Fake mental health patients

Some of you might want to crucify me for mentioning ‘fake’ patients but hold on. Wait until you’ve finished reading this post.

Pauline

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I was still in my six month preceptorship period when Pauline was admitted to Lavender Ward, an acute inpatient mental health ward. She was neat and tidy, her hair and nails were spotless, she appeared cheerful and engaged easily with the other patients while waiting to be assessed. However, during her admission assessment she relayed that she had been living on the streets, she was paranoid, depressed, anxious and suicidal – she’d actually been seen by passers bye running across a main road several times, without looking out for traffic, according to the paramedics who brought her in.

Pauline was articulate, she maintained good eye contact with me and smiled appropriately during the assessment. She said she had no family at all and had lost her friends since becoming ‘mad’ and homeless – though she couldn’t remember for how long. Pauline reported that she slept well although she had paranoid dreams, which didn’t wake her. The paranoia she described was that someone was after her and wanted to kill her but she couldn’t be clear about when this happened or who it was that wanted to kill her.

Once seen and admitted by a nurse, the patient’s baseline observations are taken i.e. blood pressure, temperature, pulse, respirations, height, weight etc. All of which were stable. After this, the patient would be seen by the ward doctor, normally an SHO, a junior doctor who is on their six month rotation and has little psychiatric knowledge.

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We had a tall, handsome and smarmy (oops, I mean polite) young chap, Dr Wellar, who looked down his nose whenever a nurse approached him. This was only his second week on the ward and I did tell him one day, “these nurses know way more than you do, and you ought to treat them with the respect they deserve.” That marked my card with him, I’m afraid.

Dr Smarmy stood to greet Pauline and, shaking her hand, he invited her to sit in ‘his’ office for a chat. She was in heaven, all smiles and giggling like a teenager. So I wasn’t sure why, when they’d finished her assessment, he announced to the team that she needs to be on close obs (There’s lots of circumstances where patients may require one to one nursing i.e. the patient is acutely physically unwell and/or requires frequent observations, the patient is acutely mentally ill and/or at immediate risk of serious self harm/suicide etc).

Depending on the level of risk, one to one nursing can be carried out by either a qualified nurse or a nursing assistant. Pauline was classed as high risk of suicide so needed to be observed by a qualified nurse 24/7, which includes when the patient goes to the loo. This takes one person from the staff numbers i.e. reducing the amount of staff by one. If you are nursing one to one, you cannot be expected to care for your five patients on top of this. Sometimes, the Trust allowed us to have an extra member of staff, more often a nursing assistant, to keep costs down.

As I’d done Pauline’s initial assessment, I was allocated as her 1:1 nurse so I spent the rest of that morning’s shift with her. We chatted about the weather, her dog and how she was worried about him – she didn’t know where he was. Pauline’s mum works “oh, I mean worked” as a teacher but she couldn’t remember the name of the school. I just kept the conversation light and said how proud she must have been of her mum etc. But something just didn’t sit right with me and I passed all this onto the afternoon shift.

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On my next shift, I was allocated to Pauline, 1:1, as apparently she liked me and we’d built up a good rapport. Again we chatted amiably about her past – what she could remember of it – she said her depression was affecting her memory. Obviously I had to accompany her while she showered and went to the loo, but to give her some privacy and to maintain her dignity, I averted my eyes temporarily. However, she was inappropriate at times, dropping her towel, not able to find her knickers, could I pass her the toilet paper or her wet wipes – almost anything to keep my attention.

Let me tell you something now; it’s no fun being in a bathroom when someone else has to poop and it’s worse still when you have to get close enough to pass the toilet paper.

Towards the end of one shift, she told me how sad she was that I’d be off over the weekend as she really enjoyed out chats. At the end of my shift she really invaded my personal space when she threw her arms around me and planted a great big kiss on each cheek “Adios. Au revoir. Bye my angel nurse. I will miss you.” I kid you not.

I’d really enjoyed my days off but still looked forward to getting back to work. On my return, as I walked through the front door to the ward, I was almost past the Dr’s office when Smarmy called me in, “Can’t you even get one thing right? You only had to look after one person – how hard can it be?” he demanded and shook his head at me disdainfully. “Pauline said you left her in the shower for nearly 20 minutes and she tried to kill herself.” I shook my head back at him, I smiled and assured him that this was simply not true.

