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Working as an HCA in mental health

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Working in mental health care is both challenging and rewarding for HCAs, who work in settings ranging from the community to secure hospitals. Ingrid Torjesen explains

Working as an HCA in mental health is very different from working in other areas of health care.

While elsewhere the focus is on physical interventions, in mental health it is on personal interaction with patients and clients. Those who choose to work in this field often find it extremely rewarding.

Alan Scally, a clinical team leader at Arnold Lodge in Leicester, which is a medium-secure unit and the East Midlands Centre for Forensic Mental Health, says it was this focus on people skills that attracted him to mental health.

‘In general medicine, it is more to do with physical interventions. In a lot of ways, you can hide behind that. You feed your patient, you lift the spoon and you put it in their mouth, you take them a cup of tea, you put a cuff on them and you do a blood pressure reading,’ he says.

‘In mental health, a lot of it is to do with interpersonal reaction and relationships and there is no way that you can hide behind anything to do with that. It is very reliant on therapeutic use of self,’ he explains.

‘It is how you use your self to interact with the patient rather than what you do to do them - it is what you do with them.’

Presentation and behaviour are key and, as HCAs spend the greatest amount of time with patients, they are the best placed to make observations. They interact with patients frequently, often keeping them busy with an activity or occupation as a diversion from any symptoms they may have.

‘Actually interacting with a patient, watching a patient, seeing how they respond to what is happening around them gives you the markers for how they are,’ Mr Scally says. ‘With the HCA being out there with the patient, they are usually in the best place to see that.’

Mr Scally started out as an HCA in a challenging behaviour unit 11 years ago, and came to Arnold Lodge as a junior staff nurse after completing a three-year nursing qualification. He says what makes the job worthwhile is when you see positive changes in a patient or see them progress.

Georgina Atkinson, who has been a healthcare support worker on a male acute admissions ward at Arnold Lodge for two years, agrees.

The admissions ward is where patients come for assessment. They can be very ill and will remain there until they have been stabilised and may be on regular medication.

‘It can be very rewarding at times, especially when you are seeing patients progress and move on to the rehabilitation ward,’ says Ms Atkinson.

She says the job is challenging because the HCAs are doing activities with the patients for the whole shift, so they are constantly busy. As it is an acute admissions ward, some patients may be on observations.

There are opportunities for HCAs to work in mental health in a variety of settings, including the community, learning disabilities, and secure units. On the face of it, working in a secure unit might appear the least attractive option, but those who work in such units would dispute that.

Ms Atkinson, who has a degree in psychology and wants to become a psychologist, says: ‘Ideally, I would really like to stay in this area.’

Frank Stabana, who is also a healthcare support worker at Arnold Lodge, admits that people might think of it as a dangerous and frightening place to work. He says, however, that staff are much better equipped to deal with risky situations than those in other settings because they receive special training.

All HCAs undergo a high level of mandatory training before they are allowed on the wards. This prepares them to deal with situations where patients lose control, and teaches them how to handle such situations safely, using de-escalation techniques.

‘As a last resort, we can restrain them using approved physical restraint without injuring them and we will take them to a safe place, a room where we can sit down quietly and talk to them,’ he says. ‘They might say the voices are talking to them and, if the voices are talking to them, we may offer them medication if necessary.’
The training equips us to deal with the unique challenges our patients present.

As a medium secure unit, Arnold Lodge is fenced. Moving from the wards to the outside involves going through eight or nine doors.

This does not mean that patients are confined indoors. They go outside daily for fresh air and sporting activities within the unit’s grounds. Concerts are held regularly, and they are allowed to receive visitors every day, if the clinical team approves.

Patients at Arnold Lodge tend to be offenders with mental illness and people who have been difficult to manage in less secure facilities. Many are referred to the service from the criminal justice system - either courts or prisons - while others come from high-security hospitals and open mental health units. Many have schizophrenia, personality disorder or drug-induced mental illness.

What happens on a morning shift at Arnold Lodge

The nurse in charge supervises six staff who care for 15 patients. At the start of the day shift, there will be a handover from the night staff and the duties will be split:

  • The two qualified nursing staff deal with medication;
  • A nursing assistant checks that sharps (such as razor blades) and other items that patients are not allowed to use (such as sprays) are all accounted for - these items have to be checked in and out;
  • A nursing assistant will be in charge of the safe where the patients’ money is kept.

8-8.30am: Patients are woken up, get up, wash and are given breakfast and medication
9am: Morning meeting with patients to find out the kind of night they had and if they had any problems. The duty doctor may be called to talk about problems or discuss increasing medication.

Post meeting: Patients will attend groups such as arts and crafts, occupational therapy, woodwork, gardening or the gym.

Patients at risk of suicide or self-harm will be on observation, so somebody will sit outside their bedroom to make sure they do not do anything to harm themselves.

The unit has 86 beds for adults aged 18-65, in seven wards, two of which are for women.

A total of 300 people work at the facility, including nursing staff, occupational therapists, gym staff, doctors, psychologists, social workers, secretaries and managers.

The unpredictability of the patients means HCAs have to be vigilant at all times.

‘On occasions, patients may walk up to you and become physically and/or verbally aggressive and you will ask what that was in aid of and they may say the voices talking to them,’ Mr Stabana explains.

‘We need to treat the aggression but sometimes we can see the trigger before it hits. They may start to self-harm to manage their distress for no obvious reason so we have a chat with them and offer them some medication if necessary.’

Mr Stabana has followed a similar career path to his mother who worked in learning disabilities. He started by working at a day centre for learning disabilities, then did an NVQ and gradually moved across to treating patients in a secure setting.

He says that seeing patients occasionally come back to the unit after they have been treated and discharged can be demoralising.

‘You get them a flat and you get them fixed up and, six months later, they are on their way back in because they can’t cope outside,’ he says. ‘Some people spend most of their lives in these types of setting.’

On the other hand, what brings the greatest rewards is seeing these same patients discharged successfully.

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