Tackling The Mental Health Minefield Part 9 - The Nurses: Carers Or Prison Warders

(This post continues the story from Tackling The Mental Health Minefield Part 8 - OT? What OT?)

The people that patients have most interaction with while in hospital (apart from other patients) are the nurses. Although in these days of tight budgets the number of nurses on a ward is supplemented with the addition of unqualified staff and in the hospital that I was in these members of staff are known as Care Support Workers. When in an ordinary hospital you have a reasonable idea of who is staff (they wear a uniform) and who is a patient (they will generally be lying in a bed or wearing night clothes and a dressing gown. In a mental hospital it is often far more difficult to make the differentiation. The nurses don't wear uniform and the patients are usually wearing normal every day clothes.

The funny side of all this is that on more than one occasion I had both patients and staff speak to me thinking that I was a member of staff. I'm not sure why this should have happened; whether it was because I didn't look like a mental patient or because I looked as though I knew what I was doing, I'm not sure.

This post will be broken down into several sections and cover areas and say things that I am sure may be upsetting to some mental nurses. Any criticisms that I make are directed at the staff that I had interaction with during my stay in hospital and not to all mental nurses, so those professionals who read this please do not think too harshly of me for I am only reporting it as it was during my incarceration.

Named Nurses

Okay, we all know about named nurses. They are the one's who you can go to when you have problems and they are supposed to be your first port of call if you are having problems. That's fine if the nurses work some sort of regular shifts, but the nurses on the two wards that I was on seemed to work a fair amount of double shifts so you would see a nurse for a couple of days and then you might well not see them again during your stay on the ward. On the first ward I was on I was assigned a male nurse 'M' as my named nurse and I can report that at no time while I was on the ward, and he worked at least four of the eight days that I was on the ward, did he ever introduce himself to me or even talk to me. This defeats the object of having a named nurse, doesn't it?

On the second ward that I was on, my named nurse introduced herself to me on my second day on the ward, and then told me that she was going to be off for the next week. At no time during my three weeks on the ward did she make any effort to actually talk to me, and I am afraid that I have to say that she was the nurse who ran around like a headless chicken when I had my angina attack and wouldn't give me my GTN spray until she had found a second nurse to be with her while she opened the drug trolley.

As far as I can see the named nurse is a good idea in theory but it is rarely going to work properly because of shift patterns and the fact that the nurses rarely seem to leave the office.

The Office

From reading other blogs it is apparent that those of us who have been inpatients in a mental hospital all have the same opinion that the nurses spend far too much time in the office writing reports about the patients and nowhere near enough time actually interacting with the patients that they are writing reports on.

My first ward had a large office that was big enough for most of the nurses and care support workers to spend much of their shift in there. Sometimes the only member of staff who was not in the office was the one going round doing the hourly checks on where the patients were. the office on the second ward I was on wasn't large enough to swing a cat in and yet at most times of the day all the members of staff would be locked away in there except for the person going round the ward doing the hourly checks and the person sat outside the office keeping an eye on one of the patients, J.

J would walk up and down the main corridor of the ward for hours. She wasn't allowed any leave and rarely had visitors; the only time that she left the ward was to go to the meeting room where ward rounds were held. J also ate constantly if she could get her hands on food. Any food. She would go into the kitchen area and take handfuls of sugar and eat it. The result was that the staff stopped putting sugar out for us to use in hot drinks except in sachets. this didn't stop J, because she would just take a handful of them and eat the sugar, throwing the packets down wherever she happened to be at the time. She would also take the little containers of jam, marmalade and honey that we had at breakfast and supper by the handful and lick the contents out of the containers while walking up and down the corridor. All that the staff ever did was to tell her not to eat the sugar or the jam. She was not told to pick up the rubbish that she would leave lying around. It was the patients who decided that something needed to be done because we were sick of finding half-eaten containers of jam in the box in which the jam and butter were stored. By watching J, and every time she threw rubbish on the floor or put empty containers anywhere other than in the bin, one of the patients would tell her to pick up the rubbish and put it in the bin, likewise with the jam containers. After a week or so of this J started to put the rubbish in the bin automatically. Because the staff spoke to her in such weak tones, and the patients used authoritative voices as one would with a naughty child, so J learnt what was acceptable and what was not. If the member of staff who was assigned to watch her walk up and down the corridor for hours during the day had been used to engage her in some meaningful activity then I am sure that it would not have been long before it was no longer necessary to have a member of staff monitoring her all the time.

