This is a post about the systematic, institutional abuse of patients by mental health nursing staff.
I had the misfortune in the late 1990s of spending a year in total as an inpatient in a Big Dublin Hospital where many of the staff treated the patients with a mixture of disgust, antipathy and contempt. We were the lowest of the low, like convicted multiple murderers. They felt justified in treating us any way they felt like it, with a let up only if they thought we were trying hard enough to redeem ourselves on a daily basis. Behaviour like self-harm, suicide attempts, anorexia or being sectioned was taken as proof that the patient wasn’t interested in getting well and wasn’t trying hard enough, and was dealt with harshly. (Yep, sectioned patients were badly treated purely because they had been sectioned, and so obviously didn’t want to get better, you read that right).
I’ve posted a rather long screed about this on my blog, here, but edited highlights include:
- Roaring and screaming abuse at me when I made a superficial cut on my wrist to the point that I ended up with flashbacks and nightmares.
- Yelling at a depressed woman who tried to commit suicide on the ward, and denying her therapy or OT as a punishment.
- Giving an anorexic woman who had previously been in another hospital a hard time continually because the other hospital would no longer take her on their ED program as she had done it 4 times. Obviously she didn’t want to get well and didn’t deserve a bed.
- Talking about patients to other patients in a derogatory manner or gossiping about them at the nurses station within earshot of other patients.
I could go on. The medics weren’t as bad, but refused to do anything to help.
I know there are plenty of places in the UK with a similar attitude to their patients. (Yes, I know not all nurses and hospitals are like that, let’s not get defensive, ok?). As long as places like this exist, there will be a large population of mental health patients who hate every nurse and doctor in the country with a passion. If you’re wondering where some of the “psychiatry is evil” attitudes come from, there’s your answer. If I hadn’t encountered my current local hospital, which is very good, I’d never want to go anywhere near a psychiatrist or RMN again, regardless of the consequences.
I’m posting this here as I’m interested to hear if any other readers of this site have had similar experiences.
hmm… well lets see… large regional hospital in Australia, where I was sent into drug toxcicity (they didn’t bother to weigh me, just guessed, and were about 10 kilos off), and then when complained wasn’t feeling well, generally disorientated, nauseous and ataxic, battle-axe old school nurse insists that I get off my bed and go into the day room, as I was just looking for attention. Result: Fell over in day room, was escorted back to my room by same said nurse who told me I was behaving like a spoilt little girl (I was 23), then, when it got to the point where I absolutely needed to go to the bathroom and was to afraid of nurse to ring bell, tried to by myself, fell face first onto tiled floor breaking both of my front teeth and my nose. Would still love to see what the old cow wrote on that incident form… I sure took that attention seeking to a new level, huh? Three years later, two root canals, and a variety of other capping procedures am still trying to get my teeth fixed. Meanwhile.. when the medication error was noticed, there was no apology, they just lowered the dose. However, she was not typical of the nurses.. my experience has been with nurses 10% are just nasty burnt out Nurse Rachet types, a good 50% are fairly benign, but slightly weary and lacking in empathy, and the rest manage to see patients as individuals worthy of dignity and respect. I had so much respect for these ones because I saw how they were treated by some patients and it must take a lot to deal with that day in, day out and not be jaded. Psych Docs pretty much fall into two catergories Narcissistic A*holes, who believe you are not responding to their wonderful treatment because you are defiant, manipulative etc etc or Benign Shadowy figure, who just tick boxes, and treat you according to what those boxes say rather than actually listen to the patient (gosh, how annoying, a patient who can still speak clearly… must up her thorazine!) Have never had a decent PsychDoc in public hospital, but my private psychdoc was wonderful.
What a bitch.
I feel sorry for the thoroughly decent practitioners who have to try and pick up the pieces for their colleagues shortcomings…
I could tell you all about the malpractice I’ve seen, but it’s become so normal and unremarkable, that I just can’t be bothered.
My best advice is have an independent witness with you at all times. Even in the shower.
Unfortunately they wouldn’t have allowed my husband into the showers on a womens’ ward…
You’ll have to borrow a uniform for him off of CD
Sadly Socrates, men in uniform don’t really do it for me….
Uniform?! No chance. We kicked off when they decided we couldn’t wear jeans anymore…
Just out of curiosity DeeDee, did there seem to be much of a religious ethos at this hospital? Im just wondering because it’s in Ireland and all the high-handed moralistic tone that seemed to be behind a lot of the abuse.
I’ve come across my share of poor practice and misconduct while working in the NHS, but not on the scale and intensity that you describe at Big Dublin Hospital.
Actually this particular hospital was protestant and was founded by none other than Jonathan Swift.
Funnily enough, in my brief time in a public hospital in Ireland, the staff were LOVELY. Just, if I had stayed there, I would have been given one antidepressant and if that didn’t work, large amounts of ECT were on the menu. Plus there was no OT of any kind as there was no funding for it.
My theory is that Big Dublin Hospital, being a private although non-profit, VHI (Voluntary Health Insurance) hospital, had a lot of patients who would be treated at home by CMHT if they were to use the public system in the UK. There were a lot of middle-aged alcoholics and teachers and police (both professions with excellent health plans) who had had a single episode of depression. I’m not saying they weren’t sick, just that they weren’t as ill as a lot of the people you’d have seen on a public ward here or in Ireland. There were not that many severely ill people (my consultant told me I was the sickest person he’d treated in 18 months, I remember thinking, obviously doc, you don’t have any schizophrenics on your patient lists), and they had absolutely no clue how to deal with them.
The staff who had worked elsewhere, in the UK or Ireland, were fine. The problem individuals were those who had worked nowhere else. The surroundings were plush, but the staff training was shit, as were the staff to patient ratios (about 15:1). I think getting too complacent in their little middle class moderately ill bubble is what caused the attitude.
This stuff just makes me want to scream very loudly. Luckily, I haven’t seen any abuses like this in the areas I’ve worked. However, Madsadgirl is currently documenting her recent experience of being on an acute ward (http://madsadgirl.blogspot.com.....art-2.html), and is highlighting some of the daily crap that might not be enough to constitute abuse but is definitely pretty shitty practice.
Really sorry to hear your experience DeeDee. Sorry you are having a bad time with memories of it just now too. [[hugs]]
I don’t want to trigger anyone else’s suffering so please stop reading now if that may be the case..
My experience started by being raped repeatedly (by a MH staff person) during inpatient ED treatment. I know I am not the only one who experienced this. Can point people to the relevant inquiries into similar cases if needed. Also being punished for not meeting weight-gain targets by removal of priviledges – including the right to wear clothes (any clothes), or sit up, or speak, or wash, or have a light on in the room, or a blanket or a pillow. Also NG tube feeding as punishment rather than for therapeutic purposes, restraint as punishment… Those were 15-20 years ago. More recent experiences include a demo by a staff member how to ‘stop wasting their time and kill myself properly’ [having just been cut down from an attempt to hang myself I wasn't quite sure why they thought I needed the demo, but...]
My trust levels in MH staff start pretty close to zero these days, despite my current CPN being bloody amazing.
Em
I’ve experienced only very little that could be considered overtly abusive and only the rare professional who I genuinely believe doesn’t have good intentions toward patients. I’ve even had a lot of professionals I would term “nice”, but they still did a lot of crappy stuff toward me.
In my undergraduate thesis (there is a link on my blog, but I have to figure out how to fix it), I distinguish between direct oppression and indirect oppression. Direct oppression is where the perpetrators of the oppression are actively doing something to the oppressed group, something that is obviously wrong to many people involved and most outsiders (which analogizes to slavery and to mental health care like in Big Dublin Hospital, lobotomies, treating patients like zoo animals, etc. And remember, in the midst of this there were slave owners who really believed they were doing right by their slaves and psychiatrists who believed they were doing right by their patients.) Indirect oppression is fuzzier, it is harder to identify because it is more subtle (like in racism, where your white peers may seem to face less obstacles than your black self, but on a situation by situation basis it is impossible to tell if your obstacle is because of your race or something else, and like in mental health care where there is extra stigma for patients, extra, or extra-negative, stereotyping for patients, etc.).
For all my complaining, I cannot say with absolute confidence that in any particular situation, I was treated poorly or absurdly by mental health care professionals because they were thinking of me as a patient rather than as a person. In any individual situation, it is entirely possible that the professionals were trying their best, in ways I would find perfectly acceptable and admirable, but had perhaps misunderstood something I said despite their best efforts. However, it is clear to me that there was an additional factor, not necessarily intentional, that kept the professionals from treating me like a person rather than like a patient, because those absurd and awful situations were SO frequent. Most people generally agree that racism has far reaching consequences even when the people keeping those racial advantages and disadvantages in place aren’t doing it intentionally and are maybe even actively trying to destroy those privilege differences. “White right” is fairly widely acknowledged now. There are plenty of people, like DeeDeeRamona, who are exposing the direct oppression of mental patients. Since I haven’t experienced much of that oppression, and since I am reasonably able to articulate the indirect oppression that I have experienced, that is where I focus my efforts. “White right” doesn’t have quite a perfect parallel in mental health care (In wider society it might, and probably does, but I’ve never really experienced stigma from the wider population. The indirect oppression I’ve experienced as a nutter have come almost exclusively from within mental health care.) but this indirect oppression of patients, and the (extra) “right” that affords to mental health care professionals is what I am trying to expose.
[An aside: Much of the time when I tell my direct/indirect oppression analogy to professionals, they react with horror because I am "comparing them to slaveowners." It's like a conversation killer. But that was never what I intended. First of all, I'm not comparing them directly to slaveowners at all, but to racists. Secondly, I expect that most of these people are people who would acknowledge that however un-racist they try to be, they probably are not totally succeeding. In trying to illuminate these things to professionals, I know that I am telling them something very hard to hear. I don't expect them to be happy about it. But I do think that they often react in an unacceptably dismissive way when they object to being "compared to slaveowners" and leave. Part of their job is to tell patients things that are hard for their patients to hear. I am here returning the favor. They also teach patients good communication skills and tell patients that these skills are especially important for difficult conversations (though they don't reciprocate, even within the context of mental health care), and here they are refusing to communicate with me. Do you think it is fair of them to dismiss me like that? Can you think of a better way for me to broach the topic to get them not to dismiss me? (If I am being appropriate in this, I do think it is pretty inappropriate that I would have to soften what I say just to get heard, since I think that the professionals who leave the conversation are acting hypocritically, but I am very invested in getting heard.)]
An example of milder, indirect oppressive attitude rearing their head was in my local psychiatric hospital in the last five years. A notice was put up on the door of one ward saying that because of concern about drugs coming in ex-patients were not allowed to visit. Most of the patients in that ward weren’t even anything to do with drugs, they had a couple of detox beds, that’s all. I found this incredibly offensive and brought it up three times at the hospital management team meetings, and nothing was done, so I stopped going. I suspect the notice was an initiative of the staff on the ward, but the management did nothing about it.
Drugs did not stop coming in, funnily enough.
Yep. White privilege isn’t the only kind that exists, there are as many types of privilege networks as there are oppressions. I guess you could call this one mental health privilege. For any one incident, there is a reasonable explanation, but there are just so many.
One of the privileges white people have is that they don’t have to talk about race if they don’t want to. They can just decide not to listen if they don’t feel like it. Same goes for the mental health staff – many will not be receptive to have their privilege status pointed out and will shut down the discussion.
It’s unbelievably offensive to ban ex-patients from visiting, assuming that they must all be into drugs.
Secondly, I expect that most of these people are people who would acknowledge that however un-racist they try to be, they probably are not totally succeeding. In trying to illuminate these things to professionals, I know that I am telling them something very hard to hear. I don’t expect them to be happy about it. But I do think that they often react in an unacceptably dismissive way when they object to being “compared to slaveowners” and leave. Part of their job is to tell patients things that are hard for their patients to hear. I am here returning the favor. They also teach patients good communication skills and tell patients that these skills are especially important for difficult conversations (though they don’t reciprocate, even within the context of mental health care), and here they are refusing to communicate with me.
