Severe attack on nurse by patient with mental illness

My last three posts

Patients being ‘bussed out’ —
Image from Kent Mental Health

You might want to read these to get the backstory:

I wrote about how our patients, having gone from being slept out on other wards within our unit, to being bussed out to spare beds in our other mental health hospitals every night. I ended my first post with things couldn’t get any worse.

Well, they did. Despite being 20-25% over our regular bed capacity, the annual cost cutting exercise came round. To save money, our Dimwit pen pushers (Dpp’s) decided that cutting staff down from 3 to 2.5 at night would be a good idea. It wasn’t. A nurse was severely attacked and almost died.

What happened next

Intensive care unit — Getty Images

Manish, our nurse, remained in hospital as he slowly recovered and while his eyes remained permanently bloodshot, he regained some of his sight. His hearing didn’t return to what it once was and his speech was badly affected along with his mobility. He was deeply traumatised and would never return to work.

Iki, our patient, was removed to Broadmoor, one of England’s high-security psychiatric hospitals, and would remain there long-term. While people might judge young Iki, he suffered with paranoid schizophrenia and probably could have been better managed. I doubt that this incident would have have happened had the staff number not been cut; Manish wouldn’t have been the only nurse on the floor that night.

As staff gathered on Monday morning, waiting for Senior Directors to arrive from Head Office, there was dismay, shock, anger and a whole host of other negative emotions. Patients were not told initially as they too would have felt shock and horror, not only because Manish was a well-loved nurse. They would have been traumatised and left feeling unsafe on the wards.

Follow up debrief

When Mr Smyth (the first Senior Director) came into the nursing office, he was ashen and anxious, sighing wearily, “how on earth did this happen?” almost to himself. Staff were talking over one another to tell him, just as our Dimwit pen pushers (Dpp’s) walked in seemingly showing no remorse rather, with their heads up and shoulders back, they looked defiant.

Female Dpp suggested they take Mr Smyth and Mr Forbes, who’d just arrived, to the ward round office. She barked at someone, anyone, to bring them all coffee and she turned to leave. “Whoa, hold on a second — we’ll all go. I think staff have a right to be involved,” I replied equally as abruptly, and ushered the rest of the team along, too angry to care if they sacked me. Fortunately Mr’s Smyth and Forbes nodded agreement and in we all went – without her damn coffee.

Conflict in the workplace —
image by Monster.com

“Right. Tell us what happened!” Dpp 1 started, “First, where was the other nurse, what’s her name, when her colleague was being attacked?” Staff watched as my eyes widened in disbelief and waited with me, knowingly — keep calm, say nothing right now.

Mr Forbes appeared horrified and whispered angrily at her “I don’t think that is the issue right now,” he looked around at the team and said more gently, “I’m so sorry to hear about what happened to Manish. You must all be shocked and traumatised and if anyone would like to speak to someone in confidence, I’m sure we can arrange this for you.”

Fact finding exercise

Mr Smyth began, “I’d also like to apologise for what happened to Manish and I know this might be hard for some of you right now. However, this a fact-finding exercise, we need to know what happened and learn from this incident so that we can prevent it from happening again. Tell me, how did this happen?”

“Unfortunately, as you’re probably both aware, we were already 20-25% over our bed capacity and were ‘bussing out’ patients each night,” I replied calmly, “then when the cost cutting was announced, it was decided that night staffing numbers would be cut……. the ward was short staffed and regrettably Manish was attacked.” Mr Forbes and Mr Smyth, along with our two Dpp’s, looked decidedly uncomfortable as I stopped to let that sink in. I further went on to explain that it wasn’t fair to place all the blame on Paru or young Iki and that this incident could have been prevented.

“Hmmm. Hmmmm. So, you were aware of the risk, yes?” mumbled Mr Forbes and I nodded at him but said nothing. I could feel our Dpp’s glaring at me as I sat and waited – angelically. “Okay, so as Ward Manager, what actions were taken to reduce the risks?” asked Mr Smyth but he turned towards the Dpp’s, “Were you aware of the risks Dpp 1, 2?” (sorry if this is confusing, I can’t even face giving them a name – just Dpp 1 and 2).

