A patient view of pharmacy medication use reviews…pharmacists would do well to listen!

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FRIDAY, 11.00am…

I am standing at the reception counter of my local pharmacy, waiting for my monthly prescription that the pharmacy ordered a few days ago. Janine, the technician, gets the bag from the storage area and shouts to the regular pharmacist:

“Hey! Tom! Do you want an MUR? Says here that she last had one eighteen months ago.”

“No, thanks!”

…comes the response.

“I reached my 400 about six weeks ago. I won’t be doing any more until April. Is there any new med on the prescription?

“Eh! Let me see …”

Janine answers…

“No, doesn’t look like there’s anything new this month.”

“In that case just hand it out,’ is the final response. “Let me go and check some blisters,”

as Tom wanders off…

Janine then hands me my bag with her usual courtesy and practised efficiency. However, I can’t help thinking about the short interchange between her and the pharmacist…

I know enough about pharmacy to be aware that an MUR is a Medicines Use Review and, having had several over the years, that it can be very useful in identifying problems with medicines use, side effects and other issues related to my health as a patient.

It seems strange that the pharmacist should be reluctant to have a discussion with me about my health and medicines. After all, a lot could have changed in the eighteen months since my last review.

But then I remember that pharmacies are paid for only 400 MURs annually. My annual review appears to have been noticed at the wrong time, when the pharmacist had reached his quota for the year, and was no longer interested in conducting MURs.

Of course this leads to other questions. Why exactly do pharmacists do these MURs?

Is it because of the financial benefits? (I can imagine that in order to generate a net profit equivalent to the £28 they get for each MUR they would need to sell goods worth a few hundred pounds; or dispense several prescriptions.)

If this is the prime driver then it leaves a bit of a sour taste in the mouth, as it makes them appear as little more than mercenaries using whatever financial incentives there might be in the health service to make money.

I would like to think that there are altruistic motivations for the provision of the service: that the pharmacists conduct MURs because they genuinely care for the health of patients.

However, if this were the case, would pharmacists stop doing them once they got to four hundred, as seems to have been the case in this instance?

I’m also fascinated that Tom completed his quota in early February. Was this because there was such a massive demand for the service that he couldn’t stretch it until the end of the year, or simply because he had some form of race to the line to get to the 400 as quickly as he could?

In all honesty, I have to admit, I have never personally requested an MUR from the pharmacist, nor have I heard anyone ask for one on all the occasions that I have been in pharmacies; hence I am inclined to believe that the pressure to get to 400 comes more from the pharmacist than the patient side. I stand to be corrected on this (and I hope I will), especially since my analysis is based on just my own experience.

There are, however, other factors that lead me to think that my experience might not be as isolated as I wish it to be.

Tom works for one of the large multiples and has, in previous conversations, expressed how target-driven the culture is within the overall organisation. He has told of the pressures he faces to meet daily, weekly and monthly targets around prescription items, services, sales and costs.

I fully appreciate that community pharmacies are businesses that need to turn a profit, but I think it is possible that in some instances the profit motive could override the genuine patient-care outlook. The premature completion of the quota and – perhaps – the withholding of the service from potential beneficiaries because there is not financial reward are suggestive of this.

Perhaps this is all symptomatic of a bigger trend: what I like to refer to as the commodification of health.

This is the propensity to value patients and health parameters in economic and financial terms rather than the perspective of lives saved, improvements in quality of life or some other tangible, practical measure of health. The value of the patient consequently becomes measured in terms of the financial benefit or cost to the professional.

It is a malady that afflicts not just some in the pharmacy profession, but doctors and politicians as well.

The GP contract, for instance, rewards patients according to the number of patients registered (patient-units as a cynical observer might argue) as well as whether certain parameters about those patients have been recorded.

For GPs therefore, the value of each patient-unit is in the income it brings in relation to QOF points plus flu jabs etc. Politicians, on the other hand, will view each patient-unit as a cost/liability, hence the current talk of crisis in the health service over an ageing population in the UK.

