Tag Archives: nursing

“Safe” staffing on mental health wards

5 Feb

Some thoughts on “safe” staffing and what this mean on psychiatric inpatient wards.

 

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Forced medication: resistance is futile

19 Mar
Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Pacific Northwest Ballet principal dancer Carrie Imler, with corps de ballet dancers William Lin-Yee and Andrew Bartee in Jiri Kylian’s Sechs Tänze (Six Dances). Photo © Angela Sterling.

Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. That lead to these tweets on my experience of forced medication on a psychiatric ward (set out below, slightly edited).

I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what. It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Someone found my blog today by searching “how to get out of the restraint that psychiatric wards use”. Yeah, no chance there: it’s six to one. I discovered that nothing I did or said made any difference to the use of restraint on me: they were going to carry on and do it, no matter what.

In my experience of restraint, once there’s a tick on the chart saying “forced medication”, it’s going to be done to you, no matter what. Once there’s a tick in the box saying “forced medication”, it doesn’t matter where you are or what you’re doing, you’re getting it.

It made no difference that I’d never been asked whether I’d like pills or an injection. The forced med squad just turned up and did it to me. It made no difference that I’d never been asked which drug I’d prefer to take. They just climbed on top, pinned me down and stuck it in me. It made no difference that I’d never had a discussion about symptoms or potential diagnoses or treatments. They just carried out orders.

It made no difference that I was sitting on my bed, reading quietly, minding my own business. They’d turn up mob-handed & do their business. It made no difference that I’d stepped out of a meeting with the IMHA to get a letter from my bedroom she’d asked to see. They came in as I sat on the floor, document wallet in hand, surrounded by papers. They did it to me there, then walked off chatting, leaving me to wander back to the IMHA, disheveled and dazed.

It made no difference when I pleaded with them to explain what they were doing, what was in the syringe (or syringes – it varied), what effect it would have on me. None. It made no difference when I talked calmly to them, speaking to each by name, asking them to explain why they were injecting me. None. It made no difference when I repeatedly called out a friend’s name, calling to mind someone who cared for me, who heard my words. None.

It made no difference whether it was night or day. They could turn up any time, stick it in me, roll off, leave me lying in dirty sheets. It made no difference when (realising nurses wouldn’t speak to me) I wrote notes and handed them to the nurses. The notes asked the nurses to explain what drugs they were injecting, what the effects were, what they were for and what the plan was going forwards. No response. They just handed each note back to me later, unopened.

It even made no difference when I was first in the drugs queue so I could take the pills instead: they still came for me again. I had a double dose that day.

The staff weren’t monsters. Far from it. They’d chat away to each other, coordinating between themselves who was going to take which limb; who was doing what when; and then when to let go as one.

They’d chat away to each other as if the person beneath them was not a person who spoke their language but a wild and senseless beast. They’d leave behind a bed pushed out from the wall, sheets trampled under their boots, empty swab wrappers on the floor, lumps and bruises on my arms and legs. They’d leave behind a person who didn’t know what had just been done to them, or why, or when it would happen again, or how to make it stop.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do.

I learned that, when they come for you, there is no escape. You are locked in and cornered. It is going to happen. It makes no difference what you say or do. You can’t reason with people who won’t listen to you. You can’t persuade people who don’t hear you. You can’t resist them when it’s six to one, even if (unlike me) you knew how. You can’t reason with people who are just carrying out orders. You can’t persuade people who don’t think you’re worth asking.

It’s like being in a science fiction novel. Resistance is futile. Your life as it has been is over. Comply, cooperate and engage. Resistance just prolongs the process. The quickest way to get out is to comply, cooperate & engage.

I found that there was nothing I could say or do to stop them using restraint on me. But things I said and did helped me cling on to me. Little things I did and said as they did their business on me helped me to cling to my sense of being a person, a human being not an animal.

It made no difference to them what I said or did. All I could do was try to make a difference to me.

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Trust, respect and coercion in mental health services

12 Feb

Trust dancers

Trust, respect and coercion: Can people who use mental health services ever really trust staff when coercion is always an option?

Some thoughts of mine on the subject.

Some responses of the lovely twitter people.

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But we’re not all like that …

16 Aug

Blue Toyota toy car

“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a  positive difference to people’s lives and do a really good job.