He continued berating and belittling me until he took a breath and I simply responded that I was off to see our Ward Manager. She believed and trusted me that it simply wasn’t true. He’d been ‘had’ but obviously this was the story he was re-telling the whole multi-disciplinary team, making me look incompetent. However, he took in what the ward manager said to him and conceded he might be wrong.

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In the meantime, I felt like I’d been punched in the stomach. I was hurt by Pauline’s tale; I thought we’d formed a good professional bond. One of our senior nurses said not to worry, don’t take it personally and reflect on this; trust me, you will learn from it.

I had to work with Pauline a few more shifts and just kept up the banter but didn’t mention the ‘incident’ and nor did she. Had I been a bit more experienced I would have discussed it with her but right at that moment, I didn’t want to upset her – there was something going on for her? and I was still trying to work her out.

After a week, we had a phone call from her mother, asking if we had a Josephine on the ward. Yes, it turns out this is something Pauline does now and again. She frequents hospitals seeking admission because she said ‘she gets a bed and fed’. In the meantime, she saves up her benefit money while she’s in whatever hospital. Some might say that this is a mental illness in itself?

Ronnie

This young lad had been admitted voluntarily after he went to A&E saying he was paranoid and hearing voices. He was amiable and loved chatting with fellow patients and the staff. He could be heard asking other patients why they were in hospital and was interested in hearing about their symptoms. After a few days staff could see that he wasn’t displaying any symptoms of anxiety, paranoia or hearing voices and had hinted as much to Ronnie.

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Late one night shift, we watched as he paced the long corridor outside the nursing office. He had his head cocked to one side, looking up towards the heavens’, and was saying out loud “Sorry. Say that again. I can’t hear you.” He gave the odd sideways glance towards the office to see if anyone was watching him and continued, “Don’t say that. I’m scared. You’re scaring me.”

Me and Billy, my favourite nurse, found this rather comical and went to sit outside to observe Ronnie and start a conversation with him. Billy asked “What are the voices saying to you Ronnie?” and Ronnie cocked his head to one side, looked upwards again and asked “What are you saying? Ah, ok, hold on.” and in all seriousness, he turned to Billy and said “They’re saying they don’t like you. They don’t want me to talk to you.”

I could barely keep a straight face as I probed a little further, “Okay, tell me Ronnie, how many voices are there?” He did the cocked head thing and the upward glance then cupped his ear, as though he was listening, then counting on his spare hand he looked at me and whispered, “two – and they said they like you.”

We continued in this vein for around fifteen minutes before Billy and I just laughed out loud. Ronnie’s utterances were becoming more ludicrous by the minute and Billy said as much to him, “Hey, soft lad. You look bloody stupid. You’re not hearing voices are you?” Ronnie knew the game was up and pleaded with us not to tell the doctors, “Anyway, they can’t send me home, I don’t have anywhere to go. They’ll have to find me a flat, won’t they?”

Emergency Treatment Team

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I worked with the Emergency Team for a while. This was where people would come during daytime hours to be assessed and we, as nurses, would decide whether to admit someone or to refer them to another service i.e. home treatment team (HTT).

We had so many ‘fake’ patients asserting their mental illness rights, looking for admission so we could find them a home with a garden. Or they needed housing application forms completed, saying that they had a mental illness, which they hoped would put them near the top of the the already groaning housing list or benefit forms so they could access Disability Living Allowance.

Many reported being depressed but when asked to explain, some would say they’ve got a bad back and needed a ground floor flat as the stairs were difficult. Or excruciating headaches due to noisy, antisocial neighbours and it’s driving them mad so they need to move. As though getting a new home would somehow magic away their pain and depression. While I appreciate that decent housing is beneficial to everyone, admission to a mental health ward is not. Furthermore, housing lists are stretched to their limits and London now requires around 66,000 new homes a year to provide enough homes for current and future Londoners.

Given that our hospital served the local population which was approximately 52% non white-British, we had patients from nearly every country and many of them needed interpreters. When they mentioned housing or benefit forms, I always asked them via the interpreter “Do you know where you are right now?” and “Do you know this is a mental health emergency department?” And often told them “This is not a housing services.” or “This is not a benefit office.” before signposting them to the appropriate services

The thing is, we had thousands of patients with chronic mental illnesses who desperately needed our support and mental health intervention or treatment. Moreover, Mental Health is like the Cinderella service of the NHS and we don’t get lots of money so what little we do get is needed for ‘real’ patients.

