Dr Selina Tour

If we could get informed consent and decision making down, perhaps we can ensure women have all the information they need to CHOOSE their care plans.

That is what worries me most about maternity services. My exp is I’ve had to always ask for the clinical rationale for options provided to me and remind professionals the choice is mine. I’ve had options taken away from me without clear clinical reasons based on culture.

If we had a consistent culture of informed consent and decision making at the heart of care then the benefits + risks would always be shared so women can make their own choices around treatment. My personal exp is informed consent + decision making is massively not practised.

@charlie_psych Yes I like that - the freedom to use it as you please. Protecting the time is important, valuing it as much as MDTs, supervision, line management. Otherwise it can easily be the thing that comes off the list when the work tasks build up which is continuous in services.

@SelinaTour yeh definitely & the freedom to not have to account for it, or measure anything. Also as you say the idea of it being 'built in' feels important. If it's just left to individuals i think many of us feel too guilty/pressured to not do this kind of thing, but if it was 'built in'👍

The idea of 'wellbeing' feels hollow when its packaged up as a commodity to improve or get trained in. Why cant we just think of normal life things- a genuine chat or a laugh with the kids, or a mundane activity like making soup or a trip to the charity shop- all can be restful.

@Shrink_at_Large “Emerging PD” is such an issue as well!!

There are three issues: - the BPD diagnosis - the increasing use of 'trait' talk - the screening for PD in an 8-question scale at primary care level These issues are connected but also separate ie one can be pro the BPD diagnosis but against trait talk and PD screening Etc.

@AlanKessedjian This is the difficulty, the ICJ did not call for a halt in war or ceasefire. How different are things since the decision for the people in Gaza

“MAP notes that full implementation of the court’s provisional measures, in particular the demand that Israel enable the provision of humanitarian assistance and basic services to those who need it in Gaza, is impossible without an immediate ceasefire”

As a patient, why should I be caught in the crossfire and the be the one to suffer the consequences? We have a duty to work through these conflicts because they are literally placing our patients at risk. The time to do this work is not present and without this 🤷🏾‍♀️

Without this, how will we authentically change cultures and working relationships so patient care is at the forefront.

In all the in-house conflict between professional groups be it medics/ PAs, midwives/ medical team on maternity units, psychiatry/anti-psychiatry. Patients are the ones who have and will continue to face the biggest consequences incl death + outcomes that can be prevented.

@Shrink_at_Large Yes… with how the state of services is becoming normalised culturally + justified too rather than seen as unacceptable + in need of change. That we’ve normalised referral rejection based rationale of being “too dependent” and detached so much from relational care to cope 🙁

I apologize for being a bit extra, but my heart is breaking over the state of mental health services, and I can't focus on anything else. Anyone else?

@charlie_psych He is a wise man in many ways and says many things that I think we can relate to in our line of work. Makes me think about how we could prevent burnout if we considered meaningful rest as part of the work to make work sustainable.

Jurgen Klopp is saying you cant sustain top form as 'normal'- you simply need a period of meaningful rest, & in his case to move on. Ofc we need sustainable Services, but it's a mistake to believe that people can be somehow managed to be on top form all the time. We need rest.

@DrAbdullahMia @NHSuk I hope not! Would like to know the answer to this.

I've been told, if I work in the @NHSuk and experience malpractice leaving me with significant consequences, I have the two choices 1) Work in the NHS but not pursue accountability through courts 2) Pursue accountability but not be employed in the NHS again Is this true?

There's something hard for us, children of the colonised, to articulate because the world is upside down. Europe and its descendants, can't differentiate between principle and episode. This is why Germany (and much of Europe) is doomed to be genocidal. Here is what I mean. 🧵

1/3 Was asked to speak to mental health professionals about racism within mental health. The well-intended organiser titled it “Decolonising Psychology” Not to throw shade, but I want everyone to know I DO NOT teach how to “decolonise” mental health. See my response.

@HughesCK @drjohnjmarshall The love and hate of this platform 😂

@DrGipps @drjohnjmarshall I think rigidly denying one lens can be just an unhelpful as holding onto one too rigidly. If a client said they felt their psychosis state was an escape from their then reality, if we don’t see any space for psychosis as a functional disorder, would we shut the patient down?

@SelinaTour @drjohnjmarshall I don't think "psychosis" is a psychiatric diagnosis (contrast bipolar or schiz), but I do think it, the psychotic state, is sometimes a refuge, a flight. I don't understand clinicians who've worked with lots of patients who don't believe this. How can they not see it?

@HughesCK @drjohnjmarshall Part of recovery though is to work with a person surely about their understanding of their psychosis within their context, all part of relapse prevention and recovery. I don’t think it would be helpful to dismiss trauma in this sense or if a client saw it as serving a function.

@HughesCK @drjohnjmarshall Yup I’ve been quote tweeted and must have said something controversial! That’s what I mean by holding loosely - rather than holding a rigid understanding which forces everyone into the same box of understanding.