I am not so naïve as to be ignorant of the fact that community pharmacies and GP surgeries are private businesses that need to generate a profit for the owners. I believe health professionals perform an important role and should be fairly compensated for the work they do.

I do, however, think that it is important to have a reward system that places patient care at the forefront of the service, so that no patient that genuinely needs medical or pharmaceutical intervention is ignored because the pharmacist or doctor has reached some arbitrary target. Perhaps I shall offer some suggestions on such a reward system in a future post.

 

Pharmapatient is an anonymous patient based in England. She has written the book, “Life at the Receiving End: The Experiences and Views of an NHS Patient”, available on Amazon in both Paperback and Kindle format.  

Check out the Pharmapatient blog.

Follow Pharmapatient @pharmapatient

* The above opinion piece is a result of a Twitter conversation between Pharmapatient and Johnathan Laird(@JohnathanLaird). Pharmapatient would like to thank Johnathan for reaching out to hear the views of a patient and for kindly hosting this guest blog post which is an excellent blog for all things pharmacy-related in the UK.

 

The Scottish Electronic Minor Ailments Scheme is a wee gem…Here’s why!

Johnathan Laird

Johnathan Laird

 

THE electronic minor ailments scheme (EMAS) is a scheme that as a community pharmacist I feel lucky to be empowered to deliver. EMAS is in my view a world leading service delivered to patients by expert pharmacists right at the heart of the community across Scotland.

Over 900,000 people have registered on the minor ailments service since 2006, and £110 million could be saved Scotland wide by treating common illnesses in community pharmacy. Evidence of this can be found in the Minor Ailment Study (MINA) conducted by Dr Margaret Watson from the University of Aberdeen in collaboration with colleagues from NHS Grampian and the University of East Anglia in 2014.

The service is offered from all community pharmacies across Scotland, and to access eligible patients must simply present to their local pharmacist with a minor ailment. Upon presentation the patient is registered electronically. A consultation with a pharmacist, in the vast majority of cases within minutes and almost exclusively without an appointment, then follows. Nearly all pharmacies now have private consultation areas which are widely used for EMAS consultations. Once assessed he service allows the pharmacist to supply a range of products and/or advice on prescription or refer where appropriate. EMAS has many benefits for both patient and professional.

For the patient, this is what they want and need at this moment. Critically our patient does not initially visit the GP or worse a secondary care setting. Instead the patient naturally thinks of the pharmacy as the first port of call for health concerns. I agree that the competence of community pharmacists, myself included, needs to evolve and improve but this service makes great use of the expertise there already.

Let’s begin with why the service is good for the patient by considering a few typical patients that I typically encounter in the community pharmacy. The first example of an EMAS patient is the teething, sniffly, colicky baby. This patient is usually just going through the normal motions of the first year of life. In the vast majority of cases the child will not require medical attention but may benefit from symptomatic treatment for these common ailments. Perhaps more importantly the support, reassurance and holistic care that the pharmacist delivers for the child’s mother on these regular pharmacy visits is invaluable.

My second example is the pregnant lady who presents with heartburn. Preventing a GP appointment by supplying an antacid to ease these short term self limiting symptoms of heartburn in pregnancy is great for the patient and makes sense for the health service too.
It’s not always about treatment. In fact I often use my good relationships and frequent contacts with patients to make useful referrals. The patient who makes repeated requests for a cough remedy is a common example of a potential area of referral as part of the EMAS scheme. Making more and more meaningful, well-informed referrals builds confidence in the growing competence of community pharmacists.
Other ailments that can be treated are included in the EMAS leaflet. However, most self-limiting conditions can be treated through the service.

Patients are encouraged to use community pharmacy first as a destination for advice or treatment. This happens naturally because the community pharmacy network in Scotland is so far reaching. Community pharmacies are located throughout the land in rural and urban locations. For a patient this is good news because in terms of accessibility there are no problems.

