Tuesday, 5 April 2011

Being Sane (ok maybe not) in Insane Places.

For the Psychology lot out there they will get the title of this as it's quite a famous study in the psychology world carried out on how people who are "normal" can come across as a bit mad when placed in Psychiatric hospitals. I love this study...

"It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment—the powerlessness, depersonalization, segregation, mortification, and self-labeling—seem undoubtedly countertherapeutic."

It is a very old study. In terms of Psychology it is anyway. It was back when it was asylums. 

Any way, this post isn't about that. Well it is in a way but it's not....

"My time working in a medium secure forensic female PD unit ".

That's the schnizzle!

I worked on the wards for about a year and a half. It's 2.5 years ago since I started at the place from hell. It was my first experience of mental health in terms of working in it and thought all psychiatric wards were like this.

The place I worked was a medium secure unit. It was very very strict about what was and wasn't allowed on the ward. I worked on the female acute admissions ward. It had between 12-16 patients who were either section 3 (high risk) or 37 and 37/41. To have the ward run well we needed about 12 staff on shift at a time. This is because we would usually have patients on 2:1 arms length obs and 1:1 obs. We would need a member of staff on security, this is the person who held the keys for things like kitchen, laundry, store room, security draw to give out pens etc. This person would be in charge of counting out cutlery and plates and bowls etc at meal times. No real cutlery was used, it was plastic kids type that couldn't be broken. Plastic plates, plastic cups, plastic everything! We weren't even allowed pens on the ward and they had to be signed in and out. So the patients, not their real names obviously...

Kay - I will never forget Kay. The whole time I was there she was mostly on 2:1 arms length obs. There were occasions where she was reduced to 1:1 AL and even line of sight but that soon went tits up. I spent hours and hours with her. Some days she would be great, be in a good mood and we would take the piss out of each other and you could have a laugh with her. Other days she would be incredibly vile and repulsive and you wouldn't want to be any where near her but you had to be because you were on her obs. So we just used to sit there either ignoring her as she called us all the names under the sun, or be restraining her. Kay had been sexually abused from a very young age and has been in psychiatric care for the past 13 years, half of her life.

She was a prolific self harmer. She would use anything. She had a habit of inserting things downstairs. She even put a mouse up her bajingo. I don't quite get why. Personally I think she must have been psychotic or something to put a live thing up there. Makes me squirm thinking about it. She was regularly in hospital as she has inserted that much in to her urethra that it had caused damage and she had to have operations. I will always remember Kay when I think about people who I have worked with. I loved her and I hated her. I had a lot of time for her as she had a wicked sense of humour and we got on when she was ok. When she wasn't she hated me and I hated her. I even forgave her after she made me have an A+E trip as she spat bloody spit at me while I was restraining and it went in my eye, in my mouth and up my nose.

There was Jayne and I hate to say it was a typical BPD. I know PD's have a bad name in services but this is the kind of one who would give people with PD a bad name.

Jayne nearly died. Due to a staff members incompetence. I will come on to the staff member in a bit. Jayne annoyed me, she annoyed a lot of the other staff and the patients. She was one of those who would say she wants something and her behaviour shows the opposite. I had spent hours with her talking about her family and how she wanted to live with them again and then she would do something which would mean we were back to minus square 1. Maybe it's me. Maybe I get annoyed with PD's. I don't know. I think it was just her as I have worked with loads of people who are PD and have never felt as annoyed with them as I did with Jayne. An example was how she expected everyone to run round after her. She was in hospital as of an act of self harm which shouldn't have happened as of this negligent member of staff. And she was making demands that staff brought her in food from Macca's

I will go on to that member of staff now as she sort of ties in to experiences.

Eileen. I could not stand her. I think she thought she was there to be the patients best friend. I am of the kind of staff that I do not share too much personal info, I keep things to my self. I keep personal boundaries. The reason being, because the patients would often turn it on you and could say some really horrible things back. And I knew a lot of staff didn't want physical contact with patients. In an environment where accusations from patients about staff were always being made I had the point of view that no touch unless necessary like in restraint. That way people couldn't make accusations about me. Eileen, didn't seem to go by this code. She would walk on to the ward, hug patients and be over familiar. I had concerns about her from the start and i just didn't like her. I felt she was responsible for Jayne self harming as she hadn't been watching properly and was sat there reading a news paper while arts and crafts were going on. These patients would do anything to self harm and if you are in a room with things that can potentially harm you then you watch. You don't read your newspaper. That's what breaks are for!

The way she was with the patients in that she was over familiar with them led to the patients thinking they were ok to do the same to me. Once I had a patient grope me and talk about how big my boobs were. I explained to her that I didn't appreciate her comments or that she groped me as it had pushed boundaries and that if I did the same to her it would be classed as sexual assault so could she not do it to me again. So what does she do! Yup. Carries on doing it and making really inappropriate comments. I am quite pissed off and I go in to the glass part of the office (it was like a figure 8. One part with glass walls so you could see on to the ward and the other that was private).

Eileen was in there and I asked her if she could be more aware of how she was with patients as they were thinking it was ok to be over familiar with me and other staff and I didn't appreciate it. Well she blew up at me. In front of all the patients. Baring in mind we were in the glass bit where if you speak loudly most things can be heard. She started screaming at me. I went in to the back office where my deputy charge nurse was sitting to diffuse the situation and she followed me in there and started screaming at me in front of the DCN. She wouldn't let me explain or anything. Just started laying in to me saying I had an attitude problem etc etc. I kept really calm and didn't raise my voice. She ended up storming off the ward and I was left to explain to the DCN what had happened.