You could have heard a pin drop as silence fell on the room, “Well, Dpp 1?”

Conflicting opinions — image by
Entrepreneur.com

“No. Nobody actually told us they were concerned about the risk,” she choked, as did most of the staff — but they waited it out. Forbes and Smyth were scanning the room now, looking perplexed but knowing at the same time and wondering where to go with this.

To save them all any further embarrassment, we passed round copies of minutes from our last Team Meeting which was only two days before Manish was almost strangled to death. These minutes were clearly cc’d to not only the Dpp’s and our local service managers, but also to Head Office Senior management.

Apologies and swift exits followed and staff watched happily as our two Dpp’s were ushered quickly down the corridors by two angry Senior Directors. Still, there were no gains to be made here, we were only glad that those two were found out for what they were.

This makes no sense

However, long story short — the Dpp’s were moved sideways to other services, probably on the same salary and benefits packages and no doubt they’d be promoted again elsewhere within our Trust.

You couldn’t make this stuff up — they should have been sacked.

What do you think? I’d be interested to hear your opinion?

If you or anyone you know is experiencing mental health difficulties, please see your GP. If you are having suicidal thoughts, please talk to someone immediately. In the meantime, this Useful Mental Health Contacts may be of interest.

fact finding learn from

defensive and

Cutting night staff led to nurse being seriously attacked

Dimwit pen pushers cut the staffing numbers at night time

Pen pushers in the NHS — image by Jetpens.com

In my last two posts here and here (you might like to read these short posts to get the backstory), I wrote about how our patients, having gone from being slept out on other wards within our unit, to being bussed out to spare beds in our other mental health hospitals every night. I ended my first post with things couldn’t get any worse.

Well, they did. Despite being 20-25% over our regular bed capacity, the annual cost cutting exercise came round. To save money, our Dimwit pen pushers (Dpp’s) decided that cutting staff down from 3 to 2.5 at night would be a good idea.

Nurse severely attacked by mental health patient at night

So — Manish was at the medication room door, trying to find the right key, and Iki was waiting behind him. Manish pushed open the door and went for the light switch when suddenly he felt himself being tugged roughly from behind and realised there was something round his neck, choking him.

Initially shocked, then terrified, Manish tried screaming. He grappled and fought hard, pulling at the ‘tie’, trying to get his fingers inside to loosen it. He tried to scream again but was finding it difficult to catch his breath. His ears popped, his eye lost focus and then it all went black.

Old hospital corridors —
Countyasylums.co.uk

In the meantime, downstairs and outside, one of our better support workers was coming back from her break. She heard muffled cries “Help. Help me!” She raced up stairs and ran through corridors back to her own ward to see if that’s where the noise was coming from. No! She rushed to find staff on her team and told them what she’d heard. They checked their ward and found all their patients in bed and safe.

One nurse remained on their ward and raised the alarm by calling for Rapid Response Team (RRT — around 6-8 members of staff, one from each ward on the unit), while the other two ran to the ward next door. They arrived to find our ward, with only a few night lights on, and as they couldn’t see anyone, they called out to get the ward staff attention.

There was no answer but fortunately by this time Rapid Response had started to arrive one or two at a time (depending on where they’d ran from), and immediately they started chasing around the ward. However, as they didn’t know our ward’s patients, they didn’t know how many were on the ward or which rooms they should be in.

It was pandemonium; nurses running in and out of rooms, offices, toilets and bathrooms. They found Paru (the other ward nurse who was on her break) asleep in one of the Doctor’s offices and woke her to help as they couldn’t find Manish. Someone eventually suggested the meds room and staff raced there. They flicked the light on and found Manish lying on the floor, his face in a pool of blood, with Iki sitting on top of him.

Staff having to restrain a mental
health patient — unnamed

Staff had to untangle a leather belt from Iki’s hands before they were able to drag him off Manish, who remained still and silent. Staff dropped to their knees on the bloody floor and saw the blood was seeping from Manish’s mouth and nostrils. Someone screamed for the “Crash Team” (now the Doctors would come running too) while someone got the emergency trolly. However, as Manish still had a slight pulse, the defibrillator wasn’t necessary.

All staff could do was stay with Manish as the medics ran along the corridors with a trolley bed — so they could get Manish over to A&E and the resuscitation team as quickly as possible. In the meantime, a few RRT clung on desperately, restraining Iki who, although slight, appeared to have hysterical strength (adrenalin figures prominently in what’s popularly called the “fight or flight” response) and was struggling against the small team.

The medics arrived and ensured Manish could be lifted onto the trolley bed before they raced back to the general hospital. Although staff were probably still in shock, they were able to turn their attention to Iki and get some intramuscular medication (IM works quicker than tablets) into him, before they took him to the seclusion room (small room which is bare apart from a large single sponge bed).

I got the phone call around 2 am and dashed to our ward to see what support I could offer. The Senior on-call Area Manager had also been informed by our Duty Senior Nurse but there wasn’t much they could do until Monday so I was to hold the fort. However, I did mention the fact that there had only been one nurse on the floor — and told him why. Heads were going to roll.

We called a few staff who lived nearby to ask if they would come in to help support the staff and make up numbers on the wards. Once it felt safe to leave the wards, I went over to see Manish who was now out of the woods but still unconscious and surrounded by tubes. The Doctors said it was the worst case of strangulation they’d ever seen where a patient actually survived.

I will wrap up this incident in my next post. In the meantime, I do hope this post hasn’t distressed you.  Do you think the teams could have done anything differently?

If you or anyone you know is experiencing mental health difficulties, please see your GP. If you are having suicidal thoughts, please talk to someone immediately. In the meantime, this Useful Mental Health Contacts may be of interest.

Shock as mental health patients are 'bussed out'

In my last post I wrote about how our patients, having gone from being slept out on other wards within our unit, to being bussed out to spare beds in our other mental health hospitals every night. I ended with things couldn’t get any worse.

Documenting risk in ‘bussing out’ patients

Safe Staffing Now — RCN Nurses — Image from Belfasttelegraph.co.uk

Our ward staff had been completing incident reports for weeks, months even, documenting the risks of bussing patients out but were wondering what the point was. Staff were reminded, “if it’s not documented — it didn’t happen.”

Unfortunately, our local Service Managers weren’t listening and were ignoring the risks and the quality of patient care by bussing them out like cattle going to slaughter each night.

We needed these incident reports to show that even under these extreme circumstances, we were doing everything possible to maintain high standards of patient care and reduce any risk.

We also needed Senior Management at Head Office to be aware that our verbal complaints were being ignored by middle management, who were essentially putting patients and staff at risk.

While we often had to sleep out 4-5 patients each night (20-25% over our regular capacity), those patients returned each morning and had to be cared for all day with the same number of staff. So instead of two qualified and two unqualified staff for up to 20 patients, we had the same amount of staff for 24-25 patients.

Weekly staff team meeting

Despite our continual complaints, verbal and written, via the minutes from our weekly Wednesday team meeting (which we cc’d to all the powers that be), our concerns were still being ignored. Therefore we invited our Modern Matron (my boss) and the Area Nursing Director (his boss) to attend a team meeting.

Ward staff team meeting — Image
by Isbu.ac.uk

Staff were encouraged to speak for themselves in these meetings — if they wanted change, they needed to express their concerns. They needed to say “we have too many patients to cope with, the patient’s are getting agitated about being bussed out every night and the risks of this practice are too high.”

Our dimwit pen pushers (Dpp’s), who’d decided that sleeping patients out was a good idea, sat silently and had to be prompted for an answer “How long will this go on for?”

Dpp’s glared at me, glimpsed at each other then their shoulders went up in a couldn’t care less shrug and our Nursing Director humphed, “not any time soon.”

“Ah, okay,” I smiled, “We’ll document this in the minutes”. Not another word, just a look of disgust and they both left. “That’s why we complete incident reports, ” I chuckled, addressing the team, “they haven’t got a leg to stand on if anything happens, we have the documentation.”

The dreaded annual cost-cutting in mental health

By now, it was December and the annual cost cutting was announced — our unit had to save money somehow otherwise we’d go over our budget at the end of the financial year, which is end of March in the UK.

Lightbulb moment — Mary Pitzer Blog Image

Our Dpp’s had an amazing idea, which was to cut ward staff at night — immediately. Instead of 3, each ward would have 2.5 which meant that each ward would share a member of staff – who would go back and forth between two wards?

Our concerns were voiced to our Dpp’s in a team meeting and ignored. I would be off for four days now and staff were given strict instructions to complete incident forms each night. Again this was documented in the minutes of the meeting.

Accident waiting to happen on a mental health ward

Just imagine, it’s now Friday night. One qualified nurse is ‘doing’ medication for 20-25 patients, ensuring that the sleep outs were ‘done’ first. The other qualified nurse is checking all our patients are where they’re supposed to be and still breathing. Then she’ll make hot drinks and toast for the patients before they go to bed.

In the meantime, the unqualified nurse is rounding up the identified sleep outs before eventually walking them down the dingy corridors to the bus waiting out the back. It’s our ward’s turn to accompany patients on the bus to our other hospitals and to give a handover to the staff there. This could take 2-3 hours.

By around midnight, the unqualified nurse was on her way back from our other hospital, things had settled and one qualified nurses decided to take her break. Manish, the other nurse, went round the ward to complete the half hourly checks on patients when he saw a young male patient, Iki, loitering near the female area.

High risk patients on acute mental health ward

Breakdown in the community — Image by Weheartit.com

Iki was a young lad with a diagnosis of paranoid schizophrenia and had just recently been re-admitted on Section 3 of the Mental Health Act (MHA 1983) following a breakdown in the community.

He told Manish that he wanted to have sex with one of the young female patients and when Manish said that he couldn’t do this, Iki became agitated. Manish suggested some medication to help him sleep and Iki agreed, so they started towards the medication room, down a long corridor. Manish stepped forward to unlock and open the meds room door …………..

I got a telephone call at home around 2 am that morning and returned to the ward before going over the general hospital where Manish now was.

123rf.com

I’m sorry I need to stop here but I’ll continue in the following post. In the meantime, I’d be interested to know what might you and your team have done in the same circumstances. Would you do something differently?

If you or anyone you know is experiencing mental health difficulties, please see your GP. If you are having suicidal thoughts, please talk to someone immediately. In the meantime, this Useful Mental Health Contacts may be of interest.

More mental health beds needed urgently

Let’s look at what the media say

We need more mental health beds — Science Photo Library

Both the Guardian and the BBC recently wrote about the need for more mental health beds. The Guardian said “Cuts in mental health beds have gone too far, leading to the ‘shameful practice’ of patients being sent hundreds of miles from home to be treated, according to psychiatrists.”

“The Royal College of Psychiatrists is calling for the NHS to urgently create hundreds of extra beds for people who are seriously mentally unwell in order to tackle a damaging shortage” wrote Denis Campbell, The Guardian (2019).

The Department of Health states that they aim to end these inappropriate far-away placements by 2021. They’ve only got one year left to reach their goal and I haven’t read anywhere yet that they’re on target.

Mental health bed crisis — closer to home

As far back as 2003, despite the increasing population (approx 210,000) in our area, we always had a distinct shortage of beds. Apart from offices, our mental health unit housed the following:

Mental Health Unit —
Image by ITV News Calendar
  • 4 x (mixed occupation = male and female) 20 bed acute in-patient wards, for for each area of the borough i.e. North, South, East and West.
  • 1 x 15 bed Female Ward
  • 1 x 5 bed Mother & Baby unit
  • 1 x 20 bed PICU (mainly men) but sometimes women had to go into their only seclusion room in the building
  • 1 x 18 bed (mixed occupation) Rehab ward
  • 1 x 25 bed Elderly ward (ditto)
  • 1 Day Hospital which had around 60 patients attend each day
  • Emergency department where people attended when in crisis and were either sent home, allocated to the Home Treatment Team or admitted to an acute in-patient ward
  • Home Treatment Team (HTT)

That’s roughly 120 beds and we never seemed to have enough, especially when we know that 1 in 4 people were experiencing mental illness at any given time.

Queuing for a hospital bed —
Image by Kim Kyung-Hoon

NHS data showed some mental health trusts were operating with all or almost all their beds full, despite the College’s belief that they should never exceed 85% capacity.

Let’s look at the reality

Once (before my time on that ward), following a hugely publicised incident (Clemence, who’d been diagnosed as having schizophrenia, had been given leave by a new Consultant, despite the fact that he’d said in ward round that he felt like killing someone), we were running at 110-120% capacity.

That meant each acute in-patient ward was regularly 2-4 patients over. The Rehab ward generally had 1-3 spare beds when patients went to try out new accommodations or went home on leave. The elderly ward normally ran at 80-85% so regularly had 2-5 spare beds.

A terrible critical incident

Anyway, Clemence had been given a few hours leave — he left the ward for a while then came back and went to bed early evening. The police arrived a few hours later with a grainy picture (snipped from a cctv recording) and asked if anyone knew this person.

Yes, it was Clemence and a staff member went to his room to get him. He just muttered, as calmly as you like, “Are the police here yet?” This patient had gone to a train station and pushed a female in front of a train — this poor lady, just in the wrong place at the wrong time, died instantly.

Of course, the new Consultant was devastated but he got to keep his job. Afterwards, he barely dared to discharge anyone. This spread around other wards and junior doctors in particular weren’t keen on discharging patients.

Mental health patients forced to sleep out every night

Sleeping patients out — Image by Fox News

From then on in, our beds were constantly over-subscribed. Some dimwit pen pushers decided; each night around 7pm, the nurse in charge on each ward had to identify at least 1 or 2 more settled patients to sleep out on another ward that had spare beds i.e. the rehab and the elderly wards.

Remember, these were our acute mental health inpatient wards and if you didn’t know already — Acute mental illness is characterised by significant and distressing symptoms of a mental illness requiring immediate treatment. This may be the person’s first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental illness.

Can you imagine — after night time medication on their own ward (around 10pm), these unfortunate acutely unwell patients were traipsed down corridors with their belongings to spend a night on another ward? Once they woke they had to wait around til after the morning handover (which ended after 8 am) before being escorted back up through corridors to their own ward for breakfast.

This went on for many months and the ‘sleep outs’ hated having to move lock stock and barrel each night, return each morning then walk around their own ward all day with their belongings. So, not only might they have already been unsettled in the community, homeless or neglected and now acutely unwell, they were being pushed from pillar to post — yet again.

Mental health patients forcibly bussed out every night

As patients returned from leave to the rehab or elderly wards, beds were becoming even more sparse. So, the dimwit pen pushers thought “Oh — let’s bus them all out to our other hospitals each night — that’s a good idea.”

Mental Health Minibus — Image by Kent Mental health

Now the identified patients were traipsed down the old and dingy winding corridors, with their belongings, to the minibus waiting at the back of the hospital. If one ward was particularly late giving out medication or there was an incident on the ward, the patients downstairs on the bus were delayed and had to sit in the minibus for up to an hour.

The risks in sleeping patients out every night

Only one member of staff (taken from a ward) was allocated to accompany the bus driver to our other hospitals which to me was a huge risk. Imagine sitting with 4-10 tired and thoroughly p’d off patients. I would have refused to do it but was fortunately never allocated that task as it tended to be a support worker role.

Never mind that (1) if a patient became unwell (physically or mentally) or aggressive, there was no qualified nurse to help them, (2) as a rule, on the wards, staff normally had only 4-5 patients to look after and (3) remember that one ward was missing a support worker for around 3 hours. Risk. Risk. And more risk!