From a professional point of view EMAS is excellent because the pharmacy contractor is paid according to the number of patients registered with their pharmacy. Registrations lapse after a year if the service is not used by a particular patient. The important aspect here is a step towards payment of community pharmacists for supporting a registered population of patients so there is no incentive for the professional to over supply medication.
The good news is that the Royal Pharmaceutical Society and also Community Pharmacy Scotland support the service. In fact I was delighted to read in Community Pharmacy Scotland’s latest manifesto that the body representing contractors across Scotland were advocating an extension of the service to make better use of patient group directions similar to those used for chloramphenicol.
I would like my EMAS consultations to be recorded in the patient record for the rest of the multidisciplinary team to see. Seamless continuous care is critical nowadays so something as simple as a coded record in the patient journal about a pharmacist consultation would be very helpful. Perhaps the service will evolve towards this capability in the future.
EMAS is only one part of the community pharmacy contract in Scotland. I am happy to say that in my view it is a great way of beginning to release the ability of community pharmacists to support patients better now and into the future.
I would urge my English, Welsh and Northern Irish colleagues to look north to Scotland to see how useful a service like this can be.

Johnathan Laird is a community pharmacist independent prescriber with a special interest in asthma. He is based in Aberdeen.

Follow Johnathan @JohnathanLaird

Pharmacy can save the NHS…can’t it?

Graham Phillips

Graham Phillips

 

AS part of his reforms, former Secretary of State for Health, Andrew Lansley aimed to remove the NHS from “the tyranny of the political cycle”. However, the recent party conference season has seen undeliverable promises of more GPs, more nurses and easier access to primary care, from all parties.

These promises were made despite a reported £30 billion funding shortfall. It costs upwards of £500,000 to train a GP, takes the best part of a decade, and then they expect an annual income above £100,000. The Royal College of General Practitioners says we need another 16,000 GPs just to cope with the current workload. It’s simply, patently, unaffordable. Even if the NHS had the cash, it doesn’t have the time.
Meanwhile, there is a crisis. One of my local GP practices has effectively collapsed due to its inability to recruit doctors. A second has the workload for three GPs but cannot recruit a third partner, or even find a locum.

But the NHS is actually very efficient by world standards. It is arguable that most of the efficiencies have already been realised. Small, incremental changes won’t cut it! We need a paradigm shift – one that takes far greater advantage of community pharmacy.

Pharmacists are perfectly placed to help relieve both the financial and GP recruitment crises, and we are ready, willing and able to start work today. These days, pharmacists undergo thorough clinical training, over five years.

Although we have a desperate shortage of GPs, we have a relative over-production of pharmacists. I use the term ‘relative’ because it is relative to the traditional ‘safe supply’ or core dispensing role. Pharmacists could do so much more – and we will need the extra pharmacists to carry-out additional services.

A few thousand freshly-minted, eager and highly-qualified professionals could literally ‘save the NHS’. They could be trained as prescribers in six months and then run clinics and common-ailment schemes in GP surgeries or pharmacies. They could also work as healthy-living pharmacists and improve the public’s health.

The entire community pharmacy service costs less than £3 billion. The NHS spends around £12 billion on prescribed drugs (half of which are never consumed). Simply put, community pharmacy is an amazing bargain for the NHS.

A modest additional investment would ensure that each pharmacy has more than one pharmacist for some or all of the time, depending on how busy it is and how many services it provides. An increase in pharmacy funding would pay massive dividends in terms of improved use of medicines, improving the public’s health, reducing costs in secondary care, and taking the pressure off the GP network. Evidence shows that every NHS pound spent in the pharmacy saves £2 in the surgery, and at least £5 in secondary care.

GPs warn of stress and burnout, yet around 57 million GP appointments each year are for common ailments that could be handled by community pharmacists. Not only would it free-up all those GP appointments, it would save the NHS around £100 million, because pharmacists are less expensive than GPs.

Yet despite substantial evidence that these ‘pharmacy-first’ schemes work, showing high patient satisfaction levels and low re-consultation rates, they remain few and far between. The pharmacy profession has argued that the NHS should commission a common-ailments service nationally (the Scottish NHS has already done so), yet these calls have fallen on deaf ears. Why?

