Monday, 2 May 2011

Patients and Professionals.

I thought I would give the blog carnival thing a go this month. The Madosphere is hosting it and I am going to have a go at making a contribution.

The theme...Patients and Professionals.

I am not usually one for joining in with things but this theme kind of spoke out to me. You see, I have experience of both sides.

Currently I am doing a Masters in Social Work. My aim; to be a mental health social worker. I want to do my AMHP's training and work as part of a crisis team. To get on to the course I have worked as a support worker in hospitals on the psychiatric wards. I have previously written about my experience of working on a ward and how I was attacked by a patient which landed me in hospital having a CT scan and being off work with concussion and work related injury. I had a comment on that post saying that I provoked that person just by being who I was and having restrained people in the past. As a support worker no one likes restraining people. It is done only as a last resort of in an emergency situation if they are endangering their own life or they are likely to cause harm to another person.

 Restraining someone is horrible. It's uncomfortable, it's hot, it's sweaty and you can end up with your head in body parts of other members of staff that usually you would wait a good few dates before going there. There is techniques you learn where everyone has their part and place. It's choreographed. In theory it works smoothly and doesn't cause you as a restrainer any pain. In practice, it's messy. You grab on to the bit that is flying towards your face and don't let go. Getting down on to the floor is not the nice 3 movements that is practiced but more of a stumble and then you right yourself in to position. Very rarely do you have the nice 3 steps.

There is more to being a support worker than restraining someone though. A lot more. When people ask what I do (or did) the usual reply is "I couldn't do your job". I even had it from police officers. I went in to the job taking a £13k a year pay cut. So when patients in their anger said to me "you only do this for the money". No. I don't do it for the money as the money is shit! Yes. It is really shit. In my first job when I would work a 60 hour week every other week and a 30 hour week every other I was taking home less than £900 per month. I did the job because I wanted to do something with my life that was meaningful. Working as a sales manager in a high street bank was not meaningful. Ok, I used it as a stepping stone to get somewhere else but the somewhere else has the same reasons behind it. I want to be in a professional role that means something. I want to feel as though I am making a difference.

Having worked in a few different settings I have found the same attitude from professionals. And that would be a long the lines of "not another PD", ( can I just say here I appreciate I may look as though I am being demeaning by referring to it as PD, however, can I assure you I am not it's just that it is a lot quicker to type PD than personality disorder each time) "why waste resources on PD's, they are never going to change", "that's typical PD, attention seeking, look at me behaviour". I have also seen how quick they are to diagnose PD. It seems to be the first thing that is diagnosed. "You are female, you self harm, then that has to be PD".

 I have seen professionals make jokes about patients and their diagnosis. Not exactly professional. Some of the professionals I have worked with really should not be doing what they are doing. I have had doctors tell me how much they hate their job and they followed the Psychiatry route as they thought it would be easier. OK, having a joke sometimes can make the job a little easier. In my first role there used to be quite lot a jokes made while in restraint. Not because they thought it was funny, not at the patients expense but because it was a highly stressful situation to be in and it dispersed some of the fear/stress/tension that they may have been feeling. But to joke about patients themselves it doesn't look good. Joke with patients but not at them. There is a thing going round on the internet about being a psychiatric nurse...
You know when you're a psych nurse when...
1. The words 'Sorry, what?!?' Come out of your mouth at least twice a day.
2. A lighter is as vital a part of your working equipment as a ballpoint pen.
3. You're more worried about the staff then the patients.
4. You spend your first shift feeling like batman with half the stuff you have to wear on your belt.
5. The first hour of your shift is gossip and cuppa time.
6. You realise you're called a nurse because they couldn't fit nurse-councillor-cleaner-cook-occupational therapist-social worker-Mother-security-clown-voice of reason-secretary-bank clerk-typist-public relations-personal shopper- maid-waitress- expected expert on everything there is to know ever, on your name badge.
7. You've ever had to stuff your fist into your mouth to stop yourself laughing because it's just not professional.
8. You'll quite happily throttle anyone who suggests you're not a 'proper' nurse.
9. You're amazed at the sheer randomness of the things you're paid to do.
10. You don't have to eat general hospital food and you're damn glad of it.
11. A cuppa is the life blood of your working day. If it aint there, you aint there.
12. Students are a brilliant one size fits all scapegoat.
13.You'll complain about what a god awful job you have but you'd never leave cause where else would you meet a group of people who could make your jaw drop, your sides ache and your heart bleed as much as this lot.
14. You realise that every taught bit of restraint goes clean out of your head and you just grab the first thing coming at you and hold on!
15. No management issues means: Couldn't think of anything to say about this patient but I thought it would look bad to write 'Patient has done nothing all day'.
16. You'll fight to the death for a black biro.
17. People are always telling you how much they admire what you do but still tell you you're mad for wanting to do it.
18. General nurses when they find out you're psych invariably answer with 'What made you want to do THAT?' As if you've just told them you juggle radioactive material for a living.
19. You find yourself trying to pull an imaginary alarm outside of work.
20. You leg it to find out what all the shouting is about and realise it's actually none of your business as you're currently in a supermarket.
21. You begin to realise that you less you do, the better the job you're doing.
22. You go into a blind panic cause you think you've lost your house keys cause they're not attached to your belt
I found the private company I worked for the most unprofessional of all the places I have worked in. That and the fact none of my views were considered were the reasons I left.

