This blog was sent to us by a NZNO member who works in mental health. We are choosing to keep their details anonymous because of the intense scrutiny that mental health services are currently under. This blog is a personal reflection on their own experience, rather than NZNO’s view, but we are sure it resonates with many of you who work in the sector. We really appreciate them sharing their story, and hope it gives some context to the recent media coverage of our mental health services.
It is 7am and I am off to see a patient in the emergency department. It is a young man who has self-harmed overnight. This scenario is becoming all too common in today’s mental health setting. You see, mental illness is the invisible disease. Presenting to the emergency department in emotional distress, the only visible signs are an unkempt man with a frightened look on his face.
Coming into the cubicle I see a young man in obvious distress. A feeling of hopelessness comes from him. I walk in and introduce myself. We begin to talk. Eyes downcast, feeling somewhat embarrassed as he shares his story with me. He talks to me in a quiet voice. He knows he needs help but does not know where to obtain the help he needs. His relationship with his family has become strained. They have tried to help, but are unable to provide the support he requires.
This man begins to articulate his struggle with schizophrenia. His self harm is due to despair: a belief that life holds nothing for him. By the end of the interview I know I have several options open to me as a clinician:
- We could send him home to his parents. But evidently his parents are unable to cope anymore with his distress.
- We could suggest his GP follow up and maybe a visit from the already over-stretched crisis team.
- Another option is to find a community respite bed for a few days. But we know that these are few and far between. I will have to telephone and “sell” his case to the respite coordinator if I am to make this happen.
- Another option is to try and organise for him to be admitted into the inpatient ward. But I know they are nearly always full or over capacity. This is yet another hard sell to find this young man a place to be safe and be supported.
I go to discuss treatment options within the consult liaison team and the decision is made to admit the young man to the inpatient unit. I call the ward coordinator. “What are his risks they ask?” Not, ‘who he is’, but, what logistical problems might he bring to the unit.
This is mental health nursing today. There is now a ‘risk adverse’ culture that always errs on the side of organisational safety: a system characterised by a lack of choices due to limited resourcing.
This is the young man’s first time in an inpatient unit. I try and reassure him, but as soon we get to the unit the door closes. People are busy. I try and find a nurse. They are few and far between. I eventually find the nurse assigned to my client. A brief introduction is shared, but I know the nurse is trying to get the paperwork done. Admission note, risk assessment, interview with the psychiatrist, place them on the observation board and a host of other tasks. This leaves little time to begin getting to know, understand and work alongside my client to better support them.
I leave my client and return to the ED, there is another case on the board.
This time another young person in a self-harm situation – they were bullied at school and decided to end their life.
Nurses do care, but we are not being given the time or resources to provide the level of service and care that I would want or expect if it was my family member presenting to mental health services.
We do not want to restrict or deny the people we care for their freedoms. Too often the concept of least restrictive practice is sidelined by lack of resources.
The organisations we work for are worried. Worried about risk and what could be in the papers tomorrow. So much so they seem to have forgotten about the core reason we are here – we are here to help.
I as a clinician welcome the reviews and public scrutiny. The current structure needs looking at so we mental health professionals are able to provide the service, care and support that our clients deserve.
October 18, 2016 at 8:20 pm
Yes SMHS are stressed and stretched. We must advocate for our patients and keep asking our MPs to take notice of all NZ citizens, especially those who need SMHS
October 18, 2016 at 9:44 pm
That’s why in the old days, mental health facilities were called asylums. They really were places where patients could have relief from everyday life and receive the support and caring we could give them until they were ready to stand on their own feet again. I think it is really sad that all care is governed by the dollar……….where has the humanity gone?
October 19, 2016 at 5:21 pm
While I agree that a hospital in the older system was supposed to be an asylum it may have seemed that way to staff Peggy. For those of us incarcerated within them it was as far from an asylum as anything could be.
November 23, 2016 at 5:32 pm
I wonder how far back you are referring to. In the 1970’s “asylums” served the purpose of withdrawing people from their everday life, but I feel that this was equally to remove them from the outside world. In my experience there was absolutley no support, no caring, in fact extraordinarily little interaction between staff and patient. They acted more like jailers with a job to do. Being there was the only treatment and caring offered. I apologise if you were referring to another era or eras. I hope you are right in saying others received support and caring in some of these “places of healing.”
October 18, 2016 at 11:28 pm
This is the unfortunate reality of the role- under skilled staff because they can’t be spared to attend training. Community Staff who are their own mini crisis teams, because you can’t effectively closely follow up a caseload of 40. Constant demands for more and better, without the investment in our staff to better support our service users and their whanau. And limited IPU beds, so we’re often discharging people who are more unwell than the one were admitting. The system is broken, and most of us are so busy trying to survive that there is little capacity to be thinking about service development and gold standard care.
October 19, 2016 at 12:15 am
The current culture of risk aversion, coupled with debilitating under resourcing, denies a crucial factor in helping another human being. That of a warm supportive relationship.
That’s where the sadness lies. It hurts carers and those who seek a healing sanctuary from turbulent mental health issues.
October 19, 2016 at 3:44 pm
Recovery model pffft
Evidence based care pffft
Therapeutic alliance woteva
Gifted clinicians experiencing moral distress …. hell yeah
October 20, 2016 at 8:33 am
Take depression of the DMS bible and set up a new organization to deal with this painful state of mind.Stop calling suicidal people insane and get it away from the Mental health organizations.Respites are thousands of times more beneficial than those hell hole mental units.These units revolve around medicating people only witch is torturous and provide no counseling, witch is the best medicine to get patients through there crisis.
October 24, 2016 at 1:58 pm
One year ago, I accompanied my son to the Emergency Department, Auckland Hospital. The Crisis Team from St Lukes Mental Health arrived, did an “assessment”, sent him home, without any treatment. Three days later, he took his life. He wanted some help. He didn’t get any.
If he had been in an accident, medical staff would have been all over him, treating the injuries. Mental Health is a silent killer. He didn’t want to die. He needed his extreme pain to lessen and a bit of help to get through the next few tough days until the new medication took effect.
How can we help other families not to go through the horror of loosing a loved one to suicide. The mental health services need more resources.
January 20, 2017 at 11:30 am
What really strikes a cord with me is the fact this person does not wish to be named because of the intense scrutiny faced by the profession. Which is also why I have not included my name in this comment. It is disgusting the scrutiny we face every day and I have no doubt this will cause my inevitable burn out, not patients! Please everyone, be a bit nicer to your mental health nurses. People want to point fingers when something goes wrong, and unfortunately we are usually at the end of that pointing finger. This is a community issue, not an individual issue
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