Evidence shows that 12 to 15 per cent of hospital admissions are directly related to prescribed drugs. Roughly half are due to complex interactions between a cocktail of prescribed drugs, prescribed in response to a plethora of concurrent disease states. The other half is due to poor compliance.

Patients are highly resistant to taking their medicines consistently, or at all. The drugs are wasted and patients don’t get the benefit, so morbidity increases and NHS costs rise. This is true for all long-term conditions: even HIV and transplant patients are poorly compliant. There is plenty of evidence that pharmacists can make a cost-effective difference if commissioned to do so.

But the NHS locality-based commissioning system overwhelmingly ‘gates’ pharmacy out. The solution is to add core medicines optimisation and public health services to the pharmacy national contract, and to align the community pharmacy contract to that of GPs. This would deliver the pace and scale of change the NHS needs. Instead of 150 different smoking-cessation services, let’s have one, outcome-driven and based on the quality and outcomes framework.

Besides smoking cessation, we should commission alcohol, drug addiction, weight management and sexual health services nationally through the pharmacy contract, plus a common-ailments service like the one in Scotland. That would free-up local resources to commission specific local services.

The pharmacy profession has an evidence base and widespread support for extending our contribution. We now need to up the ante and bang the drum for pharmacy and the NHS. But the best advocates are not pharmacists, they are patients and other professional colleagues. If, like me, you believe pharmacy could (help) save the NHS, please, please join the campaign for us to do so.

Graham Phillips is a community pharmacy owner based in Hertfordshire 

Follow Graham @grahamsphillips

The community pharmacy cuts are coming…Is it evolution or extinction?

Mohammed Ibrahim

Mohammed Ibrahim

 

ARE we going allow the slow erosion of high street pharmacy in to extinction? Or, could there be an alternative future?

I am a clinical pharmacist with a passion for community pharmacy, so here’s my point of view.

Listening to the pharmacy press and national pharmacy representatives, it seems that there is a likelihood of more cuts in the future as well as the expected 6% funding cut for community pharmacy this year.

So what does this mean for high street pharmacy, as we know it?

Will we shrink into dispensing factories reliant on NHS funding, with poor staffing and increasing workloads, or, will we evolve into accessible healthcare professionals on the High Street?

Speaking with contractor colleagues, in both small independents and large multiples, it seems that there is a sense of impending doom. Some are talking of freezing staffing levels and potentially reducing training and wage reductions for their existing staff, whilst others are thinking about cutting free services such as Monitored Dosage Systems (MDS) and prescription delivery.

Is the future of pharmacy really as bleak as this?

While the funding cuts have not yet been finalised, it is likely that they are inevitable and high street pharmacy will need to brace itself for what is certain to come. As a pharmacy contractor I completely understand the impact these cuts will have on the existing pharmacy business model, and, I fully support the protests against the cuts.

However, perhaps the 6% cut is a wake-up call for pharmacists. Indeed it could allow us recognise our own potential and shape the future of our profession, before it is shaped for us by those who don’t understand the role of pharmacy at the heart of the community.

We have been protesting for many years that pharmacist’s skills are under-utilised, and, those with clinical and independent prescribing (IP) qualifications don’t have a recognised role in the community. Up until 2015 there was no clear career structure for pharmacist IPs in the community, and the announcement to support pharmacists working alongside GPs was well overdue. Finally, we see that pharmacists are being recognised in primary care as professionals that make a valuable contribution to the clinical care of patients, other than simply supporting medicines optimisation initiatives.

But wait a minute, these pharmacists that are now working in GP practices, are they not the same ones that either worked or indeed continue to work in community pharmacy? Are those in community pharmacy not able to contribute to the clinical care of patients too? The advent of Summary Care Records (SCR) access, can allow pharmacists to play an even more crucial role in the clinical care of patients.

