I have been working in the NHS for 36 years, and I still love it – even after all this time. The majority of this time has been spent at Bethlem Royal Hospital treating forensic service patients – mentally disordered offenders. On Tuesday 29 November I’ll be featured in a Channel 4 documentary called ‘Life on The Psych Ward’ that will give the audience a rare glimpse into the work that we do.
This programme is all about rehab and recovery. The patients that are featured are trying to move forward positively with their lives and this is something I’d like the public to take from this – the hope.
The patients we care for are very unwell. Add to that the fact that they may have harmed people that they care about because they are unwell, and you have a group of people that not everyone wants to work with. It was the same when I qualified as a nurse this wasn’t an area that people immediately wanted to work in, but I knew I wanted to help people in the hope I would make a difference to their lives, to help them get back on track if possible and re-integrate them back into the community. Even though the community is probably thinking ‘I don’t really want you actually, you’re a bit risky.’
I trained many years ago and starting out in those days I was inspired by the old-school sisters and charge nurses who were very devoted and worked really hard. I started at working at the Bethlem in 1988 and then moved to the medium secure unit (MSU) at the hospital (River House) in 2010. Working in the MSU as a ward manager, I don’t have a typical working day, which is what I like. Some days I can be very patient-focused and spend a lot of time with them. Other days involve meetings, where my clinical experience is important. I also have the day-to-day parts of my job like meeting deadlines and ensuring that we meet our CQUIN targets, but no two days are ever the same.
The best part of my job is patient care – having that contact with them, talking to them and taking them on escorted leave. I’m sure if you ask any nurse what they really want to do is it emails? Is it being on the computer? No it’s spending times with patients.
There’s quite a lot of stigma about people being mentally unwell, offenders, and I know the main concern people outside the profession might have is around safety.
I think the fact that I’ve been around for three decades gives me that confidence to read the situation with patients to prevent them harming themselves as well as others. I’ve also got my training about managing violence and aggression if I need to use, it but I don’t have to very often. I think it’s just feeling comfortable in your own skin and in your own role. If I am frightened I think that would interfere with my relationship with the patient and I genuinely don’t feel that anyway. There are situations that do crop up and we’re all human but I think in the main on the ward where I work it’s about that therapeutic boundary. At the same time we care about the patients we work with and we make that abundantly clear.
Once the patients actually know that, they get to the point where they trust you and they understand that we’re looking out for them, not just doing things to upset people. Still, it’s about managing risk. We are in a medium secure environment and there’s no getting away from that.
We see patients on both escorted and unescorted leave and we want the public to be reassured that leave is a very well thought out process. There are an awful lot of risk assessments and risk management plans. Patients on leave have to wear an electronic tag called a Buddi. In some cases where the patient is subject to a restriction order the Ministry of Justice have to approve leave – we are not allowed to make the decision on our own.
I think for me I’m always surprised at how caring the patients can be, even though they may have committed a violent offence. I’ve just had a flu-bug and I was off for a couple of days and I can’t tell you how many patients said ‘are you alright now?’ and ‘welcome back’ and I think good heavens who’s caring for who here? But working in mental health services means we don’t stigmatise our patients. We know that have they have the ability to care and be responsive emotionally. It’s the public perception that we need to work on, which is why I wanted to take part in the Channel 4 programme – it’s almost like throwing open the doors and saying ‘look this is us and this is what we do, we’re no different to any other nurse we just happen to work in this environment.’ This is a chance to bust all the myths about how terrible the patients are and that they try and attack us every two minutes. Also we want to educate people about how hard the team work to help mentally disordered offenders move on safely.
It’s my colleagues that keep me going and lift me up on bad days, whether it’s the consultant you’ve worked with, the lovely psychologist social worker or the occupational therapist (OT) and nursing teams. We work as a multi-professional team and we are all working hard. We come from different angles but we usually reach a consensus, that’s how we talk about risk, we share the risk and work collaboratively – there’s no ‘I’ in team and it’s a shared responsibility.