So when a dedicated  GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.

What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me,  me, me.

Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.

It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:

Me: Someone driving a blue Toyota just hit and killed my four year old child.

You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.

What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.

Or, as mental health researcher Dr Sarah Knowles tweeted:

“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”

Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.

It’s not about you.

Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.

As Charlotte Walker (twitter @BipolarBlogger) tweeted:

“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”

And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:

“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”

Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe  it’s time, instead, to listen.  Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!

Not all drivers

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Let’s talk about poo! It’s tweet chat time …

28 Jul

Keep calm and poo with pride

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Update

 

Here’s the transcript & fab wordcloud from the tweet chat on 1st August – patients & nurses all talking about poo!

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This Thursday 1st August at 8pm, We Nurses will be hosting a tweet chat about constipation problems, at my suggestion. Here’s my earlier blog on constipation induced by psychiatric medication, including 25 tips you can try for yourself. It is my most read blog piece ever. I guess that makes me some sort of Poo Queen. Hmm …

However, if it gets people talking about an important but often overlooked or covered up topic, that’s all to the good. Let’s break the taboo about poo and make a date in our diaries for this Thursday’s poo chat!

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Background reading:

The Bristol stool tart cake!

The Bristol stool tart cake!

 

Additional information on constipation:

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Restraint – 10 ways it harms psychiatric patients

19 Jun
Greer Garson, Lauarence Olivier, Maureen O'Sullivan & Bruce Lester in Pride and Prejudice

Greer Garson, Laurence Olivier, Maureen O’Sullivan & Bruce Lester in Pride and Prejudice

 

Restraint. It’s such a polite word. What does it mean to you? Genteel Victorian ladies in romance novels? Bondage in Fifty Shades of Grey? Artistic photographs from the Held exhibition? Or perhaps the word conjures up the grotesque inhumanity of the face-down restraint and forced medication that take place on psychiatric wards up and down the country every day of the week and which are the subject of mental heath charity Mind’s new campaign. (See below for links to Mind’s campaign, press coverage, commentary and resources.)

The word restraint is reminiscent of Victorian novels of manners such as Jane Austen’s Pride and Prejudice. Of elegant ladies and gentlemen, like the renowned actors pictured above, exercising self restraint to stay within the confines of the social norms of the day. Rather than going “at it like knives on battered settees” (to quote a humorous song), characters manoevre to form genteel and restrained attachments.

Restraint also has connotations of the erotic kind. That’s especially so since the Fifty Shades mommy porn phenomenon brought bondage to the mainstream. By now there’s a Fifty Shades of Grey official pleasure collection, which includes a bed restraint kit, “approved by author” E L James. There’s even a parody novel incorporating Pride and Prejudice, called Fifty Shades of Mr Darcy.

A photograph from the held exhibition by Jane Fradgley

A photograph from the held exhibition by Jane Fradgley

Some think of restraint in mental health settings as an interesting topic for art, fashion, photography and academic discussion. Photographer and fashion designer Jane Fradgley’s exhibition Held (see here and here) has a related symposium on restraint. Her photographs are inspired by the historical collection of “strong clothing” at the Bethlem Royal Hospital Archive & Museum and explore her impressions of restraining garments as facilitating dignity, comfort and protection. That’s straight jackets..

When I hear the word restraint, however, the first thing that springs to mind isn’t Victorian ladies, saucy pleasures or artistic photos. It’s the brutal reality I’ve experienced of being pinned face down by teams of six as a vulnerable psychiatric inpatient. It was done to me repeatedly, to administer medication. There was never a justification. It was done to me without warning. It was done to me without explanation. It was done to me without any shred of compassion. It was done to me routinely, on a schedule I was not told about. It was done to me as a first resort.

It’s too traumatic for me to write about again. However, if you want to know more, read this blog, Treated Like an Animal, where I describe one incidence of face down restraint step by step.

Late yesterday, when I checked twitter,  my feed was filled with references to restraint. It was not good for me: here‘s my reaction. Hours later, after the flashbacks and tears had subsided, I was still sick to my stomach, heart pumping, unable to sleep.