Everything about this was wrong. With me now at the helm (Acting ward manager), staff were encouraged to put in incident forms each night, letting the dimwit pen pushers (who saw me as trouble) know that patients’ refused to be slept out. We’d already told every patient on the ward that they had a right not to be slept out and the right to stay on their own wards. Our staff were also advised not to let one of our support workers leave the ward to accompany the bussed out patients as it left our ward at risk.

We’d previously informed patients that Patient Advice and Liaison Services (PALS) was available if they wanted to complain. However, despite our reassurances, many declined because they didn’t have the wherewithal (too worn down from being ill) or for fear of being singled out further.

Nurse documentation is everything

Incident Report — Image by
Ambinsurance.co.uk

It was important that staff continued completing incident forms each night. They had my full support, as did the patients. Staff were to document in patients’ notes and on the incident report — how the Duty Senior Nurse (DSN) called each night for the identified sleepouts and how staff were not prepared to take the risk.

In hospital/medical care, if it’s not documented — it didn’t happen. This was my motto and I continually encouraged staff to document everything verbatim — even if they were requested/ordered by senior staff to do something they weren’t comfortable with — I had their backs.

It couldn’t get any worse. Or could it? That’s another absolutely shocking post — next time.

In the meantime, I’d really appreciate your thoughts on sleeping patients out. Have you ever come across it? How do you think you’d feel if, as an acute mental health inpatient, you were bussed out to another hospital every night?

Happy Valentine's Day to you all

Valentine’s day doesn’t have to be just about couples and while I’m one half of a couple, I also have lots of special friends in my life who deserve to be celebrated.

Yes — that’s you. Everyone in the blogging community and on twitter has been so accepting, supportive, friendly and amazing — sometimes, just when I needed you most.

That’s all — I just wanted to tell you how much I appreciate everyone that’s ever viewed, liked or commented on my blog.

Lovethispic.com

Common excuses for taking extra time off work

Hayfever — image by Getty Images

I wrote in a post yesterday about Bimbola who informed me his GP told him to take a week off work because of his new diagnosis of ‘hayfever‘. Now, my sons are both plagued with hayfever during certain months of the year and while it’s irritating and makes them irritable, they still go to work each day. And you might think I was insensitive by telling him to get his backside into work that day but Bimbola had previously used every excuse in the book for taking time off work.

The NHS

Let me tell you, our wonderful NHS offers terrific benefits, including:

  • 27 days holiday + bank holidays — after 5 years you are entitled to another 2 days holiday and after 10 years you get an extra 4 days = 33
  • 10 sick pay tho’ if it’s a long-term illness (such as mine – Transverse Myelitis) you will receive full pay for 6 months and half pay for the next 6 months
  • 5 days discretionary compassionate leave
  • 5 days discretionary carer’s leave (if you have small children)
  • Study days – discretionary

I think these benefits are very generous but unfortunately, far too often, they’re are abused. Staff would ask how many sick days, compassionate leave or carer’s leave they had left — as though this was an entitlement to have few more days off each year.

Bereavement

Our African nurses appeared to have lots of people they called brother, sister, grandmother or uncle and aunty, so regularly requested compassionate leave when someone died.

One guy had asked me for leave as his grandmother had died and when I looked through his records his ‘grandmother’ had already died three times (prior to my arrival on this ward), so his request was declined.

Carers

Image by Wavebreak Ltd

Another called to tell me his daughter had the sniffles and couldn’t go to school so he needed to stay home to care for her. The next day I asked how his daughter was and he said she was much better and was going back to school that day. “Aaaww, that’s good, bless her, how old is she?”

“Oh, she is 20 and is at university.” he smiled proudly.

“Ah. Right — that changes things Kwami. Unfortunately, you can’t have carer’s leave for your adult daughter who just had the sniffles I’m afraid.”

