Friday, 18 December 2009

Tackling The Mental Health Minefield Part 6 - Throwing The Christian To the Lions

(This post continues the story from Tackling The Mental Health Minefield Part 5 - Please Sir, Can I Have Some More)

Those familiar with how things are done in mental hospitals will probably be able to guess what this post is about from its title. Blood sports may have been banned, but something pretty akin to them is still practised in mental wards up and down this country. It is the ward round.

Ward rounds are something that may occur in any hospital. If you are a patient in one of our large teaching hospitals you may encounter something akin to those seen in Doctor in the House or Carry on Doctor. But ward round in a mental hospital is more like those olden days when the gentry could visit the local insane asylum and view the wretched inhabitants.

My first ward round was the day after I was admitted to hospital. I was summoned to a room with tables in the centre and sat around them was the consultant, the ward SHO, one of the nurses from the ward and a couple of other people, whose function I can not remember. I was invited to sit down on a chair that was placed some distance from the tables, but the position of which enabled all those present to get a good view of me.

It should be remembered that people in mental hospitals, particularly those recently admitted, are very vulnerable. To encounter this sea of faces is nothing short of terrifying. I was,frankly, terrified. I can remember little of what went on other than being asked a raft of questions many of which I found difficult to answer and when it came time for me to leave the room tears were flowing freely.

As this was the admissions ward, there was a ward round each day, Monday to Friday. the first to be seen were those who had been admitted the day before, then such others on the ward that the consultant wanted to see. I was not due to see the consultant the next day but made a request to see him because I needed some leave to get some clothes. I still had nothing but those that I was wearing when I was admitted.

I went in to see him and made my request. He asked me where I lived and I told him, and then said that I was not planning to try to get home to get additionally clothing but would be going to the shops just a few minutes walk from the hospital. He then said that as I was an informal** patient I could have leave and then asked if two hours would be sufficient time. I replied that I thought that this would be plenty of time and then made a second request. I asked whether it would be possible for me to go unescorted to the garden when I wanted a cigarette. He replied in the affirmative and was immediately overruled by the nurse who was sitting in the ward round.

This shows the sheer stupidity that exists in our mental hospitals. I was allowed to go out of the hospital, on my own, for two hours and wander around the shops, but I was not allowed to stay within the confines of the hospital and go about unescorted.

My next ward round was on the following Monday; this time there were also a couple of medical students sitting in. I was still in a very low state of mind and my time in there was short because I just dissolved into tears almost immediately. I was seen again on Wednesday and the consultant asked that the home treatment team (HTT) be contacted so that they could come to see me. (I will write more about the HTT in a later part of Tackling The Mental Health Minefield.)

I wasn't seen at Thursday ward round and that evening I was transferred to another ward. This occurred without warning; I was just going to make myself a cup of tea when a nurse told me to get my things together because a bed had become available on the ward that I was moving to and they needed my bed on the admissions ward for a new patient. It should be noted here that the literature that I was given when I first arrived at the hospital said that I would only be on the first ward for two or three days, or exceptionally a week if it was thought that I could be discharged from there. I had been on the ward for nine days. So much for believing anything in the literature.

The ward that you were moved to depended on where you lived. This meant that the patients on my new ward all lived in my particular part of London. The ward had two consultants, and which consultant you saw was decided on your initial admission to the hospital, so while I had been allocated to a particular consultant while I was on the admissions ward, this was not the consultant that I saw. The admissions ward had its own consultants who saw all the patients on that ward no matter which part of the area served by the hospital that they came from.

On the new ward, the consultants held their ward rounds on different days, and each saw patients on two days. My consultant's ward rounds were held on Mondays and Thursdays, which meant that because I was moved on the Thursday evening, I would not be seeing a consultant until the following Monday. This time the ward round was actually held outside of the ward proper. This was because there wasn't a suitable room available within the ward. However, just outside the ward there was a Meeting Room and four times a week this was used by the consultants for their ward rounds.

At my first ward round on the new ward I went into the room with trepidation, as before, only to be greeted by a lot of new faces, so introductions were made. As well as my consultant and her SHO (who sat at a laptop recording what went on), there was a psychiatrist from the Assessment and Brief Treatment Team (ABT) at the CMHT, the ward's social worker, someone from the Home Treatment Team (HTT) at the CMHT, an occupational therapist, one of the nurses from the ward (who made notes for use on the ward, but obviously not carefully enough because of the problems that followed), and myself. Fortunately this room was furnished a little more comfortably and nice armchairs were provided instead of the tatty office chairs that were used on the admissions ward.

