Saturday, 23 January 2010

Tackling The Mental Health Minefield Part 8 - OT? What OT?

(This post continues the story from Tackling The Mental Health Minefield Part 7 - The GTN Story)

Having to spend a long period in hospital, and these days anything more than a week can be considered a long time, means that there can be a lot of empty hours to fill. When that hospital is a mental hospital then one can expect to be mobile and the empty hours can seem interminable. Mental illness can make it difficult to concentrate, or to be able to do something for a long period of time. My experience of mental illness is depression and I have tried many things to deal with the hours of the day. I read, I study, I do crossword puzzles, I knit, I do embroidery and I make cards. Sometimes I can't do any of these things for more than an hour at a time and sometimes I can spend all day on one of these activities as long as I don't encounter any problems. Problems are very difficult to deal with and so I end up putting whatever it is I am doing aside until I am feeling a little better and can deal with the problem.

During my stay in hospital, life soon settled into the routine so loved of such organisations. Breakfast would be served at about 8am, meds and obs at 9am, lunch served at about 12.15pm, meds at 1pm, dinner at about 5.15pm, meds at 6pm and night-time meds at 10pm. I expect that it is pretty much the same in any hospital.

Visiting hours were 2pm to 5pm and 6.30pm to 8.30pm. The difference between visiting hours in a mental hospital and an ordinary hospital is that there are very few visitors; most patients have no-one visit them from their admission to the day that they are discharged.

So what do patients do during the rest of the empty hours in a day? Well, there are of course ward rounds, but while these may take a considerable time during the day, the patient only attends ward round for a limited time. Most of my visits to see the consultant psychiatrist and whoever else was in the room (see Tackling the Mental Health Minefield Part 6 - Throwing The Christian To The Lions) were no longer than about 10-20 minutes twice a week.

While I was on the admissions ward there was nothing organised for us to fill the empty hours. As is common to most accounts of time sent on mental wards, we were expected to spend most of our time in the communal areas. These were the TV room and the dining area/day room. During my time on the admissions ward I went in the TV room twice; both occasions being for ward meetings. The dining area/day room had tables and chairs sufficient for 12 people, but the ward could take up to 16 patients, which meant that if the ward was full it was impossible for everyone to be able to sit down together at meal times or during other periods of the day. So I spent some time in the dining area/day room particularly when I had made myself a hot drink or for meals, sometimes I would read a book or doing sudoku puzzles. I had always found sudoku puzzles impossible to do even though I understood the requirements for completing them because I have number dyslexia. However, one of the patients that I was on the admissions ward with spent time explaining how to do them and I became hooked. Most of the rest of the time I spent in my room trying to catch up on sleep that I wasn't getting at night or reading. There were no organized activities for us to take part in.

When I was on the second ward, there was an activity semi-organised for each morning (Monday to Friday) between the hours of 10-11am but these rarely took place. The two which did seem to be regular events were a session of creative writing on a Tuesday morning and a group psychology session on a Thursday morning.

The first Tuesday that I was on the ward (I had been on the ward for five days then and in hospital for two weeks) two occupational therapists approached me when I was in the main corridor of the ward walking from the laundry room with my arms full of the washing that I had just done, and tried to get me to join in with the creative writing. I took my newly laundered clothes back to my room and went to the OT room to wait for the OTs to round up any other patients who could be dragged along. They were unsuccessful, so there I was sitting in a room with two OTs and all they could suggest to me was that I might like to write about what had led to me being in hospital. Now maybe I was just being over-sensitive, but I really didn't think that was a very good thing for me to be doing at that time. So I thanked them very much and left to go back to my room to read my book.

I was absent from the ward on the following Thursday morning as a result of being on my first attempt at home leave. I arrived back on the ward at lunch time so I missed the group psychology session. The following week however, I was persuaded to join three other patients from the ward and one of the nurses at the group psychology session and spent an hour away from the ward with one of the psychologists and his trainee psychologist. Each of the patients were given time to talk about how they ended up on the ward, the other three having been present at the previous week's session they went first and then it was my turn. I was asked a number of questions which I have to admit I answered only briefly and then I was asked about my depression and how long I had been suffering from it and how I had ended up in hospital. I answered at length and what I had to say somewhat surprised the other patients who had no idea that I had been suffering for so long or that this was my first admission to hospital.

Then we began to talk about life on the ward and I raised the subject of the 'protected hour' that we were supposed to have everyday between 11am and lunch. As this is going to be the subject of another post in this series I won't go into too much detail here, but from being someone who pretty much kept to myself on the ward although I did talk with a number of the other patients, I suddenly found that I had become a spokesman for not only those patients at the group psychology session but also those who weren't.

So, at the end of this post I go back to the subtitle that I used. OT? What OT? I know that some things that traditionally come under the title of occupational therapy involve cost and money is something that seems to be in short supply in mental health services, but the significant lack of anything that could be termed as 'helpful' in making the empty hours pass more quickly for the patients was alarming. The wards had televisions, and a small supply of books, but nothing much else. The result was that some patients spent most of the time in their rooms and socialised only at meal times. It is probable that the nurses wrote up their notes on the patients on each shift and commented that the patients didn't seem to do much, but it has to be said that there really wasn't anything to do. I would have loved to be able to do some knitting, but knitting needles were not allowed on the ward. I understand that they could be used as a weapon if used in public areas, but if I was to knit in my room and return the knitting to the staff when I had finished for the time being would certainly have helped me considerably.

I was lucky: I was only in hospital for a month but by the time that I left I was desperate to do some knitting or something other than read a book and do sudoku puzzles. As far as I am concerned this is an area what definitely needs something done about it. I know that some patients probably wouldn't want to partake in anything but there are definitely some who could almost certainly be helped considerably if there was something to help to pass the time in an environment that is not always conducive to improving one's mental health.


Bippidee said...

I agree that this is an absolutely key area - for me the OT and therapy side of things are what the noticeable difference between NHS and private wards are. In the NHS ward I did nothing. Because there was nothing to do. I took my meds and there was ward round once a week, plus if you were very lucky an OT would suddenly appear and open up an art room for an hour. This happened rarely. In the private hospital there were timetabled activities from 10 - 4 every week day, plus bits at the weekend. Most of these were optional (although a few were compulsory) but most people went to them because they gave you something to do. Some of these were group therapy things (these were the compulsory ones) but there were also a lot of optional OT type activities - art/craft stuff, yoga, relaxation, drama, flower arranging, creative writing, music, etc etc. The majority of the activities themselves cost little to nothing, although I appreciate there has to be somebody to run them, but I think they really are invaluable, particularly for patients suffering from depressive type illnesses, where just medicating the hell out of them isn't going to achieve anything. NHS wards seem to vary enormously in what they provide - I feel there should be some minimum standards put in place regarding this sort of thing.

DeeDee Ramone said...

The NHS hospital I was in in 2008 had all the activities that Bipeedee describes. I know extra money has been put into mental health in Scotland though, and it was a HUGE hospital so the resources were shared across a wide catchment area. I did woodwork, gardening, art, crafts, relaxation and we also had group therapy on the ward. Most of the patients still opted to spend all day in the smoking room though.