Whilst closure of some community pharmacies may be inevitable as a result of these cuts, I am optimistic, and I believe that pharmacies that are willing to embrace the challenges and re-think their existing model of service will survive, and possibly even thrive in the future.

I fear that the pharmacists who continue to think of their community pharmacy as simply a supplier of medicines and OTC products will have their days well and truly numbered. On the other hand, pharmacists who recognise their ability to deliver enhanced services in the most professional manner, and, are not totally reliant on NHS dispensing volume will indeed survive and could even thrive in the brave new world. This means that waiting for the NHS to commission services from pharmacy is no longer an option.

I believe that we need to take the bull by the horns and invest in our high street pharmacies to provide enhanced services that people would be willing to pay for…. I hear what you’re thinking, “…but our patients don’t pay for anything.” That may be true now, but is it possible, that people, who can afford to do so, would pay for a service that offers them convenience and saves them time? Perhaps we need to seriously consider provision of private services, either as independent prescribers or through patient group directions (PGDs), until such a time that the NHS is ready to fund such services through community pharmacy. We must not forget that high street pharmacy has a significant strength of accessibility. This may mean investment in your pharmacy so that it meets patients’ expectations, but isn’t that an investment worth making?

It is apparent that the government wants to see a change in community pharmacy with a drive to increasing efficiency in dispensing so that pharmacist time is freed up to provide patient centred care in the community. Whilst there is no definitive additional funding for services, pharmacists are finally recognised to do more than dispense prescriptions and perhaps this is an opportunity for us to take the reins and demonstrate our value to our patients too.

It would be interesting to see if other pharmacists share my thoughts; or is there another option for high street pharmacy, or indeed community pharmacy in general.

Mohammed Ibrahim is consultant pharmacist, pharmacy Contractor and clinical services director at RxAdvisor.co.uk

Follow Mohammed @Rx_Advisor

Suicide risk and antidepressants… How can a community pharmacist help??

Hadar Zaman

Hadar Zaman

 

I AM passionate about mental health and especially the role community pharmacists can play in supporting patients taking medication for a mental health condition.

As community pharmacists, we are the most accessible healthcare professionals with expert knowledge on medicines within the NHS. The recent economic recession and the strong correlation between socioeconomic disadvantage and deprivation outcomes can be related to poor mental health. This said, there has been an exponential increase in the prescribing of antidepressants for depression (165% in England between 1998-2012) with clear geographical variation between the North and South.

As pharmacists situated in the heart of our communities with strong relationships with our patients, I believe we can provide a positive and lasting experience for our patients suffering from mental health conditions.

As the key document Making Every Contact Count shows, we are perfectly positioned to deliver on some of its objectives and ensure our patients with mental health conditions receive personalised healthcare advice to support their condition. Having talked to many pharmacists, they are not confident in consulting patients with mental health conditions, but  CPPE recently released learning materials on mental health and dementia, which I would strongly encourage all pharmacists to read. You may want to start reading this ASAP with newspaper headlines like this:  “Antidepressants can raise the risk of suicide, biggest ever review finds”, which appeared in the Telegraph last month (28/01/2016).

You may find patients coming in and asking for your advice about their treatment. I do not want to go into the detail of this article, but needless to say that compliance rates for medication for patients suffering from mental health conditions ranges between 50-70%, and this headline does not help that. Back to the point, what can we as community pharmacists do? The answer is plenty.

Taking 2 minutes to ask a patient how they are getting on with their medication (antidepressants/antipsychotics), or how they are doing, can be so impactful for the patient, bearing in mind that you may be the only person they talk to. I’m not saying pharmacists should become counsellors (although there is a big market and opportunity to do so), but talking to the patient about progress on medication, and signposting them to support groups can make a huge difference to a patient’s life.

Having worked in community pharmacy and talked to patients about their condition, and to see the smile on their faces because somebody has taken time with them is priceless. I have been pushing really hard to extend the ‘new medication service’ to include antidepressants, because we as pharmacists can have a huge impact on patients beliefs/compliance and ensure they receive optimal benefit from their antidepressants.