Why had there been so many tweets on my feed about restraint? Because mental health charity Mind was publicising the launch of its campaign around the use of physical restraint in mental health care using the hashtag #crisiscare. As Mind says:

“When people’s lives come crashing down in a crisis, they need help not harm. We’re calling for national standards on the use of restraint, accredited training and an end to face down restraint. Excellent crisis care exists. It can save lives. And that’s why we need it available for everyone.”

It’s an important campaign, and one which must succeed so that the harms like those that were inflicted on me when I was at my most fragile aren’t allowed to be imposed on others in the same way. Here’s my personal experience of the harm done by physical restraint in a mental health setting:

  1. It destroyed any chance of developing a therapeutic relationship with ward staff. Staff became my jailers and tormenters, wielding arbitrary power, casually chatting over me to each other as they did their business. All I was interested in while on ward was discharge, not healing: get out, get away from staff and make sure they never came after me again. Fear of psychiatric staff affects me to this day.
  2. Mentally I was pushed to a place I would never have gone to had I received care rather than violence. At my most vulnerable, I was brutalised. Like smashing down a sledge hammer again and again on a tender broken wrist instead of enveloping it in a protective plaster cast, these restraints made me much, much worse than I ever needed to be.
  3. Each time it was done to me, I was reduced to the state of a cornered animal, running on stress hormones, on fear and instinct. My dignity and humanity were removed. (One time I was carried face down and shoeless through wards and corridors and past men playing snooker, with no explanation. I was so terrified I wet myself and was left in my own urine, watched through a porthole at 15 minute intervals. After some time, I was carried back the same way.)
  4. These physical restraints caused distress to other patients, who would hear me crying out in fear as I was manhandled, or see me being taken through the ward face down.
  5. I was physically injured by being yanked, pinned down, knelt on and injected. My buttocks were bruised meaning I was unable to sit. I was covered in lumps and great purple and green bruises and finger marks. Although the severe bruising and lumps have healed, two years later I still carry two physical injuries (one serious and for which I still receive treatment). (None of these injuries will be recorded in hospital records.)
  6. Two years later, simply hearing or seeing the word “restraint” can bring on overwhelming flashbacks and deep physical responses. Two years later, I can’t even can’t watch light-hearted TV programmes with traffic police in them because, sooner or later, there will be a big scrum when officers pin down a suspect. Just seeing that can trigger the flashbacks too. I can’t even lie on my tummy without it reminding me of being brutally pinned down.
  7. Two years post-discharge, the symptoms I still struggle with – and spend a lot of time managing – relate to my treatment on ward (flashbacks and physical symptoms), not what brought me onto the ward in the first place.
  8. I have been diagnosed with Post-Traumatic Stress Disorder as a direct result of my ward experiences (I am on a waiting list for treatment).
  9. Friends and family are horrified at the barbarism of what was done to me, putting them off seeking psychiatric help themselves.
  10. Having experienced what can go on behind closed doors when no-one is looking, I will never go back into a psychiatric ward, no matter what.

Since discharge, I’ve learned that restraint is a physically risky process in which people can die, so my fears were justified. Recently I bumped into a woman called Cheryl Prax. I spent 90 minutes listening to her describe her experience of having her arm broken in two places when she was restrained by psychiatric staff (see her speak about it here).

Why am I giving all this personal detail? Because staff may believe that using physical restraint helps them to manage the ward environment in the short term. But perhaps, as caring professionals, they will reflect on the long-term implications, both physical and mental, for those on the receiving end. And perhaps they’ll reflect that some mental health trusts have already banned the use of face-down restraint without losing control of the wards.

And now it’s not just me who’s saying they have had bad experiences being pinned down by psychiatric staff. Now there’s a national campaign from Mind to get rid of this barbaric practice once and for all. See the links below to see what you can do to help. Please help. Because this monstrous practice must stop.

There are numerous links below.

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My thoughts on restraint:

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Material related to Mind’s crisis care campaign on the use of restraint:

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Commentary & additional material:

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Press coverage of the story:

Nationals:

Locals:

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The saucy side of restraint, plus art:

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Confiscating patient phones on psychiatric wards

4 Jun
My photograph of an Olympic Park telephone box, July 2012

My photograph of an Olympic Park telephone box, July 2012

Some thoughts on the confiscation of patients’ phones on psychiatric wards, prompted by the fact someone found my blog yesterday by searching the term, “If you are in a psychiatric ward do they confiscate cell phones or computers”.

I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.

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