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Hi Janet The great thing about this JISC group is that you are free to think out loud and bounce ideas around as it all adds to improving your own practice in the end. It is a widely held belief that people who talk about their delusions are less likely to act on them as opposed to people who don't talk about them. However, if you think about this further, how can we actually know this? Is it just from the accounts of the neighbours of serial killers who say 'he was such a nice guy' etc. Not quite a clinical trial for empirical evidence is it- wonder if anyone has actually has considered doing one.??? - not me that's for sure Is it just more likely that no-one can countenance such people acting on their delusions so no-one actually takes them seriously. People with delusions are deluded, their world view is skewed and their version of 'normal' is not considered 'normal' or sometimes even 'rational' by anyone else. It is hard for normal and rational people to sometimes take the leap into the mind of the not rational person. I think that the clue is in eliciting what plans they may already have made to act out, just as in thoughts of suicide - suicide ideation 'I don't want to live anyone' is not the same as collecting 20 boxes of Panadol. Saying I feel drawn to wanting to eat human flesh and there is a 'juicy little jogger I can run over' could be viewed in the same way, in my opinion. So good questioning by the OHA in this case about the level of risk which, whilst not definitive certainly signposts what needed to happen next. Sue Susan Gorton | OH Nurse Manager | Occupational Health Department | Great Ormond Street Hospital NHS Foundation Trust | Level 3, Ormond House, 26-27 Boswell St., London WC1N 3JZ |020 7405 9200 Ext 0247 | DD to OHD 020 78138554 | Direct Fax 020 78138355 | Mobile 07833294568 Please be advised that all e-mail communication relevant to assisting in the management of the OH process will be printed and entered into the individual's OH file or copied and added as an electronic note on their electronic OH record. This may therefore be disclosed under the Data Protection Act (1998). From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of janet oneill Sent: 12 January 2013 15:11 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Mental Health You are right Anne my reply was not very considered and I have been reflecting on this I will think more carefully before posting in the future I have also thought that the business may lose trust and confidence even if he becomes well so specialist input is the way forwards. Thank you for a thought provo On Jan 12, 2013 2:57 PM, "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>> wrote: Interesting case. I would be very wary of stating that he would be fit to be at work - whether this would be a distraction or not is irrelevant. I would very strongly suggest that this should be dealt with by a mental health specialist - who may well decide that he should be sectioned. Anne On 11/01/2013 08:01, "janet oneill" <[log in to unmask]<http:[log in to unmask]>> wrote: why do you feel he will not be safe at work and do you think not being at work will increase his strain even more with more time on his hands to think about his feelings? in my opinion, it is likley that as he has verbalised the thoughts openly and has good clinical support it is less likely he will act on them and he has not verbalised any thoughts towards fellow workers however would be a return to work with his level of drinking reduce inhibitions for an enactment of feelings and make him a safety risk - did he feel he could curtail this and would his line manager be happy to check for signs of alcohol use before work each day If this could be managed then perhaps being at work will be a distraction away from the thoughts and aid his recovery but perhaps I have missed something but it would be great if you could get to speak to the CPN asap On Fri, Jan 11, 2013 at 7:41 AM, Tracy Turner <[log in to unmask]<http:[log in to unmask]>> wrote: Good Morning. I wander if I can have your advice please especially those in mental health. Yesterday saw a gentleman who requested a self referral and wanted HR to be present. He had signed himself off with stress the day previously. He informed me that he had been experiencing unnatural thoughts towards meat. When I asked him what these thoughts were he replied. I want - wanted to eat human flesh. I asked him if he had ever thought how this would be achieved and he replied. Oh yes there is a jogger who lives near me and I planned to run him over and then take the body and eat it. I knew where to could be stored and everything. He informed me that he was receiving psychiatric care and that the recovery and crisis team were involved who had informed the police. He was angry that they had been informed as he thought it was unnecessary to do so. He stated that he has previously suffered with mild depression and anxiety but since September he had various family issues father with dementia and brother with cancer and he was having difficulty handling the stress. He reports that he still has the thoughts of canabalism but he knows not to act the thoughts out. He has said that his medication is being increased. He had increased his drinking to 4 strong cans of cider per day. He had one can of cider before attending clinic. He lives with a lodger and wants to come to work for financial reasons and says staying at home will affect his health more. He has a meeting with GP today and wants to return to work on Monday. He works in an abattoir. I with his consent contacted his GP as concerned he was going to be at home without support. I was advised that it would be discussed at todays appointment otherwise for me to contact the Crisis Team. I contacted the crisis team and they advised me they were only asked to do a few tel calls to the man and to discuss with the CPN. I could not locate the CPN. He confirmed that he did not have thoughts of suicide. My plan is for him to remain away from work until I have a full mental health history and I am trying to arrange a meeting with his CPN to obtain this. However HR are fully aware of all the details as they were present and they are horrified. Thankfully I am away for the next 2 weeks but when I come back I have important decisions to make. I will have limited use of email but will read any advice on my return so please offer what you can! He has said that he is being honest and test I have not kept him in work and that he has a mortgage to pay. I am concerned I do not know the full facts and that he continues to be a rsk not only to himself but others. I am also concerned that he will deny the thoughts in future in order to return to work. I am a stand alone practitioner with very very apprehensive HR team at the moment!! ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ********************************************************************************************************* This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. ********************************************************************************************************* ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH