Tag: hospital

All About Restraint

What is restraint?

Restraint is a physical intervention to de-escalate a potentially dangerous situation and protect everyone who could possibly be involved. This includes protecting the person from endangering themselves or other people. A restraint is non-violent and should only be applied as a last resort. If it is applied violently or needlessly it is not restraint- it is assault. 

I will talk about restraint in the context I am most aware of- acute mental illness.

When is Restraint Necessary?

Restraint may be necessary if a person is an active risk to themselves or others. Depending on the situation different restraint techniques can be adopted. For example there are methods to disarm somebody with a weapon, prevent someone from kicking out and injuring surrounding persons or doing something to harm themselves. Techniques like talking, distraction and diversion should be used first.

Having someone restrain you is frightening. I’ve been there. The distress that could be caused by the restraint should be carefully weighed against the distress and harm that would be caused by not intervening. The intervention should be protection never punishment. 

Sometimes medication needs to be administered to a person in a restraint in order to end the need for force as quickly and easily as possible. Sometimes this is done through injection as it is unsafe for tablets to be forced into the mouth of a patient held in a restraint.

Charities like Mind have clear cut guidelines on restraint and are calling for an end to be brought to face down methods. This is the most dangerous kind of restraint as breathing can easily be inhibited.

NICE Guidelines State:

“Sometimes people with mental health problems may need to be controlled or restrained by staff when in hospital, or have treatment without their agreement (such as medication to calm them down quickly). This should be a last resort. If this happens to you, it should be done by trained staff, and preferably by staff you know and trust. They should act with your best interests at heart and will make sure you are safe while using minimum force.”

But aside from this there is very limited legislation on what is and isn’t allowed when it comes to physical restraint.

What is it like to be in a restraint?

I have been in a lot of restraints. They would happen when I lost control of myself and was endangering my life with self harm or suicide attempts in hospital. I’m lucky enough not to remember a lot of them, one good thing about my condition is the dissociative ‘brain blanks’. There is a point where you are suddenly not in control of anything anymore and there are people on top of you. Moving you and communicating between themselves in a language you don’t understand. Sometimes my response was anger to the sudden enslaught and other times it was relief. A restraint does rescue you from yourself when you aren’t safe to be in the driving seat anymore.

Sometimes on the ward a large beanbag patients named ‘fat boy’ was involved to stop kicking and flailing limbs. Sometimes restraint was traumatic- a group of staff you barely know coming into your room and pinning you to the floor feels like an attack however with the right staff I wouldn’t fight as much because it felt safe. I always knew during this time that my body was out of control. I wanted to hurt myself and I wanted them to let me get on with it because that was the only way I could see the situation getting better.

I’ve been in bad restraints. Ones where I’ve come away with black bruises on the tops of my feet or muscle strains from being pulled around. Restraint was common practice on my first unit, happening several times a day with some staff using it as a first response to any sign of trouble. Most of my restraints were justified by my dangerous behaviour towards myself, but there are many situations that could have ended much better with a calm chat and a hug. It’s these ones that stay with me.

Restraint being used too frequently, like in my case, is a bad thing. When I moved to another unit with a more appropriate attitude towards the practise I was confused. For six months I had become used to my inner battles being resolved by third party restraint. To be doing the same things as in my original unit but with no restraint from staff felt dangerous and scary. I went from being restrained sometimes multiple times a day to not being in restraint at all. It makes me realise how grateful I am to the good staff at my first unit for making clear that the restraints were a rather unpleasant strand of my treatment that I’d get through and that they wouldn’t let anything happen to me. I am increasingly thankful too for *Cheery Lodge, because if I had been discharged straight from *Heron into the community I would have without a doubt died from the sudden lack of protection from my mind’s demands for danger.

Over time I’ve become a master in restraint myself. I can’t pin myself to the floor but I’ve learnt how to talk myself down; how to de-escalate situations and how to compromise with my mind. My body was being overrun by my mind, it was doing what the literal ‘head office’ told it to do by hitting the destruct button. That girl who was thrashing around on the floor is still there some days, but her body restrains her now. My body, brain and I keep the thrashing internal. Some days it’s harder than others. I suppose we all have to learn how to restrain ourselves one way or another.

A year ago today I moved unit via secure ambulance to *Cheery Lodge. I cannot thank the people there enough for giving me a base and support. Recently a member of staff from the unit I was moved from a year ago was suspended for misuse of restraint. More about my (surprisingly hilarious) transfer can be read here.

