Each week we publish blog posts on a whole range of topics, relating in some way to mental health — written by Mind staff, service users and health and policy professionals. Some blog posts may not reflect official Mind policy.
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Mind's CEO Paul Farmer welcomes a landmark Supreme Court judgement, which promises greater protection for people with mental health problems who admit themselves to hospital voluntarily.
29 CommentsThere’s much talk at the moment of the future of mental health services. Is NHS funding really protected? What does the move to GP commissioning mean for mental health? Yet there’s a need to focus attention on the current state of services too, which is what Mind is doing through our new Care in crisis campaign.
9 CommentsA guest post from Social Action for Health Executive Director Elizabeth Bayliss.
Here at Social Action for Health we've just published a report called Hear I Am.
It describes a pilot project that began as a means of exploring new ways of engaging patients in their own care planning, applying a community development approach.
In order to fulfil our brief we planned to introduce patients on a men's acute psychiatric ward in East London to Multi Media Profiling (MMP). Multi Media Profiling is a creative way for people to communicate their needs and potential using video, stills and sound. We hoped it would help patients to engage with their care planning and to tell their stories in their own way at CPA meetings.
We produced profiles with two patients, with positive benefits, and are keen to explore the potential of these further. However, something else was happening too. During regular reflective sessions, the project team found that their attention was focused more and more on what they were witnessing on the ward.
What they were seeing was guys who were bored, with very little going on. The men were frustrated and spent a great deal of time just hanging around waiting hour upon hour for someone to accompany them outside for a breather. They saw how quickly the men's spirits and expectations were raised by something as simple as bringing in fruit to share. But what the project team found themselves reflecting on most was the lack of engagement between ward staff and patients.
The men were clearly hungry for dialogue. They wanted to talk and exchange with other patients and staff, and yet ward life was almost totally arelational. Dialogue was not the norm.
The usual rules of social life did not seem to apply. Ordinary greetings like "hello" and "how are you" were not used. Questions were ignored and answers were not followed by action. This lack of any meaningful engagement between staff and patients made life difficult and stressful for all.
This was an emergent project, so we were free to change our focus. We decided that since the context of ward life is such a key aspect of care planning for in-patients, we could legitimately reorient ourselves. Now during our twice-weekly visits we simply aimed to build relationships with the men. We listened, talked, chatted, laughed and played games. We wanted to understand what it meant to be a human being in the mental health system.
We saw that the wards were separated, segregated airless places that weren't doing anything other than suspending people while they took their medication. The patients didn’t seem to be in therapeutic relationships. They were not involved in a process, they were just hanging around.
By the time the project ended after 12 months we had concluded that this way of conducting ward life aggravates and enervates both patients and staff, rather than creating the sort of stabilising and empowering situation that promotes care and recovery.
Our response was the Hear I Am report. It says that things need to change fundamentally and essentially around the way people on our mental health wards are related to. Patients need to be given the chance to talk and to be listened to.
In order for this to happen the wards need to be more permeable so that people can come and go and talk about ordinary things like the football or weather. Put simply, the wards need to open up.
Elizabeth Bayliss, Executive Director of Social Action for Health.
4 CommentsA post on the excellent Wife of a Schizophrenic blog describes two psychiatric wards with wildly varying attitudes from the nursing staff:
Things were so different in the psychiatric hospital than they were in the psychiatric ward in the general hospital. It was like stepping into another world. On the psychiatric ward where Mr Man had been for his first 3 weeks, the staff mixed freely with the patients. They chatted, they drank coffee together, they went for walks in the grounds, and they played board games.
In the psychiatric hospital the staff always seemed to be cooped up in the staff room, engrossed in conversation with other staff members, and not in any mood to be disturbed. Don’t be mistaken; I don’t mean that they were busier, or that they took their role more seriously, far from it. They were engrossed in conversation about their own concerns - laughing, joking, and playing computer games. Whether you were a patient or a visitor, you were met at the staff room door with the same level of contempt.
Two wards, both staffed by the same mix of mental health nurses and healthcare assistants. One with a good culture of nurses engaging with patients, and one with the staff all locked up in the office. I've worked on wards that resembled the former, and others that were more like the latter. Why do some wards get it right where others don't, and how does one change a bad ward culture into a good one?
As for the first question, it isn't a matter of training. Yes, yes, we've all seen those Daily Mail editorials about how nurse training has been taken over by politically-correct sociology-babble, churning out nurses who are too clever to care, too posh to wash (What's the psych equivalent?