I have this problem a LOT. I understand that when I sit there telling them that what they’ve just done has made me worse rather than better, then that is difficult for them. I realise I’m challenging their internal narrative about being a helper. I realise they have a subconscious expectation of gratitude which I am not fulfilling. I realise nobody likes to be told they’re Doing It Wrong.
… But oh, god, who’s supposed to be the one with fragile feelings here, and who’s supposed to be the one who’s big enough and sane enough to take it?
Yes! Yes! Yes!
Movie quotes now?
Movie quotes? I don’t know anything about that, but I do know about vehement agreement.
When Harry Met Sally
This makes me very sad. I do hope you’ve had better experiences and help elsewhere: the comments you’ve been posting are certainly perceptive, witty and in my opinion valuable. Clearly I’ve had a narrow escape as I did enquire about training at that hospital (it has to be St Patrick’s) in the 60s but there was a two-year waiting list. As to the religious moralising comment, as a religious and part-Irish person I have to admit that until very recently most Irish Catholicism has been Jansenist and most Irish Protestantism has been Calvinist, both of which are intellectualised forms of self-loathing leading to abusive treatment of others! It sounds like something that used to be very common in the days of uniforms and white coats, namely staff defining themselves as ok as demonstrated by said uniform/white coat, and patients as not-ok by virtue of their status as patients, exactly as you describe. Oh dear. Mind you, there are are some right feckin eejits work for CMHTs, as well as some excellent people.
Yep,St. Pat’s it was. BTW the staff there were all still wearing uniforms at the time (10 years ago). The medics were not though. The problem is not when the odd eejet gets a job with a CMHT, it’s when that eejet is allowed to run riot unchecked and no-one sees anything wrong with their behaviour. When the eejet is recognised as such and quickly sat on by management, damage is relatively limited. If you give every bully and idiot in the country free reign and teach them that the patients do not matter, St Pat’s is what you get.
Mmmm. It’s not the individuals, it’s the institution that lets them flourish. The individuals wouldn’t have power without the institution backing them up. I am largely scornful of the “few bad apples” defence, because a) there seems to be a lot of them and b) the rest of that saying goes “ruins the whole barrel”, remember.
It is a bad barrel.
Yes, but I suggest the problem can often be the management, generally with no clinical experience (I’m not talking about ward managers but higher up the food chain), looking for ways of doing things more cheaply (except when it comes to hiring more managers) and utterly paranoid about litigation. This leads to a culture in which a One Size Fits All and anybody different from that (i.e. just about everybody) is regarded as at least a problem and probably non-compliant. None of any of that excuses plain nastiness which as you suggest you are more likely to find in a residential context. On my first day as an NA waiting to go into School in Surrey in 1966 the charge nurse, a Dubliner who’d trained at The Gorman (St Brendan’s, Grangegorman, Dublin, for the rest of you, a hospital that at that time had a reputation for this kind of thing) punched a patient in the solar plexus before turning to me and saying: “I hope you’re not one of these Florence Nightingales”. However, my remark about CMHTs referred to stupidity rather than bullying. Recently, wearing my carer’s hat (not too starched, I hope) I have had to make sense from the actions of an Assessment & Intervention Team staffed by very strange and dilatory people in a little world of their own (GP: “Don’t get me started about the mental health!”) who, thankfully, handed over to a Crisis Management & Home Treatment Team staffed by some of the best nurses and psychiatrists I have ever met, which in turn liaised with a residentaial unit that was outstandingly good if a little prone to staff politics. A thought: the Irish Times is pretty good at investigating the kind of thing you describe.
No TWIM yet?
I’ve finished mine.
And we’ve a picture of some boobies *snicker*
Bloody hell, Socrates, you get everywhere! Minus two, stay in your room for the rest of the weekend and consider yourself lucky to get any dinner for replying to my boobs gibe here rather than in Jolly Banter or whatever it’s called. You Know Where Your Comment Belongs, hang your head in shame…
My experiences vary. From staff who care as much as they can and wish they could do more, and break the rules giving me the love, hugs and comfort that i want and need when no-one is looking – to stuck up students who think they are charge nurses already and tell their fellow students that they can’t go on a break because they are “Babysitting” (otherwise known as being on 1:1 obs with a very distressed susie belle) when i was clearly well within earshot. Luckily the caring staff, on learning the reasons behind my distress over the comment, made it clear that no matter how she felt about me and my actions which resulted in the obs level, voicing comments like that was not acceptable.
And then the many frustrations when the staff who do work hard and actually give a sh!t, aren’t on shift so I and my fellow patients end up keeping an eye on an older lady suffering with severe early onset alzheimers (she was 6 months too young to go to an eldery ward! – where they would have had more staff on shift to cater for such patients) to make sure she didn’t go into our bedspaces and throw our belongings out of the windows! I mean afterall why should the (not-so-bothered) staff care? it’s not their belongings, clothes etc, is it?
And the big (overweight and tall) coloured (male) bank nurse who was almost physically restraining me at night (on 1:1 again) because i was biting my nails (a nervous habit i’ve always had since i was a toddler) was rathering terrifying to an 18yr old of petite stature. In fact him standing in my door way (this was on the PICU with separate rooms) at night while i was supposed to be trying to sleep/relax, doing his 1:1 obs, was frightening enough. Was that supposed to scare me into not harming/trying to kill myself? Scare me into ‘appropriate’ behaviour? I don’t know but luckily the nice female nurse running the shift, got rid of the big scary man. I think she thought he was over-reacting to the nail biting too.
There’s good and bad in every aspect of life. I think sometimes though, there are some people who aren’t perhaps suited to mental health nursing, and are perhaps used to look after people who are perhaps too unwell to do anything, or are the heavy mob simply employed to restain those who become aggressive and violent.
Y’see, if I had complained in St Pat’s about the nurse who told another patient within my earshot that I was “for the birds” I would basically have been told to fuck off and nothing would ever have been done about it. Especially since it was the charge nurse for that ward who did it.
guess i was lucky that the those nurses who cared, were a bit like mother figures, at times and being 18 i was the baby of the ward age wise. On the secure unit i think the female nurses kind of liked having a patient who was simply severely depressed rather than aggressive and violent – in fact there weren’t just tears from me when i moved back up to the open ward. In fact i’m still in contact with one lovely charge nurse from that ward, to this day, although she no longer works there still.
I’ve been doing some thinking recently about how I felt reading some things about myself on my psychiatric files. There’s something rather nasty about the way in which rumour and gossip about a patient gets written down and then is taken as gospel.
But this led me to thinking further about the attitude of mental health professionals towards service users. I don’t know why we use the term professionals, because the behaviour seems anything but professional. If I go to a dentist or a solicitor, I’m treated as a respected patient/client. What I want is relevant. The process is driven by my needs, not by their system.
When I see the nurses and doctors at the CMHT, it’s driven by procedures and paperwork and all for the benefit of the system. It’s not about whether I’ve got the help I need, it’s about whether they’ve done the latest risk assessment (which is overly long and complex).
I remember some years ago travelling to London from over a hundred miles away for a series of sessions with a specialist sports physio. To be accepted as a patient of one of their physios, I had to sell myself as a serious, high-level sportswoman. However, after a couple of sessions, the physio asked me how I’d got on with my Christmas shopping. I was surprised – surely their interest was in my sporting career? But no, he was more concerned about the things that he’d picked up on that he realised I really wanted (to be able to go about my everyday life without being in excruciating pain – I was willing to put up with pain whilst training). That’s professionalism.
Just going back to what gets said about me, I’ve begun to realise that it’s safe to tell the world at large about my mental health problems (not just anonymously online) because there’s nothing that anyone has ever said, no prejudice I have ever met, that compares with what I’ve encountered within the mental health system.
All of which isn’t to say that I haven’t encountered some lovely, caring, professional people working in mental health.
I don’t know why we use the term professionals, because the behaviour seems anything but professional. If I go to a dentist or a solicitor, I’m treated as a respected patient/client. What I want is relevant. The process is driven by my needs, not by their system.
I am in the US and spent much of this past summer on various inpatient units (four different hospitalizations) and this is so true…
After my first suicide attempt I nearly died so I was treated for a week in the “regular” hospital where everyone (nurses, techs, docs) explained everything to me, all my meds, all the treatments, my prognosis, etc. Everyone was polite and professional and they treated me like someone both interested in her care and capable of partaking in it and directing it. They asked me questions and answered mine. If I didn’t want a specific med, they would discontinue it. They fetched me things (I was all connected to tubes). They kept me company.
When they moved me over to the psych hospital, all that changed. The “psych techs” on the unit not only had no background in psychology, they often had no college degree whatsoever. Their sole job was to keep tabs on and control the patients. With few exceptions they used their positions of authority to play tyrant over their captives. The hospital kept all the bathrooms locked because some kids on the adolescent unit had tried to escape through a vent in a bathroom, and the unit staff commonly denied access to bathrooms until it was convenient for them to open them. I once watched a woman with incontinence urinate on herself standing at the nurses’ desk because the tech refused to open a bathroom for her; he decided she’d asked too many times. Another woman peed in the trashcan in her room because the tech wouldn’t open a bathroom for her late at night. There was no source of drinking water for patients and we needed to rely on staff to fill pitchers for us; they sometimes went hours before giving us water to drink. They denied us access to our toiletries. They denied access to PRN meds. They locked us out of our rooms. They sometimes “made up” rules to punish patients. A favorite was “you can’t go to the cafeteria because you did [something that was ok yesterday but not today].” Most of the time, they completely ignored patients. I could walk up to the desk, look one of them in the eye and ask for something, and he or she would literally turn their back to me and walk away.
There were only a few nurses and their job primarily was to give meds. They worried me a lot. I once had to explain to a med nurse in a psychiatric hospital that fluoxetine is the generic name for Prozac. Another med nurse once tried to give me someone else’s meds (who had the same first name as me); when I protested that I took only one pill and she was trying to give me a cup with at least seven pills, she wrote down in my chart that I refused my medication. My chart contains inaccurate information about ADLs, about eating, about meds, about diagnoses. I know this only because my doctor testified in front of a judge to things that absolutely cannot be true. They would never let me see my chart even though a right to see my own medical records is included on the list of patient rights I signed every time I was hospitalized.
These were petty annoyances though. Far worse was the complete loss of control over my life. The assumption seemed to be that I was incapable of understanding and partaking in my own treatment. No one ever told me what I was diagnosed with and it changed every time I was in the hospital. At some point, someone checked a box in error and I got a diagnosis of substance abuse disorder. If they believed this to be true, they never once offered me treatment or counseling for it. I found out about in an intake interview for outpatient therapy. No one ever discussed treatment options with me. Each of the different doctors I saw had their own “favorite” drug (one was hot for Pristiq, one was all about Symbyax, etc.) and regardless of my preferences they would insist on prescribing them. Sometimes this was without my knowledge; more than once I found out from the med nurse that a med had been changed or a dosage increased. Once I found out while sitting in front of a judge that I had “refused” medications I had never been offered; my doctor told me later he had just prescribed them that morning and I was called away to the hearing before the med nurse had made her rounds. I am very medication-averse but refusing medication was nearly impossible if I ever wanted to leave and they were simply not interested in discussing any other therapeutic approaches. The social workers and psychiatrists routinely spoke about my care with people they were not authorized to talk to and kept trying to involve them in my treatment, even after I voiced my strenuous objections. They never listened to me, never took anything I said seriously, and any suggestions I had about my care were dismissed. When I argued with them about some aspect of my care or other they would merely threaten me with ward sanctions (loss of my meager privileges), longer term commitment (up to six months), and/or discharge to some other, more heinous facility (halfway house, group home). All of these would have been fine if they had been proposed to me as something therapeutic but each time it was basically “if you don’t do this, we will make you pay.” I kept as much personal dignity as I could, lied my ass off to tell them what they insisted on hearing, and finally got out when my insurance company decided they’d paid for enough.