Do you think I was harsh in turning patients away?

My journey through psychotic depression – Part III

If you haven’t read Part I and Part II and you want to, you can find them here (Part I) and here (Part II).

If you see anything of yourself or your own experiences in this post, perhaps you’ll feel relieved that you are not alone. Maybe you’ll even recognise some of the symptoms in a friend or family member? Or it’s feasible you’ll gain insight into different mental health problems and see how difficult it is for people who experience mental ill health?

……….I was struggling desperately. I couldn’t see an end to the pain. I felt scared, worthless, hopeless and I honestly felt suicidal. It was then that I had my own ‘break down‘. And that’s exactly what it felt like; both physically and mentally, I was broken.

Panic attacks

I was having panic attacks throughout the day and particularly at night, keeping me awake. Alongside the huge purple sacks under my eyes, the weight loss, dizziness and nausea, I looked bloody awful and felt even worse.  It was torturous; twenty-four-seven, week on week and, with no end in sight, I wished I was dead.

Natural Stress Relief

Girl sitting on the rock by the peaceful sea at sunset.

I tried every natural and herbal stress relief, sleep inducing, over-the-counter remedy known to man, without effect. As an aromatherapist, I made up lots of pretty little bottles of stress relief oils then bathed in them and doused myself liberally. However, despite all the lovely citrusy, spicy and fruity oils, all I could smell was the lavender, reminiscent of my grannies old underwear drawers. This didn’t work either.

Soothing massage

As a qualified massage therapist, I was aware of the benefits so I booked massagemyself in for a few sessions. However, the first lady almost pecked at me like a small bird trying to feed itself for the first time; there was no pressure applied and she missed areas of my body out! The second time, I went for seated massage, which ought to involve sitting on the massagemassage seated chair with your upper body leaning forward, your arms on armrests and your face peeking through a hole. Looks comfortable, right? This lady, who’d attended the seated massage course with me, had me sit on a swivelling office chair! With my muscles tensing, I tried using my feet and legs to keep the chair from spinning, to no avail so told her to stop. She couldn’t understand why I refused to pay?

Exercise

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I joined the local gym and went seven days a week, twice on Sunday; pounding the treadmill and pedalling like fury on the exercise bike. I got so wound up if I couldn’t go to the gym for any reason but made up by jogging on the spot and running up and down our stairs. I tried most everything to relieve the constant anxiety and to wear myself out so I could sleep, but even the excessive exercise proved fruitless.

Hallucinations and paranoia

I was permanently exhausted and after three nights in a row without sleep, I started to hear, see and feel odd things. People (I didn’t recognise the voices – but they were very real) were talking to me and about me, saying I was no good, I was dirty, together with lots of other negative comments and expletives. I could see things; mice running along my wooden floorboards and unidentifiable faces at my windows. Worse still, one night I was wide awake curled up on my kitchen floor, with my back against the heater and it came to me – I’d killed someone.

I Big treeremembered how and where I’d buried that someone; by a huge tree outside my aunt’s flats, but I couldn’t think who it was that I’d killed. The next day, I saw a police car and thought ‘This is it. They’re coming for me.’ Jeez! I was terrified. For months, if I saw a police car down our street, I’d turn and retrace my steps or go round to my back door. If the police were in the square at the back, I’d whizz round the front. I sometimes wondered if I should just hand myself in and let them find out who this someone was that I’d killed. In hindsight, obviously if they were after me, they would have got me. 

Mad, nuts or crazy

Although close friends and family were aware of my break-up with thedepressed girl boys’ dad and knew how devastated I was, I couldn’t tell anyone what was going through my head. I was afraid they’d think I was mad, nuts, crazy and that I should be locked away. Seeing mice or rats scurrying under my sofa and the unknown ugly faces frightened me, but if I closed my eyes at least I would get some temporary relief. However, the voices were incessant and unbearable; the constant rabble of people discussing what only I knew as my fears. They played on them, they were cruel, repeating the negative thoughts I’d so often had myself. They knew which buttons to push.

Trying to sleepRelaxing music

When I attempted to sleep in my bed the voices seemingly delighted in keeping me awake with their constant and irrepressible verbal abuse. One day, after work and before picking up my youngest, I bought a cd player, ear plugs and a few ‘out there’ cds with relaxing music, water sounds and dolphins in the background. I played these throughout the nights but still, my heart pounded in my chest and thundered in my ears, my breathing was irregular and the panic attacks raged.

