G (2009) Overcoming social anxiety and shyness. London: Ro binson. Herbert C and Wetmore A (2008) Overcoming traumatic stress. London: Robinson. Willi ams M-B and Poijula S (2002) PTSD workbook. Oakland: New Harbinger. Antony M and Swinson R (2008) Shyness and social anxiety workbook. Oakland: New Harbinger. Foa E and Wilson R (200 1) Stop obsessing! USA: Bantam. Kuchemann C, Sanders D Understanding health anxiety. Oxford : Oxford University Press. From the Oxford Cognitive Therapy Center, 01865 223986. Availabl e at: M http://www.octc.co.uk Westbrook D and Rouf K Understanding panic. Oxford: Oxford Un iversity Press. From the Oxford Cognitive Therapy Center, 01865 223986. Available at: M htt p://www.octc.co.uk Herbert C Understanding your reactions to trauma. Blue Stallion. From th e Oxford Cognitive Therapy Center, 01865 223986. Available at: M http:// www.octc.co.uk Schizophrenia: patient organizations Rethink (previously National Schizophrenia Fellowship) M http://www.rethink.org Head Of \201 ce, 5th \202 oor, Royal London House, 22 \200\223 25 Finsbury Square, London, EC2A 1DX 0300 5000 927 (national advice line) 0845 456 0455 (pr ofessional contact) Charity running support groups, carer support, advocacy services, residen- tial and rehabil itation services and supported housing. Books Torrey F (2001) Surviving schizophrenia: a family manual. New York HarperCollins. Somatization Books Campling F and Sharpe M (2008) Chronic fatigue syndrome: the facts. Oxford: Oxford Un iversity Press. Fennell P (2011) The chronic illness workbook. Albany Health Management Pub lishing. Shepherd C (1999) Living with M.E.: the chronic, post-viral fatigue syndrome. Verm ilion. Frances C and MacIntyre A (1998) M.E./chronic fatigue syndrome \200\223a practical g uide. Thorsons Health. Burgess M and Chalder T Overcoming chronic fatigue. London: Robinson . Cole F, MacDonald H, Carus C (2005) et al. Overcoming chronic pain. London: Robinson. 25_Semple_Chap25.indd 1017 12/7/2012 5:39:57 PM CHAPTER 25 Useful resources 1018 Online clinical resources Over the last decade a huge amount of clinically useful informati on has become available online. Most major journals, professional bodies, gov- ernmental or ganizations and clinical authorities now publish new material online and more historical ma terial is digitized and added each month. Database portals HON (Health on the Net Foundation) Portal to quality assessed medical info rmation, based in Geneva. M http://www.hon.ch NHS Evidence in Health and Social Care Nation al NHS e-library M https://www.evidence.nhs.uk/ Intute: Health and Life Sciences Catalog of hand-selected and evaluated Internet resources in health and medicine (formerly known as O MNI). M http://www.intute.ac.uk/healthandlifesciences/medicine The Knowledge Network NHS Ed ucation for Scotland e-Library. M http://www.knowledge.scot.nhs.uk PubMed Medline searches via the US National Library of Medicine. M http://www.pubmed.gov TRIP (Turning Research Int o Practice) Allows simultanous searches of multiple databases. M http://www.tripdatabase.co m