The Findings and Thoughts of a Newly Released Inpatient

  1. Toilet seats are very underrated.
  2. Oh shower with temperature control I love thee…
  3. AND I don’t have to dance around to keep it going.
  4. Sleeping in is a simple pleasure.
  5. There’s food that tastes like something I would want to eat here.
  6. Windows and doors that actually open are fantastic.
  7. Fresh air has never felt so good!
  8. I can even do my own tea the right way. In case you need clarification on this: water, teabag out, sugar THEN milk.
  9. The reality of having more than the same two options every day for lunch is mind blowing.
  10. Toilet paper in the real world is so soft!
  11. Go out? Now? Brilliant!
  12. Watching something on TV at the same time as everyone else rather than slumping over iplayer is doing wonders for my Twitter life.
  13. Space to dance around in is a good use of space.
  14. Support workers? Who have time to support? Wow.
  15. Having free reign of my phone feels so good.
  16. It’s a pain having to walk more than a couple of meters to see a doctor.
  17. The real world is a lot calmer than the inside of a CAMHS unit.
  18. Bedroom access is useful during the day for quick naps or picking up forgotten items.
  19. Space to hang my clothes means I don’t have to work the crinkled bag look.
  20. And just the knowledge that I’m no longer in hospital is pretty amazing in itself.

  

Kids in Crisis: The Bits It Missed

Channel 4 recently showed a documentary discussing problems in Child and Adolescent Mental Health Services, focusing mainly on the country’s overall lack of child inpatient psychiatric beds and lack of early intervention provision. Over the past year I have noticed many news articles and reports on these subjects. But there is one thing I think they missed.

Yes there aren’t enough CAMHS inpatient beds, but there also aren’t enough staff to cover the ones we’ve got.

In both CAMHS inpatient units I have been to there have been serious problems with staffing. Friends of mine have confirmed experiencing the same problems in other units. There are often not enough regular staff who work on the ward on shift, so numbers have to be topped up with bank or agency staff. Sometimes these workers become regulars on the unit, thus getting to know patients. However a lot of the time they are coming on to the unit for the first time, know none of the patients and have very limited experience of the setting. In one of the CAMHS units I went to, which was a closed unit, patients used to use the ignorance of the agency staff to break the rules. One of the most notable examples I remember of this was a member of agency staff being persuaded by patients that the toaster could be plugged in in various bizarre places around the ward. This resulted in patients being found smoking in an ensuing after lighting cigarettes from the toaster. It’s funny but there are many other examples I could give ended with a patient getting hurt.

Having a team of regular staff covering a shift is vastly different to having numbers topped up by agency or bank. Funnily enough patients, often with complex past relationships with adults, tend not to open up to relative strangers. Though these workers count as bodies on the ward a lot of their work is observation and directing regular staff to the young people who need them.

If there were enough staff in each unit the quality of care and patient turnover would be much higher. The increased knowledge built up over time of patient’s case alone can make a huge difference to care. Bank and agency staff get a short handover about the ward and the patients however the information given is based on what has happened recently. Staff nurses and health care assistants who work on units regularly will build up the trust and the life story (often quite complicated) of a patient; thus helping them identify crisis triggers, early warning signs and risks.

The documentary did portray really well other points, such as how children and young people can be moved all over the country from hospital to hospital and how this is often a fast decision based on their condition fluctuating. I felt sorry for parents who had to deal with their child being passed around, sometimes hundreds of miles away from home. Dealing with relapse is hard enough but if it results in more moves and being further away from home it will be even more devistating for patients.

Some psychologists are campaigning for CAMHS services to cover up to the age of twenty five. I will probably write another blog about this soon as it is something I believe passionately in. The move from children to adult services is drastic and for many traumatic. The attitude appears to shift from CAMHS teaching you to cope with what you have to adult telling you to just deal with it. There is a huge difference.

A mother expressing her concerns over her daughter becoming institutionalised made me think of the many, many, young people I have met for whom moving from unit to unit has become a way of life. I have met patients who have been in hospital for years at a time. That is years of living away from home, years out of education and years without socialising with people who are mentally healthy. Who can blame these young people for becoming comforted by the safety and routine? Especially when many will have had bad experiences with outpatient care or have difficult home lives. These units are vital but there needs to be clear paths for patients to move on.

To sum up:

  • We need to staff the beds we have appropriately to improve the safety and the treatment of young inpatients. Then we need more beds.
  • Families should not have to wait for a young person to deteriorate in order for them to become an inpatient to get the treatment they need. Early intervention must improve.
  • Ideally every region should have some sort of provision for mentally ill young people.
  • Where possible young people should go directly to the most suitable security level provision to avoid more moving, and disrupting other patient’s care in lower security units.
  • Young people should be covered by children’s and a transitional service until the age of 25. The 18 – 25’s bracket could be used as a transitional stage between the two services and their massively different approaches.
  • There are so many things that need to change. 6% of the Mental Health budget is not enough to support the country’s mentally ill young people. 

 

So Called Safe

Times like this I shouldn’t be here
Its not stopping my stress it’s stemming it
I’ve been helped
alongside the girls who eat tape measures
and the boys who breathe fire.

But I’m angry that as I lie in bed
I’m whispering to my pillow
“The door’s locked.
The door’s locked.
The door’s locked.”
And for once it’s not the OCD talking.

I’m scared because they’ve been kicking the doors in for hours
and we are three members of staff down
and as they storm the siren screaming doors
the agency blokes don’t know their names
to phone for the police.

But what are parents supposed to do?
When Seb is sixteen and suicidal so sent to be safe.
The psychiatrist is supposedly stalling their son’s surge for suicide.
But in a moment Finn throws a fist and Seb’s got stitches.
Seb’s mind must be bad for six stitches to be the safest.
How scary is that?