I don’t hate all mental health professionals. I have had excellent therapists and good psychiatrists and met any number of caring and motivated nurses and social workers during my years of treatment, both inpatient and outpatient. But the system sucks and no matter how good the people are, I am not encouraged to involve myself with it anymore. The effort involved in finding the good ones is too much and the risk of getting sucked into real horror is too great.
Wow, I’m pretty gobsmacked at some of the experiences described here.
My two cents? I’ve had some fairly dire experiences within the NHS and some even worse once privately but I still think that everyone meant well, even if it was in a screwed up and sometimes exasporated way.
The GP who I saw when I was 14 eventually said to me, “scar yourself if you like, feel free to commit suicide because there’s nothing more I can do for you.” I walked out and didn’t return until I had tonsilitis over a year later at which point he apologised and I knew that he meant it. I think that because I hadn’t been able to explain why I was doing what I was doing he’d chalked it up as a teenage fashion fad. In the mean time I’d been seeing a private counsellor who would finish each session (ten minutes late) by telling me that I should be in hospital and she would refer me if I didn’t buck my ideas up but didn”t want to abandon me like everyone else had so she wouldn’t yet. I didn’t even know that everyone else had abandoned me. She’d generally spend the rest of the hour talking about her own problems/clients/dead family members etc. Again though, she did want to help but she was just in over her head and wouldn’t admit it at the time, she more or less did a couple of years down the line.
Cue psychiatric services when I was 17. I’ve seen some very good staff, a fair few who weren’t desperately memorable and a couple who should have stayed in bed. Having seen three different trusts, they all had their good and bad points and its hard to chalk one up against the other.
My main complaints? Lack of communication – I have to tell my shrink if I’ve been in hospital. Complete inconsistency – what’s inconsequential most of the time can suddenly grounds for suggesting admission. It’s nigh on impossible to get a straight answer out of anyone, be it about treatment or when I have an appointment – the booking system is fail where I live. I just seem to get referred to places over and over again without ever seeing anyone, even the staff remark that I seem to have been passed from pillar to post.
Basically I feel like I can’t open my mouth without screwing myself over. After years of complaints that talking to me was like getting blood out of a stone I decided to be a bit more open and promptly got slapped with a diagnosis of borderline personality disorder (which I still believe is partly down to a misunderstanding). Everything I say is now seen through that construct so if I take the plunge and admit that I’m self harming or feeling suicidal nobody much suggests anything I can do to help myself, it gets chalked up as me being manipulative or I get told to come back next week/in three months in the hope that it will have disappeared. Since this point my experiences with MH services, bar one nurse, have been counterproductive.
On the bright side, my inpatient experience was ok.
I decided to be a bit more open and promptly got slapped with a diagnosis of borderline personality disorder
Snap!
Yup, same here too
I find doctors who are insecure, and cling to their authority a bit too much, are very bad at dealing with the aftermath of such events.
My current psychiatrist has clearly never heard the expression “once bitten, twice shy”. He expects every session to take place in a vaccuum, and if I don’t present as a completely blank slate then I’m just being difficult. And if I talk about things other people have done, he gets really defensive, and really insistent that he didn’t do that. Or if I talk about stuff he’s done wrong in the past. I’m not trying to assign blame; I’m trying to make sure something’s been put in place to make sure it doesn’t happen again. This is apparently personally hurtful to him. Poor baby.
He gets pissed off when I object to the way he words things, too – but in the end, his written record will be believed and my objections will not.
Generally, total failure to understand the nature of institutional power, and how it feels to be on the wrong end of it.
My current psychiatrist has clearly never heard the expression “once bitten, twice shy”.
And again.
You might find these interesting:
Let’s Face it! She’s just too F****d – The Politics of Borderline Personality Disorder
Women at the Margins: me, Borderline Personality Disorder and Women at the Margins (p 124)
I wouldn’t advise suggesting to your shrink that the diagnosis is a pejorative though, they don’t like that. They also don’t take well to suggestions that you might know yourself better than they know you.
Ta for the links – I’ll check them out. I’ve been reading Dana Becker’s Through the Looking Glass: Women and Borderline Personality Disorder. I like it. Its argument goes:
1. They’re throwing this diagnosis around when what they actually mean is “I resent this patient being a pain in my ass”; and
2. What they call borderline behaviour is actually completely predictable for someone who’s on the wrong end of a maddening power imbalance and can’t get her needs met.
Yup, the “How to Make a Borderline” guide that was on here a few months ago was a very apt description. When you find yourself on the wrong end of the power balance what the hell are you meant to do though?
I’ll have to check that book out.
Lorna, are you the same person as me? Because sometimes it seems that way, except that I’ve never said these things as a patient because I was too much a shy scared little quivering heap as a patient. I admire you for being able to say these things while a patient.
*Sigh* I used to be too scared to talk. Everybody liked me better then. I swear one of the reasons my current lot want me off meds is that I’m so much more docile when I’m too depressed or anxious to argue with them. Me in recovery is an uppity bitch.
I was actually hoping that my experience wasn’t typical and that you’d all say “nothing like that has ever happened to me”. But now I see that’s not the case, it’s widespread.
. Having a hard time dealing with this.
Really sorry you are having a hard time dealing with it.
I know this probably won’t be any comfort, but that seems an entirely understandable response on your part, especially given what you went through in hospital in Dublin. I’ve found most people’s reaction to issues such as institutional abuse and abuses of power in mental health are to deny that they exist, or to seriously downplay them, which, given your own experience isn’t really an option for you, so you are faced with the rather unimpressive alternative of having insight into the reality of some of the awfulness that goes on out there, and then having to deal with that as well as your own memories. Although I can’t know what that’s like for you, I really feel for you there.
I don’t have much helpful in response, and I’m sorry for that. Other than hugs, and to suggest that if, like me, you are given to wanting to seek out and rectify all the injustices in the system yourself, or feel some weight of responsibility for doing such, that now probably isn’t a great time to be doing that (sounds like you have enough of your own stuff to cope with just now), and also that in having spoken out about what you went through, you have done a lot more than many of us manage to in fighting against such injustice already. Perhaps worth seeking some help for yourself too. That’s what CMHT/homecare and MHAS [depending on time of day, clearly] are there for (supporting you), and it sounds pretty understandable you’d need some extra support thinking about all this. A bit ironic suggesting those as sources of support given the topic of the thread, but I think you said your local experiences haven’t been too bad? Sorry if I got that wrong. Hoping things get better for you soon.
Em
thanks.
I’m sorry you are having a hard time with this. For what it’s worth, hearing other people venting their frustrations does, to me, have some redeeming value in that it validates my experiences. Within mental health care, I was told so many times that I was exaggerating or that there wasn’t anything nefarious going on. I was invalidated in so many other ways, too, that I still struggle with doubting my own judgment about this and other things. So every time I see people complaining about mental health care in similar ways as I do, it validates my own experience, which I find very valuable, because I have such trouble finding that validation and because this is something I am so passionate about. Yes, it is horrifying to think how widespread these awfulnesses are, and my heart breaks over it, I fall asleep sobbing over it on a regular basis. I guess that for me, these discussions don’t strike me as much in that way, maybe because I am already grief-stricken that this would be happening to even one person (especially someone already struggling with mental illness). Maybe, somewhere in the depths of my mind, I didn’t doubt that these things were happening, which is why that aspect of this isn’t so striking, even while I crave validation that my perception about this is accurate.
Sorry to hear it’s affecting you badly. I tend to enjoy the power of a good cathartic rant, so it doesn’t always occur to me that other people don’t. Your posts here and in your LJ horrified me; I’m so sorry you’ve had these experiences. Take care of yourself.
Well, this is all thoroughly depressing reading for someone who was once a practitioner and now makes a valiant effort to educate the practitioners of the future. Mental health staff can have mental health problems as much as anyone else, so treating patients as if they were lesser beings makes no sense – it could be you in that bed sometime in the future. But then again, one of the most unpleasant nurses I ever met was someone who had been an in-patient herself some years before and had clearly learned nothing from the experience.
I think what is key to all this is self-awareness. Some staff act like bastards because they’re stressed and burnt out. The nature of mental health work makes stress and burnout extremely likely, and with that comes a depersonalization of the patients coupled with extreme cynicism about the job they’re doing and the effect they’re having. People who are more in tune with their own feelings know how to recognize this when it arises and to take remedial action.
Also, some patients are extremely difficult to look after – aggressive, demanding, manipulative, divisive, violent – and there can be a great sense of helplessness that goes along with trying to care for someone who is constantly in your face and/or seems to be going nowhere. Sometimes, it is tempting to switch off and stop trying, and some staff clearly give in to that temptation.
There is, of course, the nature of the services themselves. Anyone who’s worked on an acute ward can testify to the complete lack of control you have over your own workload, and the constant negative scrutiny of others. Good work never gets recognized, not by anyone. Bad work is all over the place, and policy seems to treat everyone as guilty until proven innocent of being a bad practitioner. It can feel as if people are always looking for reasons to criticize your service – how well I remember some equality and diversity advisory group woman coming into the ward and demanding to know how many black people were on section, with the implicit suggestion that this meant we were all racist bastards. As it happened, at that time, there was one black woman on a section, all the rest were white.
And finally, yes there are some people who are just tossers.
the difference, Beakie, is if the institutional culture is one that actively encourages the treatment of patients with hostility and contempt, with a complete lack of any repercussions for those who act abusively. If the management don’t tolerate it, you’ll still get isolated incidents but not an all-pervasive culture of mistreatment.
In those sorts of institutions, I would hazard a guess that the staff also tend to get abused by management and are more institutionalized than the patients.
I couldn’t give a shit, I worked in a restaurant where the boss terrorised all the staff but we were nice to the customers. And all we were doing was shoving plates of food in front of them.
I tend to think that giving a shit about everyone involved in the big old clunking system – patients, nurses, doctors, managers, carers, cleaners etc. – is the only way to improve it. Of course, I’m not asking you to give a shit about the nurses of St Pats who were bastards to you.
Beakie, I try so hard to be understanding about these things. I know that the job of a mental health care professional is hard, sometimes really really hard and really really thankless. I think that you, too, try to understand that being a patient is really really hard and really really thankless. Neither group has much patience for the other, much of the time.
But isn’t it your (speaking generally of mental health care professionals) job to be self-aware, not least because you teach self-awareness to patients? And isn’t it your job to understand that different patients have different needs and that it can be their illness that causes them to be aggressive jerks (though some people are just aggressive jerks, mental illness or not)? On what planet does it make sense that the patients should be responsible for making sure they aren’t getting abused by the professionals?
I try so hard to be understanding and diplomatic when I talk to professionals, but it doesn’t seem to work. So often they will still disregard what I say. Outside of Mental Nurse, I still haven’t managed to get any professional to have a straight, honest conversation with me. Yes, I know I’m saying things that are uncomfortable for you to hear, but that doesn’t excuse people generally from listening to criticism, and it especially doesn’t excuse mental health care professionals from listening because they are all too willing to tell me, as a patient, things that are uncomfortable to hear and because they regularly tout the benefits of straightforward discussion. This makes my blood boil. Nothing in my life has frustrated me more.
jessa – I’ve encountered people who I wouldn’t trust to look after a goldfish let alone vulnerable mentally ill people. Trouble is, it is very difficult to shake staff off once they’ve latched onto the NHS teat, a situation I find as intolerable as it sounds. I generally believe, though, that the majority of people come into this sort of work because they want to be good and caring, but that circumstances conspire to frustrate that aspiration for some of them.
I understand the bureaucracy of it, but — bloody hell! — that isn’t a good enough excuse.
Jeremy Lauarance wrote about this in, ‘Pure Madness: How fear drives the mental health system‘ (2003).
He states;
http://www.independent.co.uk/l.....04703.html
The essential driver, according to JL is risk aversion – and risk aversion results in more drugs and more patients being admitted formally.
Needless to say staff on the ground feel vulnerable because when something goes wrong, and if you hang round long enough there is a good chance it will, it will be they rather than those far away from the coal face who will be taken down.