I have found working in mental health a lot of the people I know who work in the same area do so because they have had their own mental health problems. What draws people to it. Is it because they are looking for answers about why they are like they are. I was drawn to it because of my own experiences.

I have seen it from both sides from professional and from patient. I have never been an inpatient (unless you count the 9 hours on a section 136). But I have had lots and lots of dealings within mental health services for my self. Does having the experience give me an advantage? And who has the advantage?

Well, in some ways yes. I feel I can benefit from having worked in that as it makes me more patient when it comes to receiving services. I know there are big shortages within the area. I know there is a strain on the area and it makes me more patient when I know why I am having to wait. I don't have the "they don't care, I am not important enough, I don't matter" kind of thoughts. Because of this I am patiently waiting and they don't have me on the phone chasing things up all the time (I am not saying that people who haven't worked in mental health would be, but it's the kind of person I am...I don't have much patience when it comes to things like this....being told I can have something but not knowing when and having to wait).

I do feel though when I am being interviewed by a professional for the first time or for example by the psych medicine department (which always interview you after you have received treatment for self harm), I have feel as though I get an attitude of "you should know better than to self harm, than to try and kill yourself". It's like because I have experience in that area I should see what it's all about and not do it as it is stupid. And the intelligence thing. Do intelligent people not have mental health problems, do they not self harm? What the hell has being intelligent got to do with anything?

There are disadvantages also.

The embarrassment.

I am so embarrassed by the things I have done. I hate being the way that I am. If someone said to me can I take away the self harm that it never happened and take away all the issues and interestingness I would jump at it. Mental health is so stigmatised. You would think as a person doing what I do and what I want to do I would possibly be able to be more open about things. But not at all. I am ashamed of the way that I am and I do what I can to hide it. If other people have mental health problems I am fine with it. I am not prejudiced at all. But when it comes to myself. I feel the stigma.

This also comes in when waiting in a waiting room and you see someone you know. I have seen ex patients numerous times now. Luckily I have not been recognised but I am embarrassed by it. There is also meeting someone in a professional context after you have met them in the patient-professional. And the other way around. Like when I was 136'd and taken to local hospital, the people that were on duty were people I had worked with numerous times. It was shameful. And I know. As a person training to be professional I shouldn't probably feel this way.

Another possible disadvantage is that I know how to work the system. In that I can say the right things to avoid being hospitalised. There are buzz words I know not to when you are flying you know not to say the b word. It's the same with this. My biggest fear is hospital. I'm sure if they knew what was going round in my head.. Or if they even read this there would probably be doubts about my ability to keep myself safe etc. They know that I self harm everyday. But they don't know my thoughts.

As a patient I don't feel that I have a very good relationship with the professionals. I am not very honest with them and I keep a hell of a lot of information to myself.

This is going to sound weird but, I like to think because I am also a fellow "professional" I am treated differently than I would do if I was Joe Bloggs. That they are more open with me, that they are more relaxed and they don't need to follow a strict protocol as I'm in the know and all that shebang. That is probably not the case though.

As a professional I am the patient I hate. The one who is stubborn, is set in her ways, wont listen to people, wont try certain things, and has things keep happening even though I have worked really hard putting a lot of effort in to working with her and yet she goes and messes it up and un does all my hard work.

I am an awful patient. I bet there are worse ones than me though!

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