As regular readers will know I have recently spent a week in hospital again. I thought that I would write a post in the Tackling the Mental Health Minefield series detailing how this second admission went and how I found things on the Admissions Ward four months after my first admission.
I had found things becoming too much for me and thoughts of suicide had started to crowd in again. Having got to this terrible place, I knew that the only thing to do as it was Sunday morning was to make my way to A&E. I'd previously been told if I found myself in this position that I should phone for an ambulance but I felt that this was inappropriate as I could probably get to the hospital as quickly by bus, so that is what I did.
Once I arrived at A&E I booked in at the reception desk, telling them that I wanted to see the duty psychiatric team. I waited on the terribly uncomfortable seats for about 20 minutes and was then called in to see the nurse who was doing assessments. She asked what the problem was, so I told her that I wanted to see someone from the duty psychiatric team. That didn't stop her from taking my blood pressure (which was sky high), pulse (again very high) and temperature (which was normal). then it was back to the waiting area until someone came for me.
It was a long wait. Even the CPN from the duty psychiatric team commented on the length of time I had to wait. It seems that that A&E weren't in any hurry to call her, because she had responded to the call immediately. It seems that mental patients come way down on the list when it is necessary to call someone in. I find this rather strange because you would expect that they would want to get a mental patient out of the way as quickly as possible.
The CPN took me to the room set aside for them, and learning that I was known to the mental health services she proceeded to call up my records. I should perhaps explain here that this is a separate computer system to the hospital's because the mental health services are provided by a completely separate trust. After talking me through what had been going in on my life and had led me to coming to A&E she decided that I ought to be admitted.
There now comes one of those incredible little ironies that can only happen in the NHS. It seems that as a member of the psychiatric liaison team she was allowed to discharge patients but not to admit them to hospital; that needed to be done by a doctor. So she went to the desk in A&E and removed me from their computer then bleeped the duty psychiatric SHO. As with my previous admission, I struck lucky with the doctor who took care of me at this stage of the proceedings.
We had a long talk about how I was feeling, about the lack of sleep (even though the dose of antidepressants that I take at night ought to knock me out pretty quickly), about not wanting to eat, and when I did eat it wasn't the right things, about the nightmares, about the noises that I hear and the visions that I see. It didn't take him very long to decide that admission to the psychiatric hospital was necessary.
After a couple of quick phone calls, we left the hospital and walked to the psychiatric hospital. Then it was into the lift and entry into the Admissions Ward. This time admission onto the ward wasn't the frightening experience that it had been the first time. There were two members of staff waiting for me when we arrived at the airlock, a nurse and a care support worker, both knew me so everything went very smoothly.
Once the formalities had been done, it was through the airlock and onto the ward proper. There was no need to explain to me where everything was and what the procedures were as I had been through it all before, so it was straight to my room, which incredibly was the same one that I had occupied when I was on the ward before, to drop off the belongings that I had been allowed to keep, then into the treatment room for the usual blood pressure, pulse, temperature and blood sugar tests. In the intervening period my blood pressure and pulse had dropped from their excessively high levels although they were still much higher than normal.
With this taken care of, the next priority for the staff was to find me something to eat as I had not had anything since Saturday lunch time. A salad was presented which I half-heartedly ate but the cup of tea that was also provided went down a treat. Then it was back to my room, where I was joined by the duty SHO who took down details of my medication, doses, and when they were taken. He was about to carry out a physical examination when he was called away to an emergency on another of the wards.
So, I was on the ward again. What differences did I see? Most of the staff were the same as when I was on the ward before so little had changed there. Unfortunately, they still seemed to spend the majority of their time in the office and rarely ventured out to interact with the patients. I was berated a couple of times for self-harming and told that I should have asked to speak to one of the nurses, but in my defence I have to say that the reason that I resorted to the self-harm was frustration at never being able to get to talk to a nurse when I needed to. there was also significant evidence of excessive use of force being used on patients, so significant that one of the patients was badly bruised and unnecessarily drugged when her only sin was to not be in her bed at midnight. She made a formal complaint to the consultant psychiatrist when she saw him the following day at ward round, and was discharged a few hours later because it was recognized that excessive force had been used and that it would be better if she were not on the ward when the night staff came on duty that night.
The other change that I saw on the ward was something that surprised me and made me wonder whether there were staff in the hospital, particularly on the Admissions Ward who had been reading my Tackling The Mental Health Minefield posts. And if they had, were they aware that I was Madsadgirl? At my first ward round I asked the consultant if I would be granted leave. He said yes, as I was an informal patient, without any hesitation, but did ask if I would do anything silly if I went out for an hour or two. I said that I wouldn't, but that getting out for a while was the only way that I could get the exercise that I needed (walking does help free up my hip when it is really bad) and that I wanted to be able to go to the shops to get myself a few bits and pieces that I hadn't brought with me. After I had been into ward round, the nurse who was doing that day's ward round went to the office to report that I had been given leave and could have it whenever I wanted it. When I went to inquire about when the next cigarette break would be I was handed a lighter and allowed to go out into the garden by myself. When I had asked for this when I was in hospital the first time, although the consultant had said yes, the nurses had said that it was not possible. Can my posts have been responsible for the change? It's possible, and if they were then I have at least managed to make one change to the way that patients are treated on this ward, for it was not long before another of the patients was able to also partake of this little luxury.
Showing posts with label informal patient. Show all posts
Showing posts with label informal patient. Show all posts
Monday, 15 March 2010
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.
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.
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