I hope this materialises sooner, rather than later. But, in the meantime let’s start engaging with our patients on mental health conditions and perhaps, where appropriate, providing services such as a ‘medication use reviews’ to them. On Feb 4, it was the Time to Talk campaign, which is designed to get the nation talking about mental health. It can serve as a catalyst for us as pharmacists to increase our awareness and confidence in mental health conditions. Did you get involved? If not perhaps you’ll consider doing so the next time.

Hadar Zaman is a clinical and professional advisor at the Care Quality Commission, a lecturer in pharmacy practice at the University of Bradford, a consultant mental health pharmacist and a pharmacist independent prescriber. 

Follow Hadar @hadar_zaman1

 

PTSD and surviving…A patient insight by Matt Johnson!

Matt Johnson

Matt Johnson

 

IT has quite surprised me how many people are now trying out writing as a contributory means to help treat post traumatic stress disorder (PTSD). Questions levelled at me, as to how writing helped me, have prompted me to repeat this post, which I originally published last year.

PTSD – the chemistry
In examining PTSD, one of the known factors is that an instance of overwhelming terror can alter the chemistry of the brain, making people more sensitive to adrenaline surges even decades later. This sensitivity to adrenaline surges is a major factor in post-traumatic stress disorder, in which people can experience normal events as repetitions of the original trauma. PTSD affects combat veterans, crime victims and millions of others. Its cause has biological basis in its affect on the brain.

New studies in animals and humans suggest that specific sites in the brain undergo these changes. Scientists say the findings may allow development of medications to blunt the biological changes present in post-traumatic stress disorder. For the brain changes to occur, scientists now say that people usually have to experience the stress as catastrophic, an overwhelming threat to life or safety and one over which they have no control. Less severe stresses, such as the death of a loved one or relentless financial problems, do not seem to trigger the biological changes.

When I started receiving counselling, it was explained to me like this…

When you are working in a high stress environment such as a war zone or any work where you are subject to regular, frequent and high adrenalin surges the brain is slowly, cumulatively, affected by this regular level of adrenalin in the body. Whilst adrenalin is an incredible aid in the preparation for and enactment of the flight and fight response, it has a side effect in that it ‘eats up’ a chemical called serotonin.

Serotonin is a naturally produced chemical that works in the body as a neuro-transmitter. It is widely thought to be a contributor to feelings of well being and happiness. What is does is smoothly transmit thought processes so that the brain operates in an organised and structured way. Serotonin also has some cognitive functions, including memory and learning. It’s presence in the body is essential to the regulation of mood, appetite and sleep.

So, when exposure to a work environment or a series of events causes the body to regularly produce adrenalin, the effect is that serotonin levels drop. As a result, the brain starts to operate less efficiently. Thought processes become less clear, sleep is interrupted, memory confused etc. Then a major catastrophic event causes a massive adrenalin surge.

PTSD symptoms
I wonder how many people reading this will have heard of PTSD and wondered exactly how victims are affected? How many will have seen veterans talking on TV about experiences and see that brave people become emotional and unable to talk any further, the surge in feelings overcoming their ability to talk.

In fact, symptoms are far more wide ranging than most people realise and can vary widely between individuals. They may develop during the first month after a person witnesses a traumatic event. However, in many of cases there may be a delay of months or even years before symptoms start to appear.

This is a summary, it is not exclusive, as I am not an expert.

A person with PTSD will often relive the traumatic event through nightmares and flashbacks, and have feelings of isolation, irritability and guilt.

Problems sleeping and find concentrating difficult. The symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

Some people with PTSD experience long periods when their symptoms are less noticeable. This is known as symptom remission. These periods are often followed by an increase in symptoms. Other people with PTSD have severe symptoms that are constant.

Re-experiencing is the most typical and widely publicised symptom of PTSD.

A victim may involuntarily and vividly relive the traumatic event in the form of flashbacks, nightmares or repetitive and distressing images or sensations. Being reminded of the traumatic event (the trigger) can evoke distressing memories and cause considerable anguish.