Funnily enough when NHS staff become patients themselves they often complain about the standards of care they receive.
This has at least two implications;
My own view is that health profession need to be more circumspect in deciding who they can help.
As well as Laurance’s ‘fear’ factor. the NHS is its own worst enemy because it tries to do too much for too many.
Imagine how much nicer the acute wards would be if admission rates were reduced by 50%.
But since the closure of the asylums (another failed system) don’t some wards ‘hot-bed’ patients? – admitting acutely disturbed patients into the bed of a patient on weekend leave (thus running at 100%+ occupancy) – at least that’s how it works at my Trust.
What effect does that have on staff – some patients settle (relatively speaking) and become well enough to go home, but it is possible that an extremely challenging individual is admitted to the recently vacated bed, and was well working to establish a therapeutic relationship with that person there are the needs of the other 25, or 30 patients on the ward.
Now as we have seen here and from Laurance’s observations this work must be carried out in an environment of barely concealed contempt – but bear in mind the nurse looking after you has very little power to change the system themselves?
Is this supposed to be a justification for having a nurse scream in my face that I am a waste of air? I think it’s realistic to expect not to leave hospital with an additional illness (PTSD) as a result of staff behaviour. I think it’s realistic to expect that such behaviour will be investigated and punished if I complain about it.
I have absolutely no idea how you make the leap from my comments to a suggestion that I am trying justify serious misconduct.
I offered a perspective from the ‘other side’ (since clear divisions are set up at the outset) – ‘failings’ in the mental health system are reported all to frequently and it is my view that structural reasons are an important part of the equation.
I am not seeking to exonerate ugly practice, but we still have to ask ourselves why ‘good’ people (in the main) do ‘bad’ things?
Ok fair enough. IMHO, the staff behaved the way they did at St Patrick’s because they had thoroughly absorbed the institutional culture of hating the patients and resenting them. even the patients absorbed it after a number of weeks and tended to collude in the bullying of patients the staff didn’t like. It’s very easy for people to get that way in a closed system without moderating outside influence (eg Stanford Prison Experiment). That’s why it’s really important that the people running the nursing care (in the case the matron and deputy matron) make it their business to ensure that that type of attitude will not be tolerated.
In the main, staff who had worked elsewhere were not a problem. It was those who had spent their entire working life in St Patrick’s who were the problem. They were poorly trained, encouraged to have attitudes and things like breaching patient confidentiality were not considered a big deal.
I understand what you and Beakie are saying, and generally I have a lot of time for people working frontline in public services. I do it myself. It tends to suck a great deal.
You know there’s a however coming, don’t you?
However, you’ve got to be aware of the lines of power and status between healthcare professionals and patients. I know that, as an overworked and underpaid worker, under huge amounts of pressure, it doesn’t feel as though you’re in any kind of privileged position. But compared to a patient, you are. And I’m afraid it does sort of come across, to people who’ve dealt with a lot of abuse from the psychiatric system, as dismissive of their experiences.
I have literally been out of hospital for a couple of weeks and I am in the process of writing about my experience on my blog. I’m afraid that what you describe still happens now that we have moved into the 21st Century. It doesn’t seem to matter how much publicity is given about mental health problems and the stigma and discrimination that sufferers have to endure, it still happens. I found myself suffering a fair bit of discrimination from the nursing staff and care support workers on three fronts; first because I was a voluntary patient, secondly because I was suffering from severe depression and wasn’t a schizophrenic, and thirdly because I was white. Bear in mind I am writing about being in a hospital in London, not Zimbabwe, and you can see where some of the problems lie.
My experiences as an involuntary psychiatric patient on an acute inpatient ward (which wasn’t the case, I agreed to go every time, but that is another story) have scared me so bad that I will not see any therapists at all (or even a regular MD) in case they decide for whatever reason to send me back. Once someone makes that call, I completely and irrevocably lose control over my life and my treatment and I would literally rather die than go back there. That can’t be the goal of treatment, can it? I mean, I’m not any better. They didn’t help me. I’m just coping on my own, and not all that well, actually. But that place was so utterly nontherapeutic that I actually believe it would make me worse to be sent there again.
Oh, they thought you weren’t sick enough / too privileged to merit attention?
I have a small scar on my thumb after being cut by a disturbed psychiatric patient – I have been spat at, and verbally abused (especially in A&E).
I have heard relatives, and indeed patients tell outright lies about staff – not all of these incidents can be explained away by symptoms.
We also have to bear in mind that nurses have been killed on duty and such episodes must contribute, at least to a certain extent, to the kind of mistrust that sometimes exists between staff and patients.
http://www.timesonline.co.uk/t.....388531.ece
This thread provides evidence that there is great antipathy toward (some) nurses, although I fully accept the system itself must be populated with a significant population of bullies or burnt-out ‘turnkeys’ judging from the examples given?
The obvious question is WHY this miserable state of affairs has arisen, or has it simply always been so, or maybe even worse?
Well, in St Pat’s, because it was private, there just weren’t really any violent or “rough” patients. Maybe the odd one on the male wards, but I was on the female wards. They weren’t working in a tough inner-city borough with minimal resources. Out of around 100 female beds, there would be, on average, around 10 sections, half of whom were sections because they were over 70 and suffering from dementia as well as whatever mental illness caused the acute crisis. So they had no excuse.
OTOH, the staff on the public ward I spent 2 weeks in, despite having no funding, difficult conditions and the entirety of the county’s severely mentally ill to deal with were kindness itself.
This is perhaps not a good forum in which to use scars as proof of crappy experience. Just saying
What does that mean, Lorna, exactly? Are you talking about scarred psyches or AECN’s thumb? Or both? So out with the brushes, sweep it all under the carpet because such things aren’t quaite naice. After all, those with £25 an hour or more to burn can go into private therapy, can’t they? Which, as Freud said, will only “turn disabling misery into general unhappiness”. Best to stop these things altogether and for that you really do need to be upfront about things that happen and their effects. This includes traumatised A & E nurses as well as service users, we’re all in the same boat.
Jaysus Michael it was a joke. A reference to the large number of us on here who are self-harmers.
We used to have a self-harming cat who would pull her fur out if we were out for too long.
Sorry, Lorna, dimwitted of me. I shall now point my finger at my right ear and say “red” backwards…
And, from where I’m standing, it could equally well be a reference to the fact that some of us have, as patients, gotten similar injuries from the staff. That, and to us, a psychic injury is a lot more significant and more difficult to deal with than a physical injury, and most of us have received those from professionals in spades. I’m not saying that the injuries of professionals from patients aren’t serious or lamentable, but that you aren’t necessarily going to get a lot of sympathy for them, for entirely commonplace (i.e. not crazy) reason.
I’m talking about scarred arms.
It means that it could start a “my scars are bigger than yours” dicksize war, which is idiotic at the best of times, but doubly so in a forum full of self-harmers.
And as Jessa says, deaths in psychiatric care happen to patients, too.
But mostly it was a way of saying “let’s not go there cos it’ll only turn ugly”, so well done on that.
That was unnecessarily snarky. Sorry.
At risk of getting my head ripped off. Two words:
Complaints Procedure.
I can imagine, actually I can’t, this would be a thoroughly dispiriting and useless experience. But if we have any managers remaining reading this that is probably what they are thinking.
Well, I wrote a letter and got no reply. That was the end of the complaints procedure.
I don’t want to rip your head off, but “complaints procedure” is an entirely inadequate answer. I’m sure I was told of their existence, but complaints procedures never occurred to me as a remedy for my concerns, probably because I was too preoccupied with other things to really absorb the info about complaints procedures. As a patient, it never would have occurred to me, if I did know of complaints procedures, that the people to whom I would make the complaint would react any different than the staff to who I regularly complained. They might even speak to the people I am complaining about, and I might for that reason fear further retribution. As a patient who thought herself entirely worthless, I often believed I deserved the mistreatment I received, making me unlikely to speak up about it. But that doesn’t mean it is okay for it to continue, whether the victim is upset about it or not. As a patient, I was often much less articulate about my complaints than I am now. No complaint about a vague sense of oppression is going to be taken very seriously, it would be hard to act on such a complaint, but that doesn’t make it any less valid. “Vulnerable populations” as a concept exists for a reason, part of that reason being that they are not expected to be able to make complaints or otherwise stand up for their own rights. Relying on complaints is generally a poor way of ensuring that you are doing things well, and it is an especially poor measure when combined with the above factors. Complaints procedures require a lot of assertiveness and follow-through for them to maybe even have a tiny chance of being considered by the powers that be. Many patients do not have the assertiveness and follow-through required.
I suspect you are trying to be practical, dazed, but complaints procedures are not a very practical solution to this.
*ahem*
Jessa you mistake me for someone with any faith in the complaints procedures within mental health. I got pretty much the answer I expected.
Management will still say if these things are not reported they can do nothing about it. Which probably explains why they got a slapheads post all of their own.
The problem is that simply writing a letter of complaint is in itself extremely traumatic. Not something I’m willing to do unless there’s a chance the letter will go somewhere other than immediately into the recipient’s bin.
True. I started mine a few times, and gave up in floods of tears by the second paragraph each time. A lot of the time, I suspect people rely on that very thing.
Aren’t I red in the face now. Well, it is still relevant, even if you agree with me about it.
Think Clare Allan covered this one.
I hated the acute ward I was on.
I was there under section for 28 days and voluntarily for a few weeks afterwards (well, I say voluntarily, but I was persuaded to stay during an assessment with two doctors and a social worker. I’m pretty sure what would have happened had I said no…)
I don’t remember much of the first couple of weeks or the MHA assessment, but I do remember being sat in a room in A&E with a security guard posted outside and having to be escorted by him to the toilet in front of a waiting room full of people (nothing like maintaining a little bit of dignity).
I then remember being shuffled of into a secure car by the security guard (a different one as I’d waited for hours), a nurse and the three people who would be transporting me the 100 miles back to the local acute ward. This was, again, in full view of everyone.
On the ward I didn’t want to talk to anyone, so lack of interaction with staff wasn’t a bad thing, but some of the other people staying there became very distressed when staff did not listen to them. They checked on me every 10 minutes or whatever they had written down on their piece of paper on a particular day, and that was that. I do wish they’d been more considerate at night though, because it’s hard enough to sleep as it is at night, without people nattering and giggling as they shine a light in your face.
I saw some awful things. There were nurses and HCAs who laughed at one of the patients who looked extremely upset because he was hearing voices (yes, I was on a mixed ward – we had separate sleeping areas which were separated by a door, but that was it; all of the communal areas were unisex.) There was a nurse who left someone unattended in the treatment room and when she returned all hell had broken loose because of the amount of things the patient had found to hurt herself with.
A couple of times, when I was having 1:1 with the physios (or 2:1, since they worked as a team), they would comment on other patients. They told me that someone had broken a window and been aggressive (the police were called, as they were on a few occasions) because they had been drunk, and that mentally nothing was wrong with them. Now, that may have been true, but I’m sure (in fact, I’m very sure) that they shouldn’t have been talking to me about it.
Personally, I suffered a breach of confidentiality. One of the staff nurses told my Nan that I had self-harmed (previous to being on the ward – there was no way I was going to hurt myself there and risk being kept there even longer). She apologised afterwards, and I accepted the apology (everyone makes mistakes sometimes), but it was still damaging.
The community team I see have been a bit better. They are usually supportive, with the only exception being when I wanted to return to full-time work (which I did anyway). I do get frustrated when they tell me things are only “my opinion” and ask me if I think other people think in certain ways. I guess being labelled as mental means that your opinion counts for very little (it’s ok, I know that’s not really true, I’m just bitter
)
I don’t hate mental health professionals. They have a very difficult job to do and don’t often receive much in return (whether that be financial reward, praise or job satisfaction). That said, I might view things differently if I’d been on the receiving end of some of the things I’ve seen.
