Poor standards at 28 mental health units

https://www.theguardian.com/society/2019/sep/25/inspectors-discover-poor-standards-at-28-mental-health-units

Psychiatrists call for inquiry after report on private units, many occupied by NHS patients. This is great news. Not because poor standards were discovered, but because it’s been reported and it’s out there!

Patient’s bedroom. Design Pics Inc/REX

I’ve already mentioned some of the poor practice I’ve come across in other posts but there’s so much more. Like the way some staff dismiss patients’ fears and anxieties. What appears to be a molehill for us may feel like mountains to patients. When a patient expresses their fears about admission to an acute mental health ward it’s extremely important to listen so they feel heard and know that you care. It’s particularly difficult for patients who’ve been sectioned under the Mental Health Act 1985 (MHA) and almost dragged from their comfortable homes by well-meaning (or not) family, carers, Social Workers and a Psychiatrist.

During the admission process it’s essential to accept that patient fears are real for them and not to dismiss them. Some patients are acutely unwell and can be chaotic on admission so again, it’s important to continue the conversation as many times as a patient might need. Nurses also ought to let patients know that they have the right to appeal against their Section and give them the correct paperwork to do so. Patients also need to know about Patients Advice and Liaison (PALS), a service which will support them with almost anything. They can make an appointment with the team who will come to the ward if a patient has no leave.

While The Guardian reports “Inspectors have found 28 privately run mental health units to be “inadequate” this does not detract from poor standards within the NHS. I only had one elective placement (which I chose) within a private unit and I would never go back. Most of the staff were agency who probably couldn’t get permanent jobs if they tried. They were rude, authoritarian and antagonistic not just to patients but to families, colleagues and students.

Nursing admin. Photo: Shutterstock.com

They didn’t like me and the feeling was mutual. I asked too many questions and ‘cared too much’ when I ought to be doing some work i.e. the menial tasks they couldn’t be bothered doing. What they didn’t know, because they didn’t ask, was that I had been doing secretarial work for near on twenty years and I loved doing the admin, completing computerised care plans etc; I was quick and good at it so I smiled throughout the shift – something that bugged colleagues when they disliked you.

One particular famous client (which they were called in private units) was on methadone, an opiate prescribed by doctors as a substitute for heroin, and she wanted to eat lunch before medication, which she did. However, when she went to get her medication the nurse who’d been doling out meds had left the ward.

The other nurses wouldn’t give her the methadone and told her she’d have to wait, which could potentially trigger debilitating withdrawal symptoms like nausea and insomnia and I thought the nurses’ punitive actions were totally unacceptable.

I went to the unit Manager who was sitting in his plush office and asked whether it was standard practice to hold medication hostage. He tutted and exhaled heavily, put his muscled arms up behind his dreadlocked head and proffered an uncomfortable smile. “Mmm, Nancy is it? Look, she’s a pain. Man, she always think she can bend the rules.”

“Pfft, rules?” I asked. This is a healthcare facility isn’t it? I am in the right place?”

“Nancy, we only have enough staff to do the basics, they don’t have time to run after clients whenever they want.”

“Okay, but Molly’s totally distressed now so I’ll go and talk with her and document all this in her notes.” I said with a sarcastic smile and walked out of his office. He wasn’t long in chasing me down the corridor, apologising profusely; he was just having a bad day, he didn’t realise what staff were doing! He would get the medication now. I still documented this event in Molly’s notes and asked a nurse to co-sign it.

Guess who didn’t speak to me the rest of my placement? Was I bothered? It was one less idiot to listen to as she did nothing but whinge about the job, moan about various patients and kiss her teeth throughout her shifts. She spent more time on the computers, googling hairstyles and nail art, not realising that somewhere in Head Office, the tech guys could easily follow what she was doing, see how much time she spends online and could report her for time wasting.

Busy tech guy – Photo: Gettyimages.co.uk

Much of the time on this elective placement I felt so powerless and could totally empathise with patients. No one wanted to listen and no one cared! Staff appeared to find everything a chore and it seemed they only came in to earn money. See, nursing isn’t just a job. Being a professional nurse means the patients in your care must be able to trust you, it means being up to date with best practice, it means treating your patients  and colleagues with dignity, kindness, respect and compassion.  It means understanding the NMC code of conduct. It means being accountable. Katrina Michelle Rowan, 2010. https://www.nursingtimes.net/archive/nursing-will-never-be-just-a-job-to-me-24-07-2010

I was able to complete several PBA’s on this placement and learnt more about how not be be a mental health nurse. I saw how poor the team’s communication skills were, both verbal and mainly non-verbal. I saw how badly they treated people, how unprofessional they were and how they lacked empathy for anyone. As much as the staff on this placement tried to hold me back, little did they know how much I gained and how much I’d grown by watching their indifference. I always say, there’s never a bad lesson.