This patient who was in love with Eileen had been listening and had heard everything. She saw that Eileen was "upset" and then had it in for me. She was a big girl. I mean about 6'5 and about 19 stone. She starts kicking the door trying to come for me shouting and screaming that she was gonna kill me. Anyway, after about 30 minutes it seemed to have calmed down and she was sitting watching TV. Another patient had asked if I could unlock her room. Usually we were supposed to have 2 members of staff going down corridors etc. The only person around was guy on security and he was counting everything in. I asked him to line of sight me go down this corridor and he did. I had opened this other patients door and was walking up and suddenly this other patient appeared in front of me. Blocking my way. No where to run.

She started having a go at me and got all up in my face and in a stupid act I told her to shut up and move out my way as was none of her concern. Luckily then, all the night staff were coming on to the ward. They saw security run out the office and all the staff ran at this patient getting her out of my way. They timed it perfectly. I think a few more seconds and I could have been toast. Re reading that it may look as though un-necessary force was used there but, when a patient has been known to be violent to staff in the past and I was cornered and a lot smaller than her. It was reasonable as there was a reasonable expectation that something could have happened.

I went in to the office and just burst in to tears. Proper sobbing. Embarrassing sobbing. I am not a cryer. I don't do crying. I don't do emotions that show, so if I am stressed I still appear calm as a llama, or what ever. It was even brought up in my appraisal that my lack of emotions made people think that I didn't care. Far from it. I just wasn't going to get in a flap and stress when other people were as didn't feel was the right environment to show stress in.

The thing that really rocked the boat for me was Eileen telling this patient that when the patient was transferred to another unit she would spray some of her perfume on to one of her sweat bands so she could take it with her and be reminded of her. I had already raised my concerns about this member of staff on a number of occasions. And this was just the final straw. I didn't know what to do. Luckily another member of staff had also heard that this was going to happen and reported it to a senior. I was just asked to clarify if that's what I had heard and I said yeh.

I just really did not like this member of staff. She was on the same team as me so we used to work mostly the same shifts unless one of us was on nights and the other on days. We used to have a rota for the shift so I always used to make sure I was the one who did it and so I wouldn't be stuck on obs with her.

At first I really enjoyed my job there. There was brilliant staff but after about 3 months they seemed to move all the best staff over to the male ward that was just opening and the new staff they were taking on were useless. So I used to feel responsible. Having only been there 3 months there were days where I was the most experienced member of staff on the ward and I had never done any work like this before.

They also cut down the number of staff. Meaning we would spend a 13 hour shift mainly on high obs or restraining as because of the lack of staff other patients weren't having their needs met and then kicking off when they couldn't have their needs met so they would have to be restrained. Which made things worse as you would need 4-6 people from a restraint so this would make the ward even more unsettled. At one point they removed all furniture from the communal area as people were throwing it when kicking off. So they turned it in to very low stimulus. Also patients weren't allowed in their rooms during the day so it meant that they were just lying around doing nothing and nothing could be done as there wasn't enough staff. It was a vicious circle.

I ended up making a complaint to the Charge Nurse saying I didn't feel safe on the ward and I was worried as I didn't feel there were enough staff to run the ward well. She basically turned it round and had a go at me saying that if I worked for the NHS they run on only 4-5 staff per ward of 20 patients so I should think myself lucky we weren't like that. So I left it. I thought if the NHS can manage we are lucky. And I thought all Psych wards were like that one. But 2 weeks later I was attacked by a patient. She punched me really hard in my head. It caused a concussion and meant I had to go to hospital as I was being sick. I ended up having a CT scan. I was quite ill for a couple of weeks and ended up having a couple of weeks off sick as I was still getting dizzyness etc as of the head injury. The day I went back to work was the day I handed in my notice. I was used to getting assaulted. All the time while restraining I was being kicked at or punched. But it was never aimed personally at me. This attack was. It was unprovoked and it really knocked my confidence. Also after telling the Charge Nurse about how I felt and nothing was done I felt really let down by the company. This same patient attacked 2 other members of staff and nothing was done. By another patient a member of staff was injured that badly an ambulance had to come on to the ward and take her off the ward. All because they didn't have enough staff and the ones they did hire were useless.

I did go to work for the NHS. And I loved it. It was not what I expected at all. Much better than private company I worked for. Yeah they did only have 4-5 staff on a ward but it was all you needed. All psych hospitals were not like the one I first worked in. The NHS were amazing and I actually felt like they cared about their staff. They looked after you. Forced breaks on you. At the private place I could work a 12-13 hour shift and only get a 10 min break.

So that's in a way where my title about being sane in insane places. As, sometimes I had to worry more about the staff than the patients.

There are lots more stories about that place I worked in. It was hell on earth. Out of all the staff that were taken on at the same time as me I was the only permanent one left after 3 months! Goes to show what kind of place it was.

I would like to go back there. I want to see how some of the patients are getting on. I have heard on the grapevine that some have left. I know Kay has left. I will always remember her. I will always look back and compare people to Kay. She is the first one that has left an imprint on me.


Anonymous said...

You may consider the attack upon you as "unprovoked"; however, you enter that ward as someone who holds the keys, and you engage in "restraint" and other forms of human rights violations against the inmates. You provoked it. Sorry.

Golden Psych said...

So you are basically saying that as a person who was doing a job I provoked the person in to attacking me.

Sorry, you are wrong.

These people were placed on section 3 or 37 because they were a serious risk of harm to themselves or other people.

No one goes should go in to that line of work and expect to be attacked. I interpret your comment as saying because I did the job I did and because I restrained people I deserved what I go. You should not go to work and expect to be attacked by people. People would not be restrained just for the hell of it. It was only used as a method of stopping people from harming themselves or where there is percieved risk that they could harm someone else. In the case where I was cornered by a patient it was a percieved risk and it's not something you can let play out.

Also they are not inmates. They were patients or service users.