“I do remember being sat in a room in A&E with a security guard posted outside and having to be escorted by him to the toilet in front of a waiting room full of people (nothing like maintaining a little bit of dignity)” – this can be looked at in a number of ways, Moob.
A security presence usually arises in A&E because;
*a patient is brought to hospital under Section136 and in effect staff are legally mandated to ‘protect’ the patient until psychiatric assessment has been completed.
*a concern has arisen that a patient is vulnerable and may be a harm to themselves or somebody else and that temporary coercion is in their ‘best interest’.
Now just to provide a bit more context we have to acknowledge that A&E has increasingly become a portal for acute psychiatric presentations following the closure of the asylums and switch to Crises Intervention community services – not only that, psychiatric patients are, in effect, competing for resources within a clinical setting that has seen an increase in over 30% in attendances (over the last 5 years) to a figure exceeding 19 million visits.
So given that A&E is increasingly stretched, and time critical since the 4 hour target, after all nobody likes to wait anymore – how do we deal with the 30 or 40 other patients in the department while making a cast iron judgement (that will stand up in coroners court) about a patients mental state at the time they are insisting on walking out?
To me the criticism you level at A&E smacks of the ‘damned if you do – damned if you don’t', sort?
Or put another way, are you suggesting that patients should be free to leave A&E should they choose to do so, irrespective of what they might have said, or their previous psychiatric background (which may include serious harm, etc)?
Honest question – what is YOUR solution (in the scenario that you present) that would maintain dignity without compromising either the long term well being of the patient or the professional livelihood of staff, not to mention the 30 or so other patients, a % of whom will almost certainly have mental health problems as well?
1. Patients are put in that very same “damned if you do, damned if you don’t” catch-22 all the time, as mentioned in the discussion of being branded as borderline once you start honestly answering questions. So I don’t have a lot of sympathy for professionals complaining being put in a catch-22. (Okay, I try to be nice, I want to be nice and understanding, but bringing up the catch-22 really riles me up because it is such common situation for patients to be in. No, it isn’t right for anyone to be put in a catch-22. I would rather put the professionals in a catch-22 because: they can probably handle it better, the patients are already miserable enough, and I’m vindictive and frustrated and want them to get a taste of their own medicine. Also, I am quite crabby at the moment.)
I think the whole of mental health care would need to be restructured to really avoid catch-22s entirely. As far as moob’s complaint about being guarded for all to see: a separate room perhaps? They attempt that sort of privacy for physical health patients (a curtain at least so they don’t have to be naked in front of everyone), I see no reason why they shouldn’t be making the same sort of attempt for mental health patients.
It’s not that I objected to having a security guard with me, more that I disliked it being so public. It would have been much better if I had been kept out of the way a bit, instead of being held where everyone could see me.
They would not shut the door just in case I decided to batter my head against the wall (not that I would have done, but they didn’t know that). The security guard could not sit in the room with me, presumably because of the risk of allegations/harm to him. All understandable, of course, but it wouldn’t have been such an issue if I’d been hidden ’round the corner. As it was, people kept staring as they were walking past. It didn’t help with the paranoia and made me feel very scared.
My solution? A room around the corner. I’m not expecting a whole building just for myself/other crazy folk, but somewhere a bit out of the way would be nice. Somewhere where other patients/families are not frequently wandering past and having a gawp.
When walking to the toilet/to the transport, it was literally in front of everyone. I had to walk in front of a few rows of chairs that were full of patients waiting to be seen. I’m not sure of a solution for that one. A secret passageway from the room to the outside would be handy, but I don’t think that’s going to happen
.
When I was petitioned, the police came to my house. Although I let them in without much argument, as soon as they were in the house they pushed me to the ground and handcuffed me. I had gone to bed already so I was in pajamas (red flannel…sexy). They wouldn’t even tell me what they were there for until they had me cuffed. Then they wouldn’t let me change into regular clothes and I was very lucky that they let me grab a pair of shoes. Then they walked me nearly a full block away to one of the police cars (why they did not park in front of my house I do not know). Then I was taken to the regular emergency room at the hospital, where I sat handcuffed in my red flannel pajamas in full view of every staff member and patient that came in until they could get a bed open on the psych ER unit. When they marched me over to the psych ER they walked me, handcuffed and in pajamas, through a fairly crowded children’s ward waiting area. The officer never took her hand off me and kept me in front of her everywhere we went. I was literally pushed to the unit. Once I was behind the locked door she took off the cuffs and I was pretty much ignored for hours at a stretch.
I can’t tell you how awesome this experience was. This happened six months ago and I am still afraid of police cars. It’s a good thing I don’t embarrass easily or I’d never be able to face my neighbors.
I do sympathise, Merope. My stepdaughter had to undergo a similar experience when visiting her other family in Virginia a number of years ago. Additionally, three male police officers taunted her in their squad car whilst driving 20 miles to the State Hospital, which was an appalling snake pit. I really don’t want to insult your country but this sort of attitude does seem particularly endemic in certain strata of US society. Look at the current health care furore in which provision of decent public health care is branded as ‘communism’.
The standard police approach is to assume that 1) the person they are picking up is likely to try and run; and 2) the person they are picking up is a potential suicide risk and may have a weapon secreted about their home. It is also a rule in the various police forces where I live (and this may be the case most places in the US) that civilians may not ride in a police car unless they are handcuffed.
So I can understand the handcuffing. I can’t understand the rough way they did it, the perp walking, the refusal to let me change into suitable clothes, and their absolute refusal to state their business until they had me cuffed.
My neighbors thought I was being arrested. So did I. That’s exactly what it felt like. Only when they take you in on a petition, you don’t get a phone call and you have no right to contact a lawyer or anyone else until some doctor says you can. They didn’t read me my rights because I didn’t have any.
I’ve heard awful things about the public mental health care system in the US. Essentially, everyone in the state hospital is sectioned or indigent or both, and no-one gives a shit.
I can’t really speak to the state hospitals; the places I was in were designed for short stays. People were meant to stay long enough to get stabilized on a med (or ten) arrange for outpatient therapy, and then get moved into some other placement, whether it was back home, a group home, a halfway house, a shelter, or even prison (one guy they discharged to his tent in the woods…).
I was threatened with a longer term facility when I made the mistake of telling the doctor something he did not want to hear. He told me he’d revert me to involuntary status, which would require another hearing before a judge, and he’d make me look as bad as he could. Once the judge confirmed my commitment the hospital could basically do anything they felt was in my best interest, including force-feeding me meds, sending me to another facility, etc. for the six months before I had a right to another hearing. Since my insurance company had already decided that I no longer needed inpatient treatment, the hospital would almost definitely move me somewhere else and he smiled as he noted it would probably be quite unpleasant.
On this unit there were 36 patients. I was the only one with a house and a job. Most of my fellow patients were homeless or living in group homes or halfway houses. When I asked the doctor how he could possibly think it would be good for me to lock me up for six months so that I would lose everything I had, to make me homeless and jobless like my friends on the unit, he said (and I quote) “We wouldn’t consider it punitive. We would consider it offering you a different level of care.”
So yeah, the state hospitals must be hellholes. The place I was in was no horrendous.
Although Beakie is quite right to mention burnout, especially in the case it seems to me of places like St Pat’s with an incompetent management incapable of providing appropriate support to users or professionals, one major problem is that people often go into this line of work without understanding why it has attracted them. As a maverick consultant psychiatrist of my acquaintance has put it: “All persons who enter any health care profession do so in order to address the unresolved needs of their own Child”. (The same man said a sentence or two later: “All NHS managers are anally retentive – and I intend to prove it some day by conducting a scatalogical survey in the sewers under the admin block at **** counting the number of long, thin ones.) So the inadequate person, often bullied in their family of origin and/or at school, goes seeking power for the first time of their lives and in places like St Pat’s 10 years ago (I have to qualify that in case they consult their learned friends) too often finds it. Jung called this Shadow Projection and said it comes into play if a person denies their own Shadow, calling themselves ‘good’ and others ‘bad’. Erich Neumann wrote a book, the name of which escapes me at present, demonstrating how this applied to the way the Nazis treated the Jews. It applies equally well, I think, to St Pat’s charge nurse and others abusing and gossiping about DeeDee Ramona. So what then? Therapy and psychodynamic supervision for all who work in mental health? Well yes, actually. Speaking as a counsellor, we have to and quite rightly so.
Oh, my local public ward in Ireland had no need of therapy for their staff in order to behave professionally and nor do the staff of the UK hospital I currently frequent. I suggest some P-45 therapy plus criminal convictions for those who are abusive and for the management who knowingly allow it to happen.
Re your comment further above – that does not surprise me about Grangegorman. It’s notorious for being where all violent patients in the public system in Dublin get sent and it used to be staffed by the heavy gang – lads who like a fight and otherwise would be bouncers. They may be a bit more enlightened these days.
Re the Irish Times, sadly, they have their hands full with the Murphy report right now….
I have emailed Aware, the depression charity, to see if they are doing any advocacy in this regard. No reply as yet…
BTW I don’t think the management of St Pat’s is incompetent. It’s that they genuinely don’t care about, or actively subscribe to, the abuse that occurred on their watch. They knew what was going on and chose to ignore it. That’s not the same as just being an eejet.
‘Shadow Projection’, eh? – I’d be careful about attaching too much weight to the utterances of a Nazi apologist and patient shagger like Jung.
http://www.nytimes.com/books/0.....ssbat.html
Needless to say ALL behaviour is influenced family experiences – maybe the entire mental health system is analogous to a dysfunctional child with sadistic tendencies?
Jung renounced his Nazi apologetic. It was inexcusable but if somebody says “I was wrong, sorry” I tend to accept it. Naive of me, no doubt. No matter how wrong he was it doesn’t make him wrong about everything. Tacitus: “Abusus non tollit usum,” the misuse of something does not make that thing wrong.
The same applies to his patient shagging (he was far from being the only one). Bizarrely, he trained his ex-lovers as analysts and eventually they became the Old Guard at the C G Jung Institute in Zurich. Your point about family is of course correct but obvious, have a PhD, you know you’re worth it! It applies to Jung just as much as anybody else – his father was a depressed Evangelical pastor who had lost his faith but carried on going through the motions in order to keep his house and income, and his mother was a schizophrenic, one monster of a dysfunctional family. Jung’s early experiences scarred him a lot worse than your thumb but they also gave him useful insights. Like the rest of us, indeed like “the entire mental health system” to which you refer, he was a mixture of good and bad. And I don’t like the phrase “dysfunctional child”. What function has a child as opposed, say, to a dysfunctional charge nurse, whether from The Gorman or in A & E (or both, ah God help us!).
It seems to me there’s a fair bit of Shadow Projection in your comment. I don’t suppose you listen to or watch Wagner either, another complex personality like Jung.
Incidentally, this is one of the most interesting explanations why bad things go on inside institutional settings (this time a military prison) – it runs for well over an hour but is well worth a look.
http://mitworld.mit.edu/video/459
Also Stanford Prison Experiment, http://www.zimbardo.com/zimbardo.html (great website).
OK lets forget about the cut thumb – perhaps I should have told you about a female colleague who had her nose broken after being head butted?
There are papers describing physical dangers associated with nursing, particularly psychiatric nursing – but my point wasn’t so much my scar is worse than yours, rather such experiences tend to contribute toward the ‘bad vibe’.
Emotional reactions following violence include ‘antipathy against the perpetrator, insult and fear’ according to this lot;
http://occmed.oxfordjournals.o.....l/58/2/107
Perhaps in time negative experiences become generalised if they occur often enough, or the impact is great enough (such as a fractured nose, say).
Now before we go too far down this road I am NOT for one minute suggesting that this explains the horror stories highlighted above, neither am I seeking to condone outright abuse – it seems far too many patients are not only being let down by the nurses but the complaints system as well?
But as suggested before these facts do not alter the million dollar questions – WHY does abuse happen, and even more pressingly, why does it happen with such alarming regularity?
