1. Remember the story I told you (in Let me tell you how its become a crap job Pt1) about the sadistic PD, making female staff’s lives a misery, who I managed to seclude?
At the time I put my hands on him, he had retreated to his bedroom (and there’s another post about the generous and comfortable accommodation you get to pay for) and was sitting on his bed, gobbing off some more at me. I told him we were secluding him and why. He got off the bed and – you will have to imagine the next bit. Later, another staff who’d helped us said it was a good thing he’d jumped off the bed, because – now, as your jaw drops, I want you to imagine the warm glow of righteousness the manager felt when they wrote the policy – ‘we aren’t allowed to restrain a patient if they are sitting on their bed’.
Imagine this muppet in charge of our national emergency services. Police – you are no longer allowed to arrest a suspected murderer, rapist, kiddie fiddler if he is sitting on his bed. Squaddies, you can no longer shoot the Argie conscript if he drops his rifle two seconds after firing at you and your mates. SAS – sorry but if the terrorist is sitting down while holding the trigger device, you can’t kill him.
2. This is what ‘least restrictive nursing’ looks like in action, not theory. There were these two patients, both on 2:1 close obs, both had been psychotic but were taking their meds and improving. Still insightless though, still disinhibited, still allowed to hold the street ‘values’ shall we call them, of dominating everyone around you and ‘taking no shit’ which doesn’t mean the noble, self-assured independence they try and make it sound like.
These two were allowed to (the African HCAs on the 2:1s are not only not allowed to tell patients what to do but since they are on a visa which will one day give them the golden jewel of British citizenship, they aren’t stupid enough to stick their heads above the parapet. They just put up with it, sign the hourly obs sheet and go home.) strut around the ward and garden area, carrying large, portable, re-chargeable boom-boxes (you can tell I’m old) inflicting loud, often painfully loud, poisonous gangsta-rap on everyone within earshot. That includes the ward next door. When they want to annoy someone else, they go wherever they want and the Africans have to follow them. They can only intervene once the patient has hit someone.
Now, think about what should be happening instead. To do so, you’ll need to ask these questions.
1. What is the purpose of a mental hospital?
2. What’s the point of enhanced observations?
3. What ‘values’ should be operating on a ward (and upstairs in the management offices, since we’re at it)?
4. What rules (and – sit down, liberals, we don’t have any smelling salts – enforcement) are needed to make a mental hospital ward safe and therapeutic for everyone, not just the scrotes or disinhibited.
Here are a few Rules.
1. The nurses are in charge.
2. The nurses want you to get well. But they also want all the other patients to get well.
3. The nurses want to go home this afternoon, tonight, or tomorrow morning to their families and come back to work tomorrow. They don’t want to be off sick with injuries or so stressed out they call in sick. (Their managers also want this, but for different reasons)
4. We rather like the low-expressed emotion vibe on this ward. In fact, we insist on it. It’s good for everyone. Patients get better faster. If you insist on making all this noise and rarking everyone up you can do it in a private room where no-one else is bothered by it.
5. When we tell you to calm down, take this tablet, leave this area, stop bothering that patient, mind your language, sit at this table for lunch, not that one, go and shower and change into clean clothes, make your bed, go to your room and get it all off your chest, put your earphones in if you want to listen to that, put the pool balls away now, come to the dining room for supper – do it. See rule No 1. There’ll be a good reason – usually anyway – and just because you can’t see it or don’t like it isn’t important in the grand scheme of keeping the ward a safe place. Yes, I’ll even explain it to you – once you’ve calmed down.
And an example of enforcement.
“Sit there and don’t move. Be quiet. Your nurse will have a 1:1 with you later, when he’s finished the tablets. I don’t want to hear your bullshit jabbering. Neither do the other patients who are actually trying to get well. No you can’t have your boom-box. It’s run out of charge anyway. No you can’t have your phone. If you want something from your room, you can ask and we’ll decide if and when.
Have you forgotten you’re on 2:1 obs. For fighting and threats. Well I’m reminding you. If you want all those goodies back, start behaving. Or don’t and we’ll put you back in. Oh can’t I? Yes I’m only an N/A but the staff nurse will back me. Anyway, be quiet. You’re not intimidating the other patients on my watch, sonny.”
Any taxpayer, mother or responsible citizen think there’s anything wrong with that? I didn’t think so. Only woke managers and ‘activists’ dependent on outside funding to fuel their outrage on behalf of people they’ve never met.
Both those examples were from an acute ward. Not a PICU, not forensic. The first scrote should have been on a PICU and left there until he took responsibility for moderating his own behaviour. Your wife, husband, daughter, son etc will, if they are unfortunate enough to need admission will go onto an acute ward. Where they will encounter these wretches and no-one, not even an argumentative, bristly old curmudgeon like me can do anything about it.
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