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'Why are we so scared of mental health?'

  • Comments (44)

As a student nurse, issues surrounding mental health are never far away.

Even when studying adult nursing you are encouraged to have an awareness of concepts related to mental health and mental illness.

But still, even though everyone studies it, there seems to be an element of uncertainty around caring for patients with mental health problems.

In my own experience I can think of of a good example. Let’s call her Danni. Danni was admitted to hospital after taking an overdose of painkillers and excessive alcohol. It was felt that her vulnerable state of mental health was significantly worsened by the anniversary of the death of a close family relative.

The trained nursing staff attended to her immediate medical needs and the health care assistants checked her observations and changed her bed in the morning. I wanted to be active in all aspects of her care but felt restricted by my anxiety and lack of experience with patients who had mental health problems.

If Danni had been admitted with a physical illness you could expect to see a fairly logical series of events taking place.

Give Drug A to cure disease B: it would be a set routine or pathway that you could follow to make that patient medically fit.

But with mental health, you’re faced with a greater degree of uncertainty. You become more aware of what you’re saying and how you’re acting; conscious that even the slightest intonation or vocal inflection could have an undesirable effect.

For me this is still one of the barriers that student nurses have to overcome when dealing with mental health. The perceived fear over what you should or should not be saying is ever present.

It lurks in the background and can stifle a students’ ability to feel fully engaged and able to play a proactive role in a patient’s care.

As students, we should try not to feel restricted when caring for mental health patients. We should feel a sense of empowerment in fulfilling an important caring role as part of the entire multi-disciplinary team.

Students are in a privileged position, by engaging with patients we can make important contributions to mental well-being.

No matter what branch of nursing you chose, you will encounter mental health patients so it is vital that you become fully involved with this essential aspect of modern nursing.

  • Comments (44)

Readers' comments (44)

  • I totally agree. I am a 2nd year student and am currently in an MH placement. I am on the LD branch for my training. I am really enjoying the constant challenges that this environment is throwing (sometimes literally) at me. I find, as you say, more awareness of my body language, facial expression and communication with patients. However, whenever I do successfully interact with the more challenging patients and provoke no escalation of behaviours, I do feel I have achieved something and hopefully the patient feels our interactions have been positive ones.
    I intend, through an updated action plan to continue to do my best to overcome the hurdles I still feel are ahead of me and help towards the improved mental health and wellbeing of the people I care for.

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  • George Kuchanny

    Hi Adam,
    Another good subject tackled by your article.

    Here is a recent article put up by a policeman who looks at mental health from his own job's perspective:

    ------------ ----
    This week a man went to an A&E department to seek help in crisis. He is a known mental health service user and had become unwell after 3 weeks of not taking medication – he had run out. Arriving at A&E at 10am, he was triaged and they rang for the crisis team to come and assess him.

    By 4pm, he was starting to get frustrated with the wait. He had already started protesting about the length of time it was taking and staff were becoming anxious about him and his behaviour. So they called the police claiming, “He’s threatening staff” and “about to kick off”. Five cops on a blue light run across the city later and they were there within 8minutes. The man appeared controlled and calm enough, albeit vocalising his frustration at the waiting times. He used a few naughty words, but not directed at anyone, just in the anxious parlance of someone who is fed up of waiting.

    A&E staff indicated that crisis were on their way, that they want the man removed from the department. The attending sergeant asked who the man was fighting and what threats had been made. He indicated that he wanted to arrest the man for the threats and violence. No member of staff would confirm any threats or violence were made at all.

    “So he’s frustrated with waiting and said so, perhaps in a grumpy or even belligerent fashion?” That appeared to be so. “and you want him arrested for this because he’s got mental health problems?” Yes. The police contacted the s136 suite: if they arrested him MHA would they assess him? No, apparently not. Why not? Because they wouldn’t, that’s why not. He should be removed to the cells and assessed there. Why?!! Because he’s been threatening and violent towards NHS staff. No, he hasn’t. Yes he has. NO – HE HASN’T. We’re not dealing with him.

    The sergeant took the view that it was not necessary to detain the man s136. He wasn’t attempting to leave A&E; to the extent that a police sergeant can tell, he doubted whether the man would be sectioned; he wasn’t posing a risk to himself or others. The decision not arrest was treated with opprobrium by the NHS staff in both A&E and MH camps.

    But the law requires that it be necessary, to exercise s136. If the detention is only going to coerce the man through a process with which he is willing to comply if only it gets realised this side of bed-time, then what is the utility? We are probably agreed that there is none.

    So he went unarrested and I’m telling the tale of the man who the NHS wanted to see arrested because he vocalised his frustration at a six-hour A&E wait.

    -----end of --

    As you can see it is not only student nurses who need to consider best interaction practice!

    Regards George

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  • Anonymous

    George Kuchanny | 9-Jan-2012 7:53 pm

    It's unsurprising that the police did not want to invoke the S136 'place of safety' until a mental health assessment can be done. In theory the police should remain with the person until this is completed, but usually they just leave them in a room with a nurse until it happens, not realising until they are made aware. Now that we insist they remain with them until it has been decided whether or not further input is required they are reluctant to take the matter to this point as it is very time consuming calling out an oncall psyche and all the hoops that need to be jumped through just to get a mental health assessment done and then find there might not be any call for the person to be detained if they are unprepared to remain voluntarily if deemed to be in need of mental health input at all. Then they are stuck with them.