To be fair to Bristol Michael he did offer a tentative psychological model, albeit from a disgraced patient-shagging nazi aficionado who retracted his dastardly deeds and beliefs on his death bed.
Someone who admires nazis and shags patients falls at the first therapeutic hurdle in my opinion – I suppose Jung was a kind, avuncular middle class sort of abuser unlike the uncouth bullies stalking the grim hospital corridors in Dublin?
Bristol Michael be right when he suggests that such people gravitate toward employment opportunities (therapy, nursing, etc) most likely to give free reign to the brooding and sinister aspects of their personality – but even if we accept this, it still begs questions like who picks them in the first place, who trained them and why is there not a culture within the profession curbing such outrageous excesses?
Now Zarathustra, et al, have given great prominence to the regulation debate but what good is the NMC if it only ever remains a theoretical court of appeal – needless to say therapists do not even have this theoretical forum – Jung must be nodding approvingly I would imagine.
The testimony is out there from respected commentators yet the nursing response as to why remains curiously mute (except for the opinionated A&E C/N) – I wonder if one or two of the regulars are surprised by the depth of feeling or extent of depravity?
In A&E we have 24/7 camera surveillance – not a guarantee in itself that patients will not be mistreated but the basis of some form of objective evidence at least.
Actually I would like to thank those who have contributed their stories I have been thinking about them all day.
Um, I think 24/7 camera surveillance in an acute psych ward would be a VERY BAD IDEA. Given that half the patients are convinced that it has been already installed…
I think the low regard in which psychiatric patients are held has a lot to do with it, to be honest. Mental illness is open to accusations of being “all in the mind” and “brought this on yourself” in ways physical illness, which can be independently verified, isn’t. I wish I could remember the title of a book I was reading, but it was several years ago when I was desperately avoiding economic history revision – it talked about a widespread differentiation in general healthcare between the mentally ill and “real patients”.
This seems to be backed up by the experience of a friend of mine. (I feel pretty guilty about this, because it was me who took one look at the cut on her arm and her dizzy gibbering state and told her to get stitches, and given the amount of crap that came down on her head as a result, I’m not convinced some half-arsed first-aid wouldn’t've been better.) Anyway, when she was in hospital, she got to hear the nurses talking about how they wished “we had some proper patients instead of these fucking nutters”. And I remember that when NICE issued their guidelines saying self-harmers should be given anaesthetic like everybody else, some anonymous bitch wrote a column in the Guardian defending her right to treat people badly if they’d brought it on themselves. Ooh, that made me angry for days.
It’s the good old innocent-victim-versus-deviant-who-deserves-it dichotomy. See also: AIDS.
What this doesn’t explain, of course, is why people with this attitude end up in mental health, of all places.
A+ECN, I understand your point to say that if someone has been abused by a patient, he/she is not going to be as open/kind/understanding of patients in the future because he/she fears that happening again. This is understandable on some levels. This is a pretty normal response. Most people do this to some extent. If I am mugged by a person dressed as a clown, I might be a bit more wary/skittish/whatever around people dressed as clowns in the future, in the short term or in the long term. This is probably human nature. This helps me understand why professionals might act toward patients in ways that create this awfulness for patients, which I do appreciate.
But this still isn’t okay, particularly for mental health care professionals.
1. The people they are treating are VULNERABLE. These are people who are already suffering more than most, and, to me, to add to that in any unnecessary way is unbearably cruel. Maybe you are a little wary of me because the last ghostly pale crazy girl you met punched you for no reason. But it is your job to care for the patients, and, to me, that means you suck it up and do what it takes to take care of your patients. It is not my job, as a patient, to be your punching bag as you vent your frustrations or fears from your interactions with someone else. (What would that be called? Counter-transference?)
2. I have had professionals try to teach me not to fear a new situation just because it resembles a situation in which I got hurt. I have been taught not to let my past experiences get in the way of my current situations like that. (What’s that then, avoiding transference?) But if the professionals themselves are being extra wary of me because they got punched by a patient last week, they aren’t practicing what they preach. (Maybe not all professionals preach this, perhaps I am over generalizing, but I doubt it because I can’t imagine that they wouldn’t preach that for someone with PTSD or other trauma in their past.) They also preach self-awareness, so if they are wary of me on account of being punched last week, but don’t realize that they are being extra wary of me or why, that is no better.
I’ve said before when I set down expectations of professionals like this that I don’t expect professionals to be perfect. I do expect them to try, though, and the impossibility of perfection doesn’t excuse not trying, which is what appears to be happening. Because professionals also preach the virtues of good communication, I do expect them to be upfront about these things. I know that people can’t always arrange their emotions the way they want, as would be really necessary if we were to start fresh with every new person we meet without unloading any of our baggage. However, I do expect that if a professional is wary of me and treats me differently because of that, he should be honest about that, perhaps say, “I know I’ve never met you, but you remind me an awful lot of a girl who punched me last week, so I apologize if I am a little skittish around you for a while.” Maybe then they would learn that it isn’t so very easy to keep your emotions in check the way they ask us to and that it isn’t so easy to have those open honest discussions they press us to have. And I know professionals can’t be perfect communicators or perfectly honest. There is still the chance for them to apologize after the fact, perhaps, “I’m sorry I snapped at you, but my fuse has been shortened after being punched last week.” And sometimes, maybe none of those things will happen, my original expectations or any of the communication fixes. That is okay as an occasional thing, because no one is perfect, but that these things happen so rarely indicates to me that professionals simply aren’t even trying.
You asking me Charge Nurse ? I am surprised by the depth of feeling. Don`t suppose I`m ever surprised by the extent of human depravity. Some of the depravity outlined here is entirely a criminal matter as far as I`m concerned. Thankfully, though, in the parallel universe in which I reside, I have not encountered anything of that nature. I live about 1.5 miles from where I work. Anyone requiring acute in patient psychiatric care in my street would be nursed on my ward. Perhaps I`m not a natural conduit for negative sentiment but I`ve only encountered positive regard. In fact, in town this morning I met 4 ex patients, 3 of them female. Two of the females, who were out together, greeted me with great affection and invited me for a drink ( I suspect they meant Wetherspoons, I would have nipped in too and bought them a festive drink if Mrs OSB wasn`t dictating the schedule ). Another lady acknowledged me with a smile and the man exchanged pleasantries. I have no doubt this type of scenario is the norm.
There are certainly well-run, good hospitals, I have the good fortune of living in the catchment area of one. Also, as I’ve stated before, the public ward in Ireland where I lived was fine.
There does appear to be a lot of shit practice about though. I was hoping when I posted this that I’d get loads of comments saying “no, my local hospital is fine” but apparently I am not the only one to have been abused as an inpatient. Make of that what you will.
I’m sorry, OSB (and other MH folk) – I said I hated the ward, and I did, but as well as the difficult staff, I also came across those who were exceptional.
A male HCA had the ability to make you feel a little bit normal. Instead of asking difficult questions and expecting deep answers, he’d talk about what was on television last night or discuss something he’d read in the newspaper. It was refreshing to talk to someone who wasn’t trying to extract information from me. About a year after I’d been disharged from inpatient services, I saw him when I was walking to the gym. He remembered me and asked me how things were going, and when I told him about the positives, he shook my hand and gave me a hug. He was a nice guy.
Another HCA was also brilliant. She made time for people: she’d sit with us at lunch and play wordgames using the dry wipe board in the quiet area. It was a break from the boredom (after a few weeks, when I was well and didn’t need to be in the hospital, it became very boring) and kept my mind busy (well, as busy as a mind that’s doped up with anti-psychotics and lorazepam can be). She congratulated me when I became an informal patient and she was never without a smile.
I don’t remember any of the good things that the staff nurses did. That’s not to say that they didn’t do good things, just that I’m not aware of them. Possibly because I did my best to keep my distance from them as I perceived them to be quite threatening (along with social workers and doctors). They were the ones keeping me captive (for my own good, I’m told, but that’s not how it felt at the time). That wasn’t their fault though; they were just doing their job.
I daresay the main reasons YOU have a well run ward, OSB is the presence of staff like yourself who lay down clear markers regarding standards and integrity – this I think is one of the most, in fact THE most important mechanism, to protect vulnerable individuals?
But I wasn’t thinking of you specifically when I suggested that one or two of the regulars had been rather less forthcoming than usual.
If I have understood commentators here correctly there is a barely veiled accusation that abuse (involving nurses) is not only present but is, in fact, disturbingly commonplace – and these abuses are so damaging and widespread that patients actually ‘hate’ nurses, as well as other mental health professionals.
What a sad and shocking state of affairs, eh?
I must expect I anticipated either some form of immediate rebuttal, or at least an explanation (from the regular mental nurse heavy weights) as to why such a dire situation continues to thrive in this day and age?
I know Mr Ian is in a state of grace, languishing on a sun drenched Australian beach, but I expected something suitably Wagnerian from him (nods to Bristol Michael).
Even the normally loquacious, and internet savvy Beakie has retreated into his shell.
Our resident intellect, Zarathustra is conspicuous by his absence bearing mind the gravity of the accusations flying around.
I assume mental must be bogged with tweaking the site design while E prepares his latest thesis on why ALL nurse eduction is pointless.
Perhaps one or two shell shocked observers will at least feel encouraged the relative tranquility can be found in your neck of the woods – as I say, I simply cannot imagine you standing by while patients are treated in the kind of threatening and unprofessional manner highlighted by DeeDee and several others.
It must be very lonely up on that cloud all by yourself, AECN. Why do you feel the need to attack by name “the regular mental nurse heavy weights”? DeeDee Ramona will doubtless correct me if I’m wrong but I read her as saying that people hate mental health professionals when they’re treated as she was at St Pat’s, and other commentators have confirmed this with their experiences. But DeeDee goes on to say that things were/are vastly more professional at the public unit she was on in Dublin and at her current NHS catchment unit. You seem to have an agenda that you’re not stating. I’m new to this site so I don’t know your style but you seem to want to turn a serious (and at times shocking) discussion into a holier-than-thou rant, all heat and no light. Yes, over the years (I’m now 67) first as a nurse and later as a carer I’ve had to deal with bullying and crass stupidity in mental health units. But I’ve also been moved by very kind, empathic and competent people. Some even believe I was one such myself (aw, shucks). And I’ve had bad experiences at times in A & E I might add, not least a bullying senior registrar earlier this year when I was brought in by ambulance with acute cellulitis. Again, as described by DeeDee Ramona, the “it’s all your own fault” scenario was played out by him, which it wasn’t, honestly! Arrogant medics, etc., are a pain the arse in whatever context they operate. But that doesn’t mean all medics, nurses, whoever are like that. Unless something really out of the ordinary turns up I doubt whether I’ll add any more comments to this post. Thank you very much, DeeDee Ramona, for your courage in starting it.
I haven’t kept quiet, AECN, I’ve pretty much said everything I want to say on this subject. I suspect further input from me might only be viewed as defensiveness. I’d like to see a thread dedicated to the work done by good nurses/doctors/other healthcare workers to provide a bit of balance.
Beakie, I’m afraid I can’t oblige you there. While there is good work done by nurses, as long as people continue to abuse patients, that will overshadow any good work being done by others. Feel free to start such a thread if you like, but don’t expect me to participate in it.
Really, Beakie, you’ve said all you really have to say on the matter? (I mean that entirely sincerely.) Maybe this is why I have such a hard time getting professionals to talk to me about these things? Maybe they really just don’t have much to say on the matter? But that perplexes me. Most of the professionals here seem to be highly invested in doing right by their patients, so it doesn’t make sense to me that you lot aren’t more vocal in these discussions. Wouldn’t you want to work with us at making things better? Yeah, right now this is mostly commiseration, but it could turn into a lot more than that. We are here saying, “things are really awful and we don’t understand it.” You guys have given some explanations for why that awfulness persists (and though I do tend to counter with why those reasons are indicative of unacceptable behavior, I am grateful for the light you shed on this), but I just don’t understand why you don’t have more to say. I almost want to tackle you and badger and threaten you into answering our questions because it doesn’t seem fair for you to get to say that you don’t have any more to say on the matter when that isn’t an option patients ever get (and the questions asked of us aren’t always of the, “if you don’t tell us what’s wrong, we can’t help you” sort). On one hand I want to respect you if you don’t want to talk more about these things, but on the other hand, why should I have to respect that for professionals when they routinely refuse to respect that for me?