Paternity

Remember Bimbola, who wanted a week off for his hayfever? Well, one of his girlfriends was pregnant and had gone into labour. Bimbola called to say he would be taking his two weeks paternity leave and the next day he let the team know that he’d had a healthy baby boy named Rio – whoop, whoop. We were all delighted for him and put in a kitty to buy a gift — two of our girls went shopping and brought back loads of goodies, all blue, together with a card and one of those huge helium balloons.

Beautiful baby girl — image by
Mom365.com

About three months later, Bimbola’s girlfriend dropped by to show us their beautiful baby girl who was just two weeks old. His face was a picture when I went to let him know the said girlfriend was on the ward. Of course, he was disciplined and was unable to take any more paternity leave.

Compassionate

Another chap, our in-house Latino lothario, was continually hooking up with girls via the internet, called to say he was locked out of his house and couldn’t get in to shower or change his clothes. When he came to work the following day his wife rang asking to speak to him. It turns out his long-suffering wife had locked him out — no, no one knew he was married. His compassionate leave day was cancelled.

Glenmore had me spluttering coffee all over patient’s notes when he rang to whisper “I can’t come in today. Me swollen — down there. I can’t get me jeans on”

image by 123RF.com

“Eh? Sorry Glen, I don’t understand,” I mumbled to cover the sound of me putting him on loudspeaker cos our deputy manager was in the office and she loved a good laugh too.

“My girl, she pierce me, with her teeth, ya know…….”

“No, sorry Glen….”

“Girl, when things get heat up, ya know. She go a bit wild and me thing swollen now,” he grimaced.

Me and Jackie sniggered and spluttered as I suggested I call him an ambulance, which would bring him to our general hospital next door, so we could visit him in our break. Kissing his teeth, “No girl. No. Don’t put me there. Let me fix it,” he groaned and this was real — this was no malingering or joking, Glenmore was in pain. His request for a few days off was granted.

Anon

He was mortified when he returned to work. He made it clear he didn’t want to talk about it or how the problem was resolved. However, his new attire of jogging pants, his strange new strutt and the eye watering bulge didn’t need any explanation.

His kind GP had chosen to leave the full details off his sick note and Glenmore asked me to do the same.

Sick

We live in a world now where taking the occasional “sick day” is often actually frowned upon — that’s probably because lots of people tend to take advantage, as I know from my time in the NHS.

However, we all know it’s essential when you’re genuinely ill, you take some time off to recuperate. But often one of the most difficult reasons to request sick leave is often for mental health.

Anecdotal evidence says that some companies offer duvet days, in an attempt to reduce sickness leave, which offer opportunities for people to take a break during difficult times, particularly for those with mental health issues and who, on certain days, just can’t face getting out of bed.

Hmmn. Why do people who have mental health issues have to request a duvet day? Why is it so difficult to ask for time off sick when we have mental health problems?

What the worst excuse you’ve heard from people asking for a sick day? Have you ever given another excuse to cover for mental illness?

Mental illness and the "sick role"

Adopting the “sick role” —
Image from Spectrumnews.org

When I worked as a senior mental health nurse, we had a particular male support worker who regularly adopted the “sick role”. He called in, yet again one Friday and whispered, “Hello……… I been to my Doctor today…….. he tells what is wrong with me……” pausing for effect and in that desperate manner, giving the impression he just he had a month to live “My Doctor insists me to take one week off sick.”

“Ah, okay. What’s the problem Bimbola?”

“He tell me I have hayfever and now, I go to the chemist to buy some medication and I will come back next week.”

Holding back my giggles, “Aw, you poor thing Bimbola. Okay, get yourself off to the chemist and then — get your backside into work. I’ll see you in half an hour.”

The above was something I wrote on a friends blog the other day, in answer to one of his questions — which led to him further questioning my use of the term “sick role”. Hence this post.

So, what is the “sick role”?

Sick role, 1951 — Getty Images

It’s a term used in medical sociology regarding sickness and the rights and obligations of the affected i.e. the patient. It’s a concept created by American Sociologist Talcott Parsons, 1951.