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  • Anonymous

    if that is the respect and treatment offered by the NHS to a patient who has a mh problem - I am speechless!

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  • tinkerbell

    It is sad and i have been left speechless as a RN(MH) on many an occasion to see a situation escalate that could have been brought under control with just a few kind words. Once when i worked inpatient on young adults psyche ward we had a regular young chap who use to present for admission, ?mental health/learning difficulties. On this particular day he came onto the ward but before he could even chat with anyone about his distress our ward manager called the police to have him escorted off the ward. His anxiety mounting, frog marched from the ward by our staff, police arrived took over and frog marched him to the glass entrance of our building. What could possibly go wrong? As he was ejected from the front doors i watched on with sinking heart at his treatment and guessed what he would do next. He picked up one of the big cobble stones at the entrance and hurled it through the windows and shattered the main entrance glass doors, was frog marched back into the main entrance and i sat down with him whilst he cried and told him i was sorry. He was then arrested by the police. I know we shouldn't give people false expectations of being admitted (as was told me on occasions by my management) but come on at least give them the chance of a cup of tea and a chat until they calm down. All the cobble stones were later removed from the entrance but they weren't really the problem to start with. Hopefully things have moved on as that was many years ago.

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  • Anonymous

    "All the cobble stones were later removed from the entrance but they weren't really the problem to start with."

    That is exactly the problem, people do not take the time, show the interest or perhaps even have the experience or training, to find out what the problem was to start with, sometimes leading to severe or even tragic consequences. Just ignoring patients' problems, symptoms and difficulties, declaring zero tolerance, letting them escalate out of control, calling the police or having the patient arrested doesn't solve anything or help the patient at all. Whereas kind and gentle attention and trying to understand the situation may help the patient a whole lot more. Nurses after all are supposed to be able to show genuine compassion and empathy.

    I feel sad and angry in the case cited above by George Kuchanny that many nurses are working in areas such as A&E where they do not have the relevant experience to cope with people with MH problems, fail to recognise the signs and do not understand them, and that many staff and health care providers do not always act in the best interests of their patients no matter what group they have been classified into whether it be MH or the elderly or anybody else and these individuals are not being treated with respect. In a general setting we are not free to choose which patients we wish to treat or which not so what is the point of discriminating against them. Far better to exercise our clinical judgement, skills and expertise. All this is may be as much the fault of the organisation and management as it is with the healthcare staff themselves for not attending to the adequate provision of human and other resources.

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  • Anonymous

    from Anonymous | 10-Jan-2012 0:01 am

    I could go on and on, but at the risk of stating the obvious, I would also like to point out the it is also sometimes the attitudes of the staff, the perception of the patient of their attitudes (as Adam points out in the article) and how they treat the patient or handle a particular situation that can be the cause of the problems. It often takes two and the patient may have an impulse control disorder and less degree of control than one would expect professional staff to have so it is up to them to try and act as appropriately and respectfully as they possibly can, but obviously without putting themselves or anybody else at risk, which can in some instances be a very fine line and requires training, experience and good skills in assessing the situation.

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  • Thanks for the mention, above: I just wanted to correct the misunderstanding that the police are or can be obligated to remain at a Place of Safety because the NHS would prefer that to be true. There is no obligation in the MHA for the police to remain and the only obligation to do so, is where other legal duties exist to prevent crime or protect life.

    I often ask A&E staff to understand that if it took too long for the police to turn up to violent drunks in A&E, it may be because the MH trust up the road are busy holding officers against their will in a mental health unit PoS when there is no reason to do so.

    It is up to the NHS to commission, operate, staff and train their people to deliver upon healthcare responsibilities. Plugging gaps in provision by inappropriate use of the police, strips officers away from their legal duties and prevents them fulfilling statutory obligations to the public.

    Using the police for non-police purposes comes at a cost to the public and the public includes the rest of the NHS who need policing services.

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  • Catherine Lowe

    I'm a 3rd year mental health student nurse and must say that when my peers who are studying adult nursing went on their mental health experience placements they were all very dismissive of the role us MHNs do. Lack of importance is often expressed by people and it seems to be an overlooked area which frustrates me greatly. I have also had a recent experience on placement were, when doing an escort to a hospital appointment, adult nurses in the hospital made inappropriate comments about "all that money spent on nutters" as i'm working on a brand new purpose built acute mental health ward. So i guess the question i feel the need to ask is, are general nurses scared of mental health or do they simply not care? I love my area of work however often get frustrated at peoples views on mental health nursing.

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  • Anonymous

    I can't understand why adults and professionally qualified nurses can make such discriminatory comments about patients. why do they find their remarks so clever. mental health is a pathology like any other and people do not choose it. There seems to be a lack of awareness possibly due to inadequate training and placements.

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