If we were to ask very specific questions, rather than beg that you join an open-ended conversation, would that go better? Would you be willing to answer us? Then we might feel a bit less ignored and get information for which we have been hankering.
What more CAN I say, jessa? I see from Z’s more recent post that we (by which I mean the “MN Big Guns”) have been accused of inadequate outrage and condemnation. Fact is, I suspect any response would have been considered inadequate, because I would suspect the point of this post is not so much to get a response from me or Z or Mental or OSB as we aren’t the people who were doing the abusing, but to provide a place for people to vent their anger.
I could talk about the crap I’ve experienced at the hands of my fellow nurses, but that’s inappropriate; I could talk about the crap dished out to me by service users, but again, that would be inappropriate; I could give reasons why I might have been less than caring on some of my off days but that would be defensive. So what can I say? Yes, I want things to be better. I try in my own small way to bring that about. No, I don’t want anyone to experience violence and abuse at the hands of staff. Yes, I’m horrified by some of the accounts here. No, I don’t think that the majority of staff are like this.
So perhaps it’s best for me to just shut up and allow the conversation to continue without my input.
Read the title of the post again, Bristol Michael – “Why Some People hate ALL Mental Health Professionals” (my accent).
Something is rotten in the state of Denmark, yet the mental nurse big guns are quiet ………. curious?
Surely the likes of DeeDee should at least have the courtesy of some kind of explanation?
You will get used to my style (or please feel free to ignore my ramblings) – I have certainly had at least one run in with DeeDee before but she is still talking to me (I think) – hell I even upset myself sometimes.
You seem like a clever guy despite your advocacy of certain disgraced therapists – if I had seen an A&E Reg belittle a patient unnecessarily I would make it my business to reflect back to that doctor the effects on the patient, the department, and his/her profession.
Pushing patients around is simply not on – that is the entire point of this post, surely?
To be fair, I suspect the ‘mental nurse big guns’ know this goes on, know it’s an institutional problem beyond the individual’s ability to fix, and know how it affects people’s willingness to seek help, but also know that saying “well, my ward’s not like that” just comes across as kind of defensive.
You’re tripping over your own adverbs – how is it possible or legitimate to belittle a patient “necessarily”? If we have bad experiences we don’t trust the class of person who did it to us, which is where the “all” comes in and we’re far too angry and frightened to make subtle distinctions that we shouldn’t have to make in the first place. Add to that the fact that the middle class doesn’t like to have its boat rocked and we get denial, the shaking of heads and patronising weasel words such as I’ve heard recently when criticising the denizens of a certain Aggravation & Irritation, erm, Assessment & Intervention Team. As a friend texted me today in a totally different context: “When the shit hits the fan switch off the fan”. But, AECN (I think you should be called Puddleglum), the world isn’t divided into splendid RGNs in starched uniforms (or in your case scrubs) in an ordered, CCTV-linked world, and wicked RMNs carrying out their dastardly deeds in dark corners. The problem is human beings and some of them are gobshites in need as DeeDee says of P45 therapy.
Not sure how much problematic institutional abuse you imagine goes on in staff rooms, CAMHS offices and the outback, Lorna. I`m now in my fourth Staff Nurse post, all on the wards. If you find me defensive, you find me defensive but I am rebutting your suspicions with the utmost vehemence.
This post was an invitation to those who have utilised in – patient services to outline their experiences. I know nothing of services in St. Pat`s, Dublin, the Republic of Ireland, ED units and wards staffed by Zimbabweans in the urban utopias. Why should I ? I simply report the state of affairs in my little backwater and I do so honestly.
The fact that things are fine in your patch is not the point OSB. It’s obvious that they are not fine in very many places elsewhere.
Part of the problem here is a difficulty differentiating between extremely serious criminal behaviour and nursing misconduct. There are some horrific reports in this thread and, inevitably, feelings run high. I, and the other MHP`s on this site, will feel awful when reading of “repeated rape” on a ED unit but there is no logical reason why we should. It has absolutely nothing to do with 99.9% of male employees of the mental health system. Rapists, I`m sure, emerge from every walk of life and every trade / profession. I`m not sure if they gravitate to the likes of ED units seeking vulnerable prey. I have never heard of rape by staff on a psychiatric unit. I am sure, though, that they deserve to be taken out and shot and as the site`s resident right winger you would hear no protest from me if it were to be the literal punishment.
When the dust settles and emotions have cooled I think there will be acknowledgement that it is important that areas of good practice are highlighted and that the Charge Nurse is allowed to make his spirited and noble defence of the decent majority
I haven’t commented much because I know there is nothing I can say that will make up for the abuses that people have suffered at the hands of a profession I am attempting to become part of. The abuse of vulnerable people by those who are supposed to be caring for them is abhorrent. I think it is important that people are able to discuss it, and be believed, and that the perpetrators be punished.
As I have said, and at the risk of sounding defensive, I have not encountered this kind of abuse in my (admittedly brief) time in MH. Obviously, that is in no way a denial of it’s existence. I hope never to see it, however.
For whatever it’s worth – if, indeed, it’s worth anything – I am truly sorry that you all have suffered this. All I can personally do is promise that I will never consciously behave in this way, and I hope to have the self awareness to avoid doing so unconsciously.
I very much respect your position cellar and Z. I know that we sort of put you in a catch-22, which means most things you could say would sound defensive. I also deeply deeply appreciate your being upfront about that, rather than lashing out at us for it, which is what I generally expect, though not at MN. (And this isn’t to say anything against those professionals who have spoke up more.)
Cellar, I thank you for the pledge you have made to us to try not to treat patients the way so many of us have been treated. I definitely believe you. But, I also believe that most professionals don’t want to consciously treat patients this way. I suspect that there are people like you who patients are experiencing in these awful ways. Are there ways that we, having experienced this awfulness from the receiving end, can help you and other similarly open professionals to succeed at your promise?
If there are professionals who really aren’t falling into mistreating patients in whatever way, professionals who would be responsive to a patient saying, “I am not okay with this,” patients may still feel mistreated. After being mistreated by other professionals who were not responsive to their objections, when a patient is feeling mistreated by one of those superhero professionals, they might not speak up because they expect their objection to be ignored (or worse), which means you don’t get to resolve things by being responsive to them when they object to being mistreated. I guess that means that if you really do try to be sensitive to how your patients experience your care, you will still have patients who leave you feeling mistreated because of other professionals. Maybe if you are extra conscious of this, you can ask patients periodically if they are feeling mistreated? Perhaps in a way that says, “I am a responsive one”? But that puts the responsibility of cleaning up the messes of all of your colleagues on your shoulders, which I know would suck. And while this isn’t the main work of therapy, I do think it would have a therapeutic effect, even if that effect is only to lessen the trauma of the experience of mental health care itself.
My response would be pretty much an echo of cellar_door’s comment above.
Also I’ve mostly kept out of the debate not because I don’t believe the accounts above (I do) but because, as someone who wants to see good quality mental health services and who works hard to try to ensure I’m doing a good job, all this is bloody depressing. As a result I find it hard to come up with a response that doesn’t sound defensive..
I may have remained more-or-less silent in this particular thread, but I promise you it isn’t because I don’t care about the issues raised.
I think, short of leading the revolution (I’m kidding; the revolution is inevitable as the current system holds within itself the seeds of its own destruction*), your and cellar_door’s responses are about all that can be sensibly and meaningfully said, from the non-evil-medical-professional end. I like sensible and meaningful and non-evil
* I’m still kidding.**
** Mostly.
Funnily enough ‘Silver Chair’ was one of my favourite Lewis books, although I identified most of all with the dwarves in the ‘Last Battle’ (if we take the Narnian Chronicles as a whole).
Your semantic point about ‘belittling’ adds little to the issues in hand – I think my meaning was clear enough.
Do SOME A&E patients deserve a rollicking – well, yes it does happen, but if your doors are open to all and sundry (irrespective of how pissed they are) then we shouldn’t be too surprised if one or two misfits find a way to wind staff up (such as pissing in the sink, or nicking other patients property, etc).
Sacking a few bad apples (or P45 therapy, if you prefer) might be a start, but fails to explain why the barrel itself is rotten (if we acept this premise to begin with)?
So, to refocus, and in DeeDee’s own words, “This is a post about the systematic, institutional abuse of patients by mental health nursing staff”.
At the moment there are two main narratives unfolding – nurses saying things aren’t too bad (in their personal experience) while patients report a very different perspective.
Now if we two can both put our toys back in our pram, perhaps we can press on to the real issues in hand?
Toys, eh what? You are wilfully misconstruing what is being said to you and there’s no point arguing with you. Dwarfs are apposite, presumably the ones in ‘The Last Battle’ who stayed in the fetid shack of their own imaginations refusing to accept any perspective but their own. “The dwarfs are for the dwarfs!” Dear me! Here’s an idea. Take a year off being an A & E charge nurse and take a job as an HCA in a mental health unit. You might learn something or, sadly, you might not. And telling someone off for real misbehaviour (e.g. thieving) is not belittling them. You have Humpty Dumpty’s view of words, they mean what you want them to mean. And that really is my final word, rant away as much as you like, Puddleglum.
I thought the post originally said Why ALL People Hate Some Mental Health Professionals.
I could see why we were all hating those described initially.
I touched tangentially on this years ago:
http://www.mentalnurse.org/200.....h-nursing/
Where I argued that at times as nurses we should just face up to the fact some of our actions are easily perceived as evil by those on the receiving end of our care. For example here is a story:
On a night shift. Get a phone call saying the police are bringing in a 40 year schizophrenic gentleman in the back of a van and it took six coppers to get him in the back. They were going to be with us in about 10 minutes and could we please do something psychiatric with him.
Goodness I thought. What shall I do? That was it that was all my information. Myself and the others on the night shift had no idea who this man was. Predicting there was a possibility of trouble and the gentleman not wanting to come in to hospital I got a few staff together and cleared out a single room in case we had to drag in in kicking and screaming.
Now in the end there was no problem and there was no need for the man to be met at the door by some large and beefy looking nurses, who to and untrained eye were ready to pounce on him, the man was ecstatic and thought we were there to protect him from the police. So everyone was happy.
He could easily have been mortally offended that without knowing him we had predicted he would be violent and dangerous. He could have been at this minute writing a comment about what a bad and wicked nurse I am. He would probably be right.
Based on my experience at the time I thought I did the right thing. I would probably do exactly the same thing again.
If I read about it as a case vignette I would probably argue against meeting somneone at the door with the beefy nurses.
Must go.
Since I am getting involved. Forget where the comment is can I just point out, speaking as a Calvinist, the whole humourless thing is entirely optional and a choice. Not compulsory. I tend to find I am no more morose and miserable than the Sith.
as an RMN I find that most of my colleauges have an understanding of mental health theories, facts, figures etc. but not a good understanding of human beings and how others may feel being treated in the way that mental health work seems to treat people. I find that working in the way that is expected of me compromises my relationships with others and when I try to explain this to other professionals they just don’t get it, it’s ‘boundaries’, ‘policies’, ‘procedures’ but only a really superficial nod to individual support. I find it a struggle and am always in fear of being called into the manager’s office and being ‘told off’ for being too friendly with the ‘service users’, it’s a big no no where I work and it sucks because your encouraged to work in a way that is not therapeutic. It would take a huge shift in people’s understanding of others, empathy, compassion, patience and intelligence to change the way that mental health workers are perceived by people and I feel we are only at the start of a revolution, but I feel it will happen
Seriously though how many people skills does it take to refrain from saying to an anorexic patient, “I’ve got 3 daughters at home and they’re all nasty little bitches like you”?
well, that’s extreme and I’ve never heard any outright rudeness like that in my workplace, but I’ve definitely heard things like that said behind patient’s backs. You’ve hit the nail on the head though there dee dee because the fact that people think that someone is a ‘nasty little bitch’ and would express this to another person shows we have a long way to go.
