D is for...

A quick note before I start D: I got my marks back, and I've officially passed my second year, yay! :o) Somehow managed to pull out a 70% average, which fantastic, but a bit scary. It kinda opens the door to the possibility that I could get a first class degree. So now there's pressure; if I knew I had no chance of getting one, it would be easy and I would be very happy with a 2:1 (thrilled, in fact). But now I, and more importantly, Mr Door and my mum, have got a glimpse of it, we'll all be wanting me to get a 1st. Which I'm really not sure I can do. I'm pretty sure I've been lucky so far, and this year gets harder. Bah. Oh well. I'll just keep doing my best and hope for kind markers.

Onwards...

Death in custody

Patients sometimes die in hospital. It is always tragic and, no matter how much of a pain in the arse they were as a patient, their death will affect the staff. Mental health tends to be a small community, and every loss is felt.

Luckily no-one has died unexpectedly where I work during the period I’ve been there; not through lack of trying, I might add*, which in some ways is testament to the skills of the staff. Whether we should actually be letting them do it is being discussed on Mental Nurse, and isn’t a subject I’m going near even with a bargepole here because I'm a coward. People have died of illness; there is a general hospital nearby where they tend to get transferred and then, when the MoJ is sure they are definitely dying and not just faking the terminal cancer, they may get taken off their section. As long as they are too ill to get out of bed, of course. If the person has been a long-time patient and has no family, the unit might send staff to sit with them as a friendly face (as opposed to a legal obligation) so they don’t die alone. This is either very nice of them or extremely cruel; you can’t even get a break from us when you’re dying...

There are very strict things that have to happen when someone dies in custody. I don’t really know much about it; the extent of my knowledge is that, when removing a ligature, we are not allowed to cut through the knot - if the patient is successful then it might be evidence. Which, frankly, is the last thing on my mind when I’m confronted with a blue-headed person** but rules are rules…

*The women’s ward is averaging an attempt a day at the minute.

**i.e. Cyanosed. Not just blue.


Drugs (that is, illicit ones; not the ones we give out like Smarties. Cause those ones are ok.)

Also banned, but easier to smuggle in than alcohol and potentially easier to avoid detection, if you choose your drug carefully (i.e. don’t come back off leave stinking of weed, since that is a smell instantly recognisable by mental health nurses everywhere who, of course, never use the stuff*). We have drug screen tests, but they are actually used less in secure than acute services, due to the theory that patients have less access to drugs than people on open wards. This is odd when you consider that the local dealers have figured that hanging around the hospital grounds is a potential goldmine; particularly once they’ve witnessed the overweight, arthritic security guards unsuccessfully trying to persuade unruly 8 years olds to leave the premises and realised they are no great threat. If you have no leave, then you are reliant on other patients smuggling stuff in for you…which often means buying stuff that has been residing in someone’s rectum for as long as it’s taken them to find a way to get it to you. Delightful.

*That actually largely true. Weed is for pussies. Mental health nurses need much stronger shit.


Discharge

In the 14 weeks I was on placement on an acute ward, almost all of the patients were discharged. New ones came in, obviously, but towards the end there were only a couple who had been in when I started. I was struggling to keep up with the pace on occasion, but then I'm atrocious with names anyway.

I’ve been working in secure services for 6 years. Around 80% of the patients who were there when I started are still there. Discharge, on the odd occasion it happens, is a very slow process. Even on our ‘short stay’ ward patients aren’t expected to be discharged in under 18 months. On the plus side, it means you get to develop some very good relationships with patients. On the down side, if you hate a particular patient, there’s a fair chance you will still be nursing them in ten years time, by which point you will be ready to be committed yourself. Some patients get so settled that rather than face discharge after that length of time, they sabotage any efforts to move them on. A patient who has been completely non-violent for years will start pulling sinks off the wall at the very mention of going to a hostel. Although frankly, having seen many hostels, I’d become violent at the thought of living in one too.

Diagnosis

A few generalisations here for you. For example, you don’t see many people with affective disorders (e.g. anxiety, depression) in secure services. The bulk of patients have schizophrenic-type illnesses, bipolar disorder (which I know might technically be affective, but I always consider alongside psychosis in my own head) or personality disorders. Depressed and anxious people are not big criminals; if you lack the motivation to get showered and dressed, you’re quite unlikely to go robbing any banks in your dressing gown. A lot of the crimes committed by those with schizophrenia are related to their delusions; lots of murders/assaults are caused by paranoid beliefs. I mean, if your mum has been replaced by a demon then killing her is actually self defence. People who are manic seem to lose impulse control and tend to get into fights quite easily, and sometimes come to the attention of police through inappropriate sexual behaviour in public places or with the people on the bus who really didn’t want to be shown your new genital piercing, thank you. Patients with PD’s characterised by emotional instability tend to lash out at others, when not lashing out at themselves. Either can get you admitted to a secure ward if severe enough.


Danger

I would argue that working on a secure unit is less dangerous than working on an open acute ward or in the A&E on a Saturday night. For example, we have lots of locked doors, a lot of people trained in C&R, and a lot of sedative drugs immediately to hand. Still, attacks on staff are common, be it being spat at (one of my pet hates), having things thrown at you (cups, tv’s, pool tables, etc) or getting properly physically or sexually assaulted. You have to watch your back, and hope everyone else is, too. It’s easy to get complacent, especially with patients who have been in a long time. One minute you can be happily playing wii golf supervising a patient activity and the next you can be rugby tackled by the little 70 year-old fella’ who missed his meds this mornings. Sometimes, you get a patient in who is very dangerous, usually towards females, and they limit women working/coming onto the ward until he is drugged into a stupor and unable to hurt anyone. I would think it was an excuse for the male staff to lie around farting, swearing and getting takeaways without anyone to nag them, except that the majority of the female staff are actually worse for that stuff. Myself included*.


*Except the farting bit. I don't do that.


More from Quacktitioner :o)

Delusions - Fixed, false beliefs, often in secure services with a paranoid theme. Although I did once walk into work to find three patients who all had religious delusions and varied beliefs of messianic missions sat around a table poring over the bible.You know it's going to be a loooong day....

Duty Rota aka the "off duty" - Move over Dan Brown, this is the most read book on the ward. It is recognisable as being the dirty, tatty old A4 binder ... the binder that was new three days ago.

(Completely agree with the off duty one; also immediately gets covered in crossings out and scribbled-in names, until it is unrecognisable from the original published rota and people have swapped about until they have the shifts they wanted in the first place)