Mental Health Care

All I can offer here is, 'Thank God they do not exist like this anymore.'

I began my journey into the realms of mental health nurse training way back in September 1989; after having worked as a care assistant for a year before embarking upon this course, to gain a view of just what looking after vulnerable people was really like. It was to be a career choice for life - or so I imagined for myself. At the time I was living at home with my mum and step-dad.

To give you an idea of just what my life in the younger years had been like, then please see my other article through the link below: 'Time To Let Go.'

https://shopping-feedback.today/psyche/time-to-let-go-sd6hyv0wux%3C/strong%3E%3C/a%3E%3Cstrong class="css-1mrz9mz-Bold">

I needed to learn more about Elizabeth Kubler-Ross (refer to the article link above for detailing) and just how the grieving process was perceived by others, discover more on just what therapies and in-patient care was available, learn about the numerous medications that were available for mental health issues, work with like-minded professionals, and learn all there was in very rapidly expanding world that is Mental Health.

I had moved away from my home in Worcester (Hereford & Worcestershire) all the way down to the South of England, to the city of Southampton (Hampshire.) Much of that reason was to develop my own network of support in developing my independence and 'spread my wings,' so to speak.

The start of the course, admittedly, had me and the rest of the 'inset group' as we were known as then, fairly bored to tears, we were subjected to an entire two days revolving around the history of Knowle Hospital - as nursing students then we were employed fulltime by Southampton University Hospitals and actively based at the psychiatric location in Wickham (Knowle Hospital) 21-30 minutes away by car; there was free hospital transport runs between Knowle & Southampton several appointed times per day.

Short History

The hospital had been constructed resulting from the 1845 Lunacy Act, in order to comply with its rules at the time. And known as a County Asylum - opening shortly into 1852. The hospital was taken over by The National Health Service (NHS) after its development in 1948 history following on from Florence Nightingale's visionary plans. The NHS then brought about a transfer of management from the county council lining up Knowle Hospital to be managed by the NHS structure. Following on from The Community Care Act (1990) the long-stay services, providing for the continuing care needs for patients, were gradually replaced by community and nursing home care and Knowle finally closed its doors in 1996. I was glad to have been a part of its history towards its final years, as it gave a very 'eye-opening' experience into the levels of care quality at that point within our history.

1845 Lunacy Act what a disgraceful term to have used to describe those suffering from a mental illness. Should you look up in any dictionary today, yes 'mental illness' does come under the word 'lunacy' but it is not very polite or caring to do so - a vulnerable person needing full-time care and treatment IS NOT A LUNATIC.

To describe & label those vulnerable with it is both disgusting, discriminatory, demoralizing, and just not acceptable in today's modern-day world.

Suicides & Death do still occur more & are humanly unacceptable in today's standards (yet much less) than those occurring in earlier times within in-patient hospitals. Nowhere near as much as in psychiatric care now, but, it still happens though - which I might add, is my main focus of this article - to make more people aware of it.

Special observations(SO) of in-patients assessed to be at-risk, either on admission initially or at random points throughout their care as needed, in hospital, is now a common practice in acute psychiatric facilities (Bowers & Park, 2001), and practice in SO management has had both an important & integral part to play in mental health nursing care for decades (Buchanan & Barker, 2005.)

Within mental health hospitals, patients would be assessed as either 'informal' or 'formal' (the latter being detained under the MHA for their own safety needs.) The 4 levels of SO's then come into effect legally. It is likely though that an informal patient would be on a lower SO, which would require the implication of that patient agreeing to the observation - by way of signing a consent form whilst staying on the ward. For the higher levels of SO's, then they would already have been assessed as needing to be Sectioned under the MHA anyway.

A brief and most common of the two sectioning powers under the MHA are Section 2 and Section 3 powers.

Section 2 - 28 day period of detention to a mental hospital for observation & assessment.

Section 3 - initial 6 months detention to a mental hospital for necessary treatment.

As you may probably see, section 2 may lead to the order ending (thereby the patient returning back to informal, or it may be escalated upward to section 3.)

More about Special Observations and the four special levels explained.

Level 1 SO (General) - This is the minimum acceptable level for all patients. The location of the service user should be known to staff at all times, but not necessarily within sight (60-minute patient checks)

Level 2 SO (Intermittent) - Appropriate for those patients who are potentially at risk of disturbed/violent behaviour, including those who have previously been at risk but are in the process (15-30 minute patient checks)

Level 3 SO (1-1 staffing level within eyesight) - Patients, who could, at any time, make an attempt to harm themselves or others should be observed at this level. The patient should be within eyesight and accessible at all times, day and night unless a multi-disciplinary team (MDT) decision has been made that the patient can have use of the bathroom privacy. This must be documented within the patients' electronic computer record (ECR)

Level 4 SO (2-1 staffing level within arm's length) should be kept within very close proximity at all times, day and night.

It is imperative to maintain that positive engagement with the patient takes place. This is an integral clinical duty for the staff assigned to undergo any SO responsibility. Evaluate the patient’s moods and behaviours associated with disturbed/violent behaviour at every contact, and make certain to record these. Any concerns regarding the service user must be immediately escalated to the nurse leading the shift. Observations should be carried out in a respectful manner, ensuring the patients' respect and dignity is always maintained.

Incidents do STILL go very wrong. Data collected by the Care Quality Commission (CQC) shows that 224 people died of self-inflicted injuries between 2010 and 2016 in mental health hospitals across England. I am pretty certain that most of the readers here will find this both intolerable & inexcusable. Having been registered in mental health in my past work.

I have come across a nurse telling me that 'we do not have time to do the pre-community risk assessment, it is too much work, and I have management paperwork to complete.'

To explain, before a patient is either allowed on a 'grounds walk' within the hospital or a 'community trip' with his/her family, they need to have a physical search for dangerous items before & on return (on the ward I worked on) and undergo a short conversation to assess as to how they are feeling first - before leaving the ward, and another on return (to ensure they are not at risk of hurting themselves in their ward bedroom) by concealing something that they had brought in from the outside. I will not here mention where this statement came from, nor from whom, but this has been addressed as I reported the comment to the hospital director after it was said to me.

There is NO excuse for this attitude from anyone in the field of nursing. It is remarks like that which cause the unacceptable to occur, and hospitals to be highlighted on media news reports.

If you know about any incidences like this, then please speak with your senior manager immediately, or you can speak out by reporting anything like this to the CQC.

**Together we can reduce and STOP self-harm & suicide within psychiatric care hospitals**.

**Use the Special Observations as they were meant to be used.**

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