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD.

Reminders (triggers) can take the form of people, situations or circumstances that resemble or are associated with the event.

Many victims of PTSD will try to push memories of the event out of their mind. They do not like thinking or talking about the event or events in detail. Think of those WWII veterans who well up when being interviewed for documentaries, a display of emotion repeated by Iraq and Afghan veterans who appear to talk about their experiences in more recent programmes.

Some victims repeatedly ask themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and whether it could have been prevented. Often, they may blame themselves and many feel guilt that they survived when others didn’t.

Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyperarousal. Irritability and anger may be a clear indication of this arousal state.

Some victims try to dampen down their feelings by trying not to feel anything at all. If you know an ex-cop or a veteran who you might describe as a ‘cold fish’ then what they may be showing is emotional numbing, a way of coping.

Someone with PTSD can often seem deep in thought and withdrawn. They may also give up pursuing the activities that they used to enjoy.

Other possible symptoms of PTSD include depression, anxiety and phobias. Drug and alcohol misuse are common as a means to dealing with the symptoms expreienced.

PTSD often leads to the breakdown of relationships and causes work-related problem.

Surprised at the range of symptoms? Imagine trying to cope with them and you will have a handle on the challenges facing victims.

Writing
Many victims, me included find that counselling helps them to understand what is going on within their own minds and bodies. It helps to appreciate how a simple chemical imbalance in the brain has been triggered and how the physical and psychological effects that follow are a result of that imbalance.

But counselling doesn’t fix the symptoms on it’s own. Anti depressants are a great help and they worked for me. The pills help the body restore chemical balance so that the brain can then start to regain control.

For me, writing started as a way of helping the counselling. Like many victims, I became emotional when prompted to talk about experiences and describe what had caused the PTSD in the first place. Like many, I was advised not to worry and to try and make notes to bring back to counselling session that I could use to refer to and which might help the counsellor to help me. I made the notes at times when I felt up to it, writing down what had happened, how I had felt, how it had affected me. I recorded dreams that I had, flashbacks and imaginary. Over the weeks and months I found that writing things down helped my brain to get things focussed, to get my thoughts back in order and to regain structure and control.

When asked how it helped, I describe it like this. Before the writing, my brain felt a bit like a fragmented hard disk. Lots of data, confused, hard to join up and recall. Thought processes were slow, decision making was poor. After writing, it was like a PC de-fragment, where the information/memory is more organised and easier to use. It works more quickly and efficiently, thereby reducing frustration and making life easier.

Also, consider the analogy of a PC screen with too many tabs open to really use any of them effectively. After writing/counselling I was able to close down many of the tabs and focus on the relevant. Memories and distractions were filed away enabling me to concentrate on the here and the now.

It helped immensely.

And had an unexpected benefit when my counsellor was moved to comment on how much she enjoyed my writing.

So, one day I followed her advice again and started to weave the notes jotted down into a novel. The more I wrote the better I felt. There were several dips, several times when I found myself reliving things in a way that I preferred to avoid, but, despite the low points, the overall direction was onwards and upwards.

The final result was ‘Wicked Game’ a thriller that had now changed my life for the better. It has received better reviews than I could possibly have imagined and has provided the means for me to be introduced to people I had only been able to admire from a distance. The last couple of years have been quite surreal, my only explanation being the realisation that it is possible for good to come out of disaster.

PTSD affects people in many ways, so what works for one will not necessarily work for another, but the fact that so many people have had such enjoyment out of reading a book that came about in such an unexpected way has given me immense reward. People have contacted me, some have described me as inspiring. That may be. What I can say is that the feedback has inspired me to carry on writing and we’ll just see if it continues to help keep the demons at bay. Not just for me, but also for the many others that have and will experience the nightmare as well.

Order Matt’s new book, Deadly Game, on Amazon UK or Amazon US.

Check out Matt’s blog here, and follow him @Matt_Johnson_UK.