By the time I got the boys up for school, I was a wreck; my eyes were red-rimmed and it felt like there sand in them. I was sluggish and jittery, but I somehow managed to hide it from the boys. My job at a high end clothing company was demanding, which helped abate the voices for a few hours but the anxiety, depression negative thoughts and panic remained. Colleagues at work noticed the 4 stone weight loss and saw how my clothes fell from my gaunt body. It certainly wasn’t a good image for the brand. Fortunately, a good friend in the sewing department kindly offered to take them in.

hypnosisHypnosis

I even tried extortionately priced hypnotherapy but I couldn’t relax enough to go into a trance-like state. However, I’d bought myself a Paul McKenna relaxation video and when the boys were I bed I’d get it out. I’d half sit, half lie in one of my padded beach chairs, directly in front of the t.v so I could get the full effects of both the visuals and the sounds. Amazingly, I managed to relax and as the video ended, I’d carefully take this relaxation up to bed with me and finally managed to get a few good hours sleep. Sometimes it didn’t work and I suffered the torture again but I was so grateful for the times it did work.

What’s the problem?

After a while, not sure how long as I was in a constant haze back then, I took the boys to see our GP 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’s the problem? You so thin and though you smile, I think you very sad.” The floodgates opened and it all came tumbling out; I sobbed and wiped the tears and snot on my hand as I explained how the boys’ dad had been seeing someone else and about the breakup around eighteen months ago. He told me to let the boys go home, he would make some telephone calls and I was to come back in to see him.

Having spoken to a colleague who agreed to see me, like – now, at our local general hospital, Dr Nga was going to drop me off! I knew it was a general hospital, rather than a mental one, but I soon found out that there was one mental health ward there.

The asylum

I thought back to how, as kids we’d all say stupid things like “The men in white coats will come to get you.” or “You’ll end up in Stratheden, (our nearest asylum) you will.” We were all terrified just at the mention of the asylum.

Well, one day mum said my stepdad was taking her to hospital for a few days and I asked if I could go with them. Dad said no, mum said “Yes; she’ll be fine.” So off we went and when I noticed we’d gone past the hospital, I didn’t think too much of it – until I saw the huge sign looming up – Stratheden Hospital.

Stratheden Hospital
Stratheden Hospital –CC0 1.0 Universal

I assumed and hoped we’d just drive past that too. However, when we pulled up at the foreboding buildings and the grounds surrounded by high metal railings – and gates that were opened by the porter who otherwise sat in his wooden lodge, reading a paper. I was petrified and felt a certain shame; my mum was going into an asylum. Oh my God!

From the car park I could see people roaming around, some with an odd gait, others making strange utterances. A lady with long scraggly grey hair, wearing unusual clothing, waved at me frantically then cackled like an old witch. Not sure if it was designed to frighten me, but that she did! Mum and dad got out of the car but I wasn’t allowed to go into the building with them so was left sitting in the car and told not to open the doors to anyone. Ha, as if.

ECTIn later years I would learn that mum had been in an asylum once before and on both occasions she had ECT (Electroconvulsive therapy),  which is given under general anesthesia. Doctors use a course of ECT

  1. if you have severe or life-threatening depression where your life is at risk so you need urgent treatment
  2. and to treat severe depression where there’s a lack of response or intolerance to medication.

I’d say it looks barbaric but ECT is said to be one of the fastest and most effective ways to relieve symptoms in severely depressed or suicidal people. Some people find ECT helpful while others don’t and repeated ECT is only recommended if you have previously responded well to it, or if all other options have been considered.

Back to the future

Dr Nga had dropped me off at the hospital and fortunately, although I had suicidal thoughts, the Consultant Psychiatrist and the Psychology team were confident that I had no intention of killing myself – I’d said even though I felt suicidal, I knew I couldn’t do that to my sons. I couldn’t possibly leave them with that legacy. So, no admission was necessary and three years of weekly painful, gut-wrenching counselling followed – on and off, because sometimes I was too afraid of myself and my responses to the psychologist. I didn’t want to hear what I had to say, so how would the counsellor feel?

I do hope you’ll continue to read My story, Part IV (The finale) which will follow shortly. You’ll learn about my suicide attempt and the hell I went through during my Psychotic Depression.  Thank you for staying with me.