Too posh to play pool?) and so forth.
But the nurses on the "good" ward in the above quote had undergone the exact same training as those on the "bad" one. Besides, when I was a student nurse my nursing lecturers repeatedly exhorted us to engage with our patients, work to build therapeutic relationships, and so on. It was certainly made clear to us that we shouldn't be hiding in the office avoiding our patients.
Some have suggested that the problem is that too much of nurses' time is taken up with paperwork and "firefighting". There's a degree of validity to this. It's certainly true that nurses, along with so many other public services (see also the police, social work, teaching etc) have become bureaucratised and forced to spend more time form-filling and less time doing their jobs.
It's also true that on a hectic acute ward nurses' time can inevitably be distracted into dealing with the more challenging patients at the expense of everyone else. Even so, I can't help notice that those nurses who claim most forcefully that this is the problem often seem to be the ones who've just spent the past ten minutes sat in the office discussing the esoteric mysteries of The X Factor. Besides, even if the staff nurses have a mound of paperwork to complete, there's no reason for the HCAs (Health Care Assistants) to be sat with them.
Quality of leadership comes into it. The personality of the ward manager can have a big effect. So too can whichever staff nurse happens to be coordinating the shift at that particular time. Good ward leadership involves leading by example, showing that you value engaging with patients and expect others to the same. It also involves occasionally being willing to crack the whip and start shooing staff out of the office.
The calibre of healthcare assistants matters a great deal too, as they're usually the people who have the most contact with patients. Attitude can often be far more valuable than experience. A HCA who's young, inexperienced but keen as mustard is much better than one who's been there for 20 years and stopped giving a toss 10 years ago.
Physical design of the ward can have a surprisingly high influence. If the ward office is large and comfortable then nurses have a tendency to gravitate towards it. If it's small and cramped then they're more likely to be on the ward floor with the patients. I once knew a ward manager who was closely involved in the design of a new psychiatric unit. He went to great lengths to ensure the office was as nasty, uncomfortable and impractical as possible. If he could have put razor blades on the seats, he would have done so.
As for the second question, can ward cultures be changed? Certainly attempts have been made to do so. Perhaps the most well-known of these is the Star Wards initiative, which focuses on staff-patient interaction, promoting therapeutic activities and combating boredom. There's also the Productive Ward scheme, which aims to improve efficiency on wards to release time for direct patient care.
Others have called for a radical change in the ethos of mental health nursing. Phil Barker's Tidal Model claims to provide "a philosophical approach to the discovery of mental health" enabling people to "reclaim the personal story of mental distress, by recovering their voice". Some of my colleagues regard it as a sincere attempt to base mental health nursing on humanistic principles. Others dismiss it as "beardy-weirdy, New Age hippy bollocks". Feel free to make your own decision.
As for myself, a while back I was coordinating the shift on a ward, and I discovered an anorexic patient, supposedly on 15 minute observations, who had spent the past half hour surreptitiously exercising in the toilets.
Meanwhile the bulk of the staff had been sat gossipping in the office. I considered the lessons from Productive Ward, weighed up the philosophical values of the Tidal Model, thought back to my university lectures on the Force Field model of change management...then stomped into the office and threw a massive tantrum in front of the entire team.
Two minutes later, the office was empty and all the staff were on the ward floor, looking slightly afraid.
Crude, but it worked. Maybe I should market it.
Zarathustra, from Mental Nurse
13 CommentsTo what extent do TV hospital dramas reflect reality? Not much, according to Antony Sumara from Mid-Staffordshire NHS Foundation Trust. He particularly targets BBC dramas, but I doubt they are alone in ignoring good practice, patient confidentiality and attention to hygiene in the search for a gripping storyline, as he claims. Perhaps writers don’t feel that an episode of someone waiting for treatment or extolling the virtues of hand washing will draw those viewers in.
How well versed are you in what you can expect from your hospital stay? Every local NHS organisation is expected to produce a guide to local services and deliver that to all households in their area. This one is from Milton Keynes (PDF).
Have you read the NHS Constitution so you know which waiting times have been enshrined within it – no longer than four hours in A&E, for example? The constitution says that you have a right to be treated with a professional standard of care, though to be fair it doesn’t explicitly say that staff shouldn’t be sorting out their love life in corridors when they’re not treating you.