After all the usual questions from the consultant, she decided that I should be given some home leave to see how I coped. So she said that I was to go home for a few hours during the afternoon of the following day, Tuesday, and if that went well I should spend the night at home on the day after that, Wednesday. This meant that I would be back on the ward for the next ward round and further decisions could be made then. The problem, as those of you who read the posts that I wrote while I was in hospital will know, is that the nurse wrote down that I was to go home for two nights.

Tuesday morning, one of the nurses came to see me in my room and told me that my medication for my two days at home was ready for me and asked what time I would be leaving. No matter how many times I said that was not what my consultant had decided, the attitude was that the nurse who was at the ward round had written the consultant's instructions correctly, and that I, the patient who was obviously so stupid that she hasn't heard things correctly, was wrong. I insisted that they check with the SHO, but they wouldn't do this so I was left getting angrier as each minute passed. Things came to a head just after lunch when I was asked again when I would be going for my two nights home leave. I said that I would be going home for a few hours, but would be back in time for dinner. This again caused the nurses to tell me that I was to go home for two nights. Half an hour later I had an angina attack (more about this and the problems that I encountered in a later post) and all thoughts of me going home for any home leave that day were put on hold.

On Wednesday, I did collect some medication and go home for the night. It was not a success. I did not sleep at all, and by the next morning I was in a terrible state. I went up the road to catch a bus and make my way back to the hospital. That afternoon's ward round was almost more than I could manage. It seemed that the whole world had come to sit in on this one. I did a quick count as I entered the room and there were more than 12 people in there, and that didn't include me. Apart from those who had been present for the previous ward round there were a host of medical and nursing students. It was apart to my consultant that things were not well with me and she asked all those not absolutely necessary for the ward round to leave. This left just five of us in the room and although I felt less overwhelmed I was still very upset. When my consultant asked about the home leave and I explained what had happened with the nurses saying that I was to go home for two nights and me saying that was not what had been agreed between her and me. At this point my consultant went mad. She understood why everything had been so difficult for me and when she reiterated that what she had wanted was for me to try a few hours home leave before having an overnight home leave the following day. At this point the nurse(the same one who had been in the previous ward round) piped up that I should have gone home for two nights because she had written that down. I was surprised that my consultant didn't ask everybody to leave before she decided to tell the nurse that she had better listen better in future because she had never intended me to go home for two nights, and was perfectly certain what she had said and that I had understood it too.

This whole episode delayed my recovery. Instead of being ready for a longer home leave in a few days, possibly over the weekend, I ended up having to stay in hospital for another two weeks before I was ready for more leave.

Every ward round that I attended after that went without too much of a hitch, but my consultant always made sure that there were only people who were absolutely necessary present. No more medical students, nor more nursing students, and no-one who was not involved in my immediate care over the next few days.

I found out afterwards that I could have asked for just myself and the consultant to be present when I was seen, but like so many of these things, you don't find out until it is too late. I really believe that ward rounds where there are so many people present are not good for the patient, especially if they are distressed and have no-one who can be with them such as a partner or other family member. I likened it to a blood sport at the start of this post and it does very much feel that you, the patient, are the fox, and all the other people present are the hunt and the hounds. Definitely not conducive to a speedy recovery.

** Informal is a euphemism for voluntary. Political correctness causes the powers to be to use the terms formal and informal in place of involuntary and voluntary.

To be continued.


Achelois said...

I find this hard reading so think you must find it hard to remember and then write it all down. Its just so distressing that it had to be this way.

I know BG contacted you off blog but i am not sure how to do this so have to comment via this facility.

I hope when you write all this it doesn't frankly traumatise you. I hope its cathartic for you?

Why it has to be this way apart from the obvious 'funding issues' I do not know. I look around my local hospital and its full of artwork and expensive garden architecture, is it something about big cities that mean the surroundings have to be so dour.

In all honesty I am worrying about you somewhat this week with Christmas coming up and I haven't been able to pluck up the courage to say so, because I don't want you to be alone. But you won't be because I and I am sure others in blogging land will be clocking in to see how you are and sending all surrounding virtual hugs to keep you safe.

Take care xoxox

mags1234 said...

I have been following your blog since it was mentioned on Mental Nurse. I am pretty sure we live in different parts of the country but your experience sounds so very similar to mine it could be the same hospital(though more likely not)I feel for you reliving your experience but am grateful for you writing about it. I hope you are doing better now.
I have my own blog and have just written on my experience of a crisis/safe house. I don't know if your area has one of these but it is a kind of half way place of safety when you are feeling too vulnerable to be at home but not ill enough to be in hospital.

Alison said...

I am just catching up on the latest installment... :)