My question is, why do so many of the staff need to spend so much time in the office ostensibly writing reports on the patients? Because they spend so much time in there and so little time with the patients, anything that they write must be a fairytale anyway.

Protected Time

Protected times are something that seem to exist in all mental hospitals. They are useful because it means that certain things can be done on the ward without unnecessary people (and that does include visitors) being around. This means that mealtimes were protected times and each morning the hour between 11am and midday, was protected time. There were notices to this effect at the entrance to the wards and they made it quite clear that the hour of protected time before lunch was for the nurses and patients to interact.

The problem was that this never seemed to happen. This hour each morning when nothing was happening (no OT, no psychotherapy group, nobody allowed to use the gym) was, except for Monday mornings when a ward meeting was held, were just an excuse for all the staff to congregate in the office.

It was near the end of my stay in the hospital that I was asked to take part in the group psychology session. Four patients, including myself, one of the nurses, the ward psychologist (who is the psychologist that I see for psychotherapy now) and his trainee were sat in a room with the aim of doing some talking. The other three patients had been present at the group session the previous week so the had done all the introductory stuff and their input was to talk about how things had been since that last session. I, however, was new to this and I was expected to do a bit more talking, which somewhat surprisingly I did, about why I was in hospital and about how long I had suffered from depression. After having done this, the psychologist asked if there was anything else that we wanted to talk about, or to raise for the group to discuss.

I'm not sure how it happened because I am not naturally someone who would speak up in these circumstances, but I found myself talking about how little interaction had taken place between me and the nurses. I said that I had been in hospital for nearly a month and during that time only two nurses had taken the time to actually sit down and talk with me, to find out whether there was anything that they could do for me, and to generally put me at my ease. I questioned the point of the hour of protected time in the morning if the nurses were just going to sit in the office as they did for the rest of the day and ignore the patients. At this point, the other patients at the session also joined in and made similar comments all of which left the nurse, who had decided to come to the session to see what went on, somewhat red-faced.

I think that what I said struck home because the next day on the stroke of 11am, the office emptied and the nurses went in search of a patient with whom they could interact. This practice continued after I had left the ward, but I would question whether they have gone back to their bad habits now we are a few more months down the line.

Conclusions

It is important that anyone reading this should recognize that the views expressed here are my own based on my experience of a month in a mental hospital. I don't wish to offend anyone but I am telling it how it was in the hospital that I was in; I am sure that things are not as bad everywhere, and it is possible that there may be some hospitals that are even worse.

I have been on surgical wards with as many patients as there were in the wards in the mental hospital that I was in, which operated with a similar number of nurses, where the patients were not as mobile as they tend to be in a mental hospital, and yet where I would have regular periods of interaction with the nurses. And on the surgical ward the nurses had to do proper nursing things like changing dressings and helping the patients with their ablutions. So why do mental nurses consistently fail to interact with the patients?

One thing that concerned me greatly was the number of coloured nurses on the ward and the difference in their attitudes to the coloured patients and those who were white. It is bad enough to suffer discrimination because you have a mental illness, it is appalling when the discrimination is actually being shown by the people who are supposed to be helping you, not only because you have a mental illness but also because you are white. Another bad practice that was common among a particular group of nurses was their having conversations in front of the patients in a foreign language. The Nigerian staff were the offenders here, breaking Mental Health Trust policy by so doing.

I found, and have mentioned this in various of the posts in this series, that the nurses seemed to have little respect for the consultant psychiatrists and had no qualms about contradicting their (the consultant's) decisions or arguing with the consultants over what had been said. To have done this is bad enough, to have done it in front of a patient is unprofessional.

So all in all, I do not have a high opinion of the mental nurses (and care support workers) that I came in contact with. Yes, there were a few very good nurses and I was thankful when they were on duty, but the majority of them left a lot to be desired. I was left with the feeling of being discriminated against because I was not schizophrenic or a drug addict, because I was white, and as another patient said of me, because I was probably more intelligent than most of them.

To be continued.