Bridget O'Connell, Head of Information
5 CommentsA guest post by Marion Janner, founder of the Star Wards project
Hmm. Perhaps the only uncontroversial words in the heading are those with a character count below 4. That’s 3 of them (I’ve just started ‘tweeting’ on Twitter and am now obsessed with character count as each tweet has to be haiku-like petite, under 140 characters. I usually find it hard to express myself in under 140 minutes).
Anyway, returning to my own character, it’s been totally fucked over in the last seven years by the explosion of borderline personality disorder. BPD is actually as common as schizophrenia but most people have never heard of it. I hadn’t until many months after I became inexplicably hyper-depressed and started, completely bewilderingly, self-harming as a way of managing extreme plunges in mood (I go on and on about this in my website Mentalising). And when my partner of 20 years walked out on me, a month after our civil partnership ceremony and having forgotten to mention her plans to me, the suicidality started.
You might be familiar with OCD-type compulsions – hand-washing, germ-avoidance, safety rituals. My compulsion to kill myself is broadly similar. Although obviously with the opposite intention in terms of life preservation. It’s pretty exhausting (not least for my extensive team of therapists) trying to contain this force and all gets very messy when I decide to take an overdose as a way of flirting with death and simultaneously gaining a sense of being able to control my destiny when I sheepishly land in A&E to get the overdose reversed.
So. The chance of a break from having to internally manage my self-demolition urges is irresistible. Butlins is great, what with all the entertainment, slot machines and good grub, but it’s a lot to ask them to manage my suicidality. Whereas my lovely local, St Ann’s in Tottenham, may not have the slot machines, but they do lock me in and remove all tolerable methods of disposing of myself. Such a relief.
I’m a bit of a regular at St Ann’s, and the familiar staff team greet me with hugs and welcomes, perhaps temporarily forgetting that I’m a nightmare patient for them. For example. I’m 4’9” so not very tall, but while being ‘specialed’ via 1:1 staff with me 24/7, I’ve still managed to unscrew a lightbulb from the ceiling and use it to self-harm. All very David Blaine and presumably infuriating for staff. Yet they manage to respond to my relentless self-destructiveness with patience, understanding, non-judgementalness (?) and to use an old-fashioned term – compassion.
I love it there. I don’t need to worry about work or my weird eating nonsense or looking after my foster sons or (not) answering the phone or writing blogs or going to meetings or acting cheerful. I know from my work running the Star Wards project that St Ann’s is scarcely in the Premier League of hospitals, indeed it’s going to be knocked down and replaced. But it has exactly what I need, and what my friends and family need, to keep me safe and provide a little break from the overwhelming task of keeping it all together. There are very few days when I’d rather be at home than in hospital.
Marion Janner
Marion was awarded an OBE for services to mental health care in the New Year Honours list 2010.
20 CommentsI've got a cold and am oscillating between coughing loudly in the hope of garnering sympathy, and pretending I'm fine due to the embarrassment at feeling so lousy with something so commonplace.
What then, to make of the recent report from the Royal College of Psychiatrists that half of people in hospital due to mental health problems do not receive any gifts or cards during their time in hospital, compared to a third of people in hospital due to physical health problems? If it is hard to admit to being laid low by the common cold, how much harder to try and explain about a mental health condition?
A British study found that psychiatric patients were significantly less likely than other patients to inform friends and family that they had been admitted to hospital, despite spending a significantly longer period of time in hospital.
The study found that the psychiatric patients received fewer cards and gifts. Further, patients with mental health diagnoses tended to receive toiletries, food and cigarettes as gifts, while other patients receive flowers, balloons, magazines and chocolates.
Another British study confirmed the finding of fewer greeting cards for patients admitted to psychiatric wards. There seems to be a combination of people in hospital due to acute mental distress being unwilling to tell people about their problems, and others not knowing what to say or do when people are admitted to hospital due to a mental health condition, so end up doing nothing. What could people need more during a time when they are on a hospital ward, feeling vulnerable and distressed, but to know that others are thinking of them?
It can be easy and inexpensive to show that you care. Some hospitals, such as the North West Wales Trust allow people to send an email to a patient that will be printed out and handed to the patient. The Royal College of Psychiatry has launched their own get well soon cards that are on sale via their website.
You could also make your own, and getting the family involved in creating or writing in a card could be a good way of having a conversation about why someone is in hospital and what they might be experiencing.
Bridget O'Connell, Head of Information
6 Comments