His sick role prescribed customary rights and obligations based on the social norms for the patient.

The rights included;

  • the sick person should be excused from social roles and should not be held responsible for the illness;

while the obligations included;

  • the sick person should try to get well and should seek technically competent help from the medical professional.
Sick role and your ‘right’ not to have to tidy up — Bigstock

So, in plain English, if you were sick it was your right to take to your bed, not to go into work, to hand over the school run to someone else or to ignore the housework.

And it’s not your fault you broke both legs, so no one can blame you for the pile of dishes in the sink, the sort-yourself-out-dinner or the kids emptying the kitchen cupboard contents onto the floor then thought it funny to crack half a dozen eggs into the mix.

However, you have an obligation to try to get well — like taking pain medication, sitting in A&E for hours on end, having x-rays, a cast and attending outpatient appointments.

Do people still adopt the “sick role”?

Do you remember when people went into hospital say to have their tonsils out and often stayed for days, a week even? They lounged around in their best nightgown, a woolley cardi and slippers, looking pale and sickly. They actually played out the “sick role“, smiling weakly and almost whispering when visitors arrived. Never mind they were only in there to have an ingrown toenail sorted out.

For all that, times have moved on and it seems that most of us no longer voluntarily accept the sick role and we don’t comply with those old rights and obligations of the sick role.

With our busy lives, we have no time to comply with the rights like taking to bed for a few days. We tend to get up and get on with our social obligations like washing up, making dinner or taking three kids to karate, swimming and football. We’re more inclined to resist help, decline medication and not worry about visiting our GP.

Mental illness and the “sick role”

Mental illness and stigma — Twitter

We tend to avoid the sick role even more if our illness is stigmatised — like mental illness. At first and for many years, I hid my mental illness. I was scared and I didn’t want people to judge me for having a mental illness, hence my initial fear of seeking help and treatment.

For someone with say a wrist fracture, playing the “sick role” enables them adopt an identity (Look at me, I’m sick) that, more often than not, brings support and acceptance from others — they receive cards saying ‘Get well soon’ and people call to ask how they’re doing. Hospital admission also offers that person a clearly defined place in a social network — they’re off work, sick, they get lots of visits from family and colleagues who come bearing grapes, flowers and chocolates.

Not so with mental illness.

I might have seen a dozen or so get well cards in fifteen years working in mental health and I most certainly never saw flowers or a bunch of grapes. Visitors, even family members, were few and far between on acute mental health in-patient wards. Families that initially turned up, often looked down their noses at other patients with mental illness saying, “my son doesn’t belong here — these people are all mad, my son is sick,” or they never visited again.

Panic attack — Image by Medicalnewstoday.com

Let’s be clear here. We don’t want to adopt the “sick role”. We don’t want to have anxiety, depression, OCD, PTSD, schizophrenia, bipolar or personality disorder any more than someone else wants broken legs.

According to the WHO (World Health Organization), mental health is:

“… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

And people with mental illness want to be able to fulfil our social obligations and just get on with it, to work productively and to contribute towards our communities.

Does that mean we have to adopt the “sick role” so that, perhaps we’ll be diagnosed sooner and the quicker the symptoms can be treated?

It took eighteen months before my GP finally pulled me aside, when I’d taken the boys to be seen about their asthma. Once he’d seen them he sent them out, turned to me and, with his hand resting lightly on my arm, he said “Tell me, what is the problem? You so thin and though you smile, I think you very sad.”

As a single parent, working part-time and taking the boys to the various activities most nights and each weekend, there was no “sick role” rights for me — I couldn’t take to my bed and curl up into a ball.

Seek help from a medical professional – Getty Images

However, my “sick role” obligations were carried out as I sought competent help from a medical professional (well help found me really — in the form of my GP.

What are your thoughts about the sick role model. Do you think it’s outdated? Perhaps you know someone who constantly adopts the “sick role”?

Sources:

Parsons, T. The Social System. 1951. Glencoe, IL: The Free Press