DeeDee, There are 90,000 RMN`s and Lord knows how many associated people. Amongst that number there will always be a good few with the potential to abuse. It will always be so, I`m afraid.
Bristol Michael, there is a context to everything and you`re a bit naive regarding the MN context. If you stick around long enough you will discover the Charge Nurse to be our most intelligent, wise and measured contributor.
Jessa, Beakie is a complete buffoon but even his worst enemy ( me ) would have to say his heart is in the right place.
This is all about nursing teams. Managements eyes have been off the ball ( perversely on such things as patient focus ). Nurses themselves have been neglected when, in fact, they are much more important than anything else, including patients. If you get your teams right, or as right as is possible, then patient issues will be taken care of naturally.
Unfortunately, there isn`t that much hope. In the short term things should improve. Any sensible management should be putting new starters on short term contracts until they have proven they have something to offer and can complement the team. In the longer term the axeman cometh and looking at public finances he`s going to be a particularly furious axeman. Rather than pay redundancy, vacancies will be filled by reshuffling people. Potentially unsuitable people, will be levered in.
I can only suggest that anyone who has been abused should go to the police ( easier said than done, I`m sure ). I`ve no great confidence in our criminal justice system but there is some chance wrongs will be righted. Media attention may put the brakes on the abusers out there.
Oh dear. I never tried to insinuate that Beakie’s heart was anywhere but the best place. Rereading what I wrote, I’m still not sure how that got misconstrued. I have a lot of questions and a lot of problems with how things are done, but there are very few mental health care professionals whose sincere desire to help patients I actually question. A lot of them seem to be making an appearance in anecdotes in their thread, but I don’t question the sincerity of the vast majority of professionals.
The chances of the Gardai getting off their backsides and doing anything at this stage is about nil. And it wasn’t a case of a few bad apples. The management of the barrell colluded in maintaining an atmosphere where patients where viewed with disgust and contempt. However this is not a police matter. Civil legal matter perhaps, not criminal as there were no actual assaults.
Err, I was a child when I read the Chronicles of Narnia, sorry for liking the dwarves – Puddleglum was a hero by the way, remember when he put the enchanted fire out with his bare webbed foot?
I suspect you have anger issues, Bristol Michael, or how else do you explain your bizarre attempts to derail a very important thread by proffering unsolicited and inappropriate careers advice?
What am I suppose to learn during this sabbatical – the art of promoting disreputable therapists?
By the way, I spent several years (as an RMN) on an acute admissions ward, and even some time in one of the old asylums – the problem is not so much what I would pick up as an HCA, as you quaintly put it – but practices that were unacceptable back then, are still more prevalent than they should be today?
Apologies to other posters, especially those who have contributed distressing personal experiences – I can see that I have provoked Bristol Michael somewhat, and our silly bickering is diverting attention away from some very interesting posts that have emerged over the last few days.
We, OK, I should know better.
I’ve just come back to this thread.
Sadly, I think that the people that these feelings really need to be directed at probably don’t read blogs like this, although I could be wrong.
I just wish that I didn’t feel so damaged by the mental health system. I laud the government’s initiative towards social inclusion, except for the fact that it doesn’t seem to come with adequate funding and my local mental health trust is using it as an excuse to withdraw lots of services. In that respect, it’s rather like care in the community that turned into no-care in the community.
Nevertheless, the mental health services where I live seem very good at spending hours upon hours going through paperwork, assessments, plans, summaries…but not much time helping with the essentials in life like benefits and work and social life and practical support in the home. Daily life is a struggle, but when my psychiatrist asks if I’d like to do anything, I gently point out that he has, in reality, no services to offer me unless I go completely bananas and by some miracle he can persuade the crisis team to see me a couple of times. There’s a duty clinician one can talk to, but I think the Samaritans do a far better job and at least they don’t put a distorted account of it on one’s notes.
There’s something about the attitude towards service users (how I hate that term) that is destructive. I remember being in hospital and sent to OT. I was offered a choice between making a bead necklace (and paying for it) and making a spaceship out of a cardboard box. I wanted to scream “I’m not creative, but I am intelligent, why isn’t there anything appropriate for me?”
This leads me to something about social status. From time to time, I read debates on the net about class. One can talk about working class, middle class (upper class seems to have largely disappeared and become upper middle class). Inserted under working class is the underclass, except that mostly we can’t say that. What they have in common is that they set Mail readers fulminating. Well, in that class are to be found the nutters. We’re scroungers if we claim benefits but we should all be locked up (ok, so that’s more expensive, but then we wouldn’t be scroungers).
The sad thing about all this is that the attitude that places us amongst this underclass is to be found within the mental health system. Just as many of the people so despised by others find themselves in this group because of the way others have treated them (schools that were crap, parents that abandoned them, lack of DAT teams etc.) so we find ourselves in that group because we’ve been moulded into care in the community failures.
I once took my father to a CPA meeting. Something I said wasn’t taken seriously. My father looked put out and backed me up. He wasn’t taken seriously, and you could tell it got to him. You see, my father is the sort of person that people take *very* seriously. He is *very* successful. But once you’re in the system, you’re not taken seriously. I won’t tell you what I’ve done with my life, but I was used to being taken very seriously until I ended up as a mental health patient. Years in the system have gone a long way towards destroying me and it’s only by backing off that I’m making some serious recovery.
There’s only one thing that stops me asking to be discharged back to primary care – benefits. The DWP takes regular appointments with a psychiatrist as some sort of proof that I’m really nuts. So my psychiatrist and I meet four times a year and he asks stupid questions and I give stupid answers and we go away again for another three months. I’ve given up on CPNs. I can’t take listening to them talking about themselves and their other patients any longer. I’ve done it for years, and I wish I hadn’t. I’d swap my CPN for a welfare and career adviser any day.
I was in a variety of institutions in the US for a good portion of my adolescence about 7 years ago. I too had horrific experiences with staff in private hospitals, while the staff in the State institutions, although weary and lacking knowledge and training, generally meant well. Private hospital managers and docs were more qualified, better trained, and received higher pay…and were also arrogant and intolerant of any patient who did not “get better” on their short-term care plans.
I was admitted because of my self-harm that had culminated in a suicide attempt. In one particular private institution, the first thing I saw upon arrival in the ward was a screaming child of about 6 being hauled to isolation, literally thrown in the room and left sobbing alone for hours. I had been placed outside the nurses desk to fill in bubble forms for those hours, so I had plenty of time to absorb and internalize that suffering. “Treatment” consisted of an IQ test and an ink-blot test, as well as 5 minute weekly sessions with the psychiatrist. Needless to say, I became considerably more depressed. I used erasers on pencils to harm myself, which was seen by another patient and copied. Afterwards, I had my longest session with the psychiatrist in which she accused me of poisoning her ward and maliciously harming other patients and preventing their recovery. She informed me that I would be transferred to a State hospital in two months, and until then she wouldn’t allow me to influence others. I was never allowed off the ward and was isolated from all in-ward activities. I was always on 1:1 supervision, and staff resented having to “babysit” me. I was allowed to wear only hospital gowns and was made to wear rubber gloves all the time, even when sleeping. I was denied a blanket at night, as well as toilletries, regular showers, and the opportunity to take off my contacts, so they desintrigrated in my eyes. But all that poor treatment was nothing compared to the utter shame I felt when told I was poisoning the ward and harming all the patients around me. I will never forget that 3 months of living in constant, unbearable guilt.
Now I work in mental health, because I had the (perhaps misguided) idea that I could make a difference in the running of mental health institutions…and as a result, I’m experiencing the other side. Now, when my caseload is beyond manageable, and I can’t give someone all the time and attention that I feel they need, or I say something that could have been said better or not at all, or I make any other sort of mistake, I suffer from that same guilt, that same shame, that same feeling of being a poison to others. Although I know that my psychiatrist’s statements were wrong on so many levels, I dread the possibility of causing more harm in a population of people in which I am both patient and treatment provider. Even after all my training and experience and learning about myself and my illness, I can’t shake her voice, and I’m not sure I ever will.
That’s horrifying.
Ive been a service user, a HCA on an acute ward, now I work in a mental health charity as a social work student – I’m new to this blog and I’m using to challenge my anger in a more productive way rather than doing what I really want and that is to use a few straight jackets and inject depots in some of the NHS staff.
As a service user, I didn’t feel listened to, I felt I was treated with contempt by some of the staff, however, one was nice (but that was out of about 20) – the way I dealt with it was to be compliant but I now question whether that was more to do with how scared I was – rather than be non-compliant and have the guts to question things which non-compliance is seen as part of your illness – I really question that.
As a member of staff I enjoyed my experience – but I felt the power imbalance strongly – most band 6′s were ok – the odd few would not talk to the likes of a HCA and I felt bullied by one of them – also on a night out I soon realised staff still saw me as ‘them’ not ‘us’ and I felt I became a victim of verbal abuse due to that. Staff comment on the service users notes that they are ‘grandoise’ but I have seen more grandoiseness between staff members
In staff meetings I have heard comments such as ‘she makes me sick’ not from a HCA but from a consultant psychiatrist – there is no non-judgemental pratice in place and I question whether nurse training includes looking at their values.
As a student social worker – well all I can say to that is thank God – I’m very lucky that my placement is in a drop-in service at a very well known charity – I am able to speak to the service users there in the way I want – I have found some very disturbing facts from them too.
However, I have found that some service users see a psychiatrist as someone who can help to cure them – we tell them that they can only give you a diagnoises and give you meds – many service users feel that they are so cut off from the psychiatrists and many are not humanistic or attentive to their needs. Service users tend to respond better to psychologists as they feel they are more humanistic.
Being restrained can cause them extreme psychological pain – traumatic for many especially new admissions.
Many feel that the meds are helping them but they also feel that they are over used to control them and ‘best interests’ often means best interests of the staff.
Many feel that they are treated like criminals by society and children by the staff.
Many don’t feel listened to as the psychiatrist always knows best.
My experience is that there are many workers who are very ambivalent to people in distress – staff don’t recognise that many service users have had or are having experiences of trauma. We diagnose people who have had very difficult upbringings as personality disorder – so we are basically saying it’s not your childhood – it’s they way you dealt with it that’s the problem. I personally feel that burnt out staff should be able to go to workshops and events to revisit their values – I feel that there should be more service user development workers on the wards to ensure we have a non-judgemental practice – restraint shouldn’t be used as much as as it is and ‘listen’ should be on care plans as well as others such as offer PRN and use restraint – in fact I have never seen a care plan with listen on it – it should be the 1st one.
Having said that – there is a lot of good workers in the NHS – very caring, who listen, who give hope to people, and help to create the wards safe for people – in fact most workers are like that – it’s just the odd burnt out few that perhaps need to revisit there values or perhaps experience things from a service user perspective
I have an example of something that has just happened to me. I have recently stayed in a crisis house most of the staff are lovely, kind, caring and helpful, however, i don’t know if it is a clash of personalities or just the personality of this one particular person. I have trouble sleeping and requested my safe key to access my meds earlier than normal as i knew i could take them and get a few more hours sleep. Her amswer to this was “do you need a drink because i find people who need a drink and can’t have one often want there meds early” i was in shock there is nothing to suggest that i am an alcoholic it was 6 o’clock in the morning so not that early to be taking my meds and she then went on to accuse me of having taken an overdose once before when i had stayed at the house. The night before when i had gone to my car to get some sweets she had followed and watched and on one occassion accused me of not taking my meds and made me show they were not still in my mouth. It is people like this that make you dislike and be wary of all carers/nurses etc who are in mental health. I mentioned this to the house supervisor who advised me to talk to her as he is sure it is a misunderstanding. He obviously didn’t take what i was saying seriously. The whole situation left me feeling very upset and low.