The ceiling screams when we do,
Staff scatter.
Skin splits.
And sewn on the skin of my teeth
Are slideshows of scenarios
Seen in children’s psychiatric settings.

But we’re safe. Right?

From the Rubble I Can See the Stars

Today I’m in hibernation. My body says sleep and my legs say still and my head says no.

Over the last few months it has felt like I have been mentally burgled.  Everything that I thought was nailed down in my life has been dragged away and burnt to embers, leaving me sitting with the scuff marks on the ground.

The pursuit for housing seems to be going on forever and in the meantime I’m stuck in hospital. To understand all of the systems I am stumbling through I would need a degree. Everything seems to be set up for people with one disability or illness- any more and it turns into a clash of services and procedures.

Yesterday I had an unexpected blow. It broke me completely at first but if anything now I feel relieved. I say to myself “there is nothing to lose and everything to gain”. Again and again. Something will change. The only way from here is up. It’s stoked the fire for me to keep going. Well that’s the case at the moment anyway.

To Be Crafty- Crochet Crazy 

In my last post I expressed my complete frustration with being in hospital in the form of an extensive list. The birth child of frustration when you are in a situation you can do nothing about is boredom. It’s sneaky. It is when you find yourself feeling rubbish and then having nothing to do to prevent you falling head first into a relapse or episode. Nothing to distract yourself.

I think I do pretty well at keeping myself occupied. I have notebooks filled with memorised French grammar, six months worth of scrapbooks from my other unit, films, books and more. But these options get exhausted as time goes on.

One thing I have started doing is crochet, which was taught to me on a visit from my sister N to Heron unit. It was pretty hard to crochet there as you weren’t allowed the needles unsupervised and only one ball of wool at a time. Of course this was subject to your presenting mood- so half the time there was no chance!

I’ve just completed this crochet blanket for my best friend’s eighteenth birthday. It was a really good project for me and I found the repetitive action of crochet really soothing. I’ve always wanted to be a ‘crafty’ person. Making things that look reasonable and having things to do other than watching my Skins box set and reading (both activities I love dearly).

The unit craze at the moment are the amazing Kerri Smith books, in paticular wreck this journalIf you haven’t encountered it before- it is a fantastic book which instructs page by page how to destroy it. It creates some hilarious staff-patient dialogue, for example: “Ellie why are you crushing blueberries into that book?!”, “Sophie don’t bite novels”.  The list goes on.

I’m now onto crocheting a ‘leggy cat’ which Hobbycraft has promised to be easy. We will see about that- two paws in and the poor thing already looks like he could apply for cosmetic surgery on the NHS!

This was just a quick post- but I would love to know if you guys have any projects or any future project plans? Are you crafty?

A Non-Definitive List of Things I Will Not Take for Granted Once I Have Left Hospital

I have now been in CAMHS inpatient care for nine months: AKA far too long. I’m now approaching my discharge and, as it edges closer, I become more and more desperate to get out. The gripes and the grudges build up until I just have to make a list. So here it is.

A Non-Definitive List of Things I Will Not Take for Granted When I Have Left Hospital

  1. Being able to get a drink whenever I am thirsty and not having to wait for staff to be free to get it for me.
  2. Sleeping in when I am tired.
  3. Going to bed when I am sleepy.
  4. Being able to say that I have a headache without a doctor pouncing on me.
  5. Not being questioned on how I care for my dog.
  6. Having the option to be with people or not be with people.
  7. Not being surrounded by distressed people constantly.
  8. Not suffering the horrible noise of the panic alarms which seems to change pitch as you move your head.
  9. Absence of people playing ‘devils advocate’ every time I just want to have a little grumble.
  10. Choosing who I spend my time with.
  11. Going out when I want
  12. Going where I want
  13. Singing at the top of my voice
  14. Going to College
  15. Being with friends
  16. Not being alone
  17. Internet access
  18. Social media support
  19. Independence
  20. Food which isn’t from a silver tray
  21. Privacy
  22. Organisation
  23. The power to change the central heating temperature
  24. Not being observed
  25. Not having an ever changing conveyor belt of staff in charge of my care
  26. Having more than one 16th of control over the television remote
  27. Watching soaps without people moaning
  28. Long dog walks to nowhere in particular
  29. Loud music
  30. Laughter
  31. Doors that aren’t locked
  32. Being able to go and see people
  33. Being stable enough to make plans with more than a 60% chance of it actually being carried out.
  34. Gyms and swims!
  35. Fresh air
  36. Not having visiting times to stick to.
  37. No ‘compulsory’ workshops to go to.
  38. Watching DVDs rated above a U
  39. Not being woken up during night observations (they turn the lights on once an hour)
  40. Not being in hospital!

I am currently camping in a coffee shop making my time off the unit last as long as I can!

If you have been in hospital, what will you never take for granted again?  

The Life of Robyn- Let’s Evaluate and Do Something

This is my blog following the catchily named ‘Discover’ Children and Young People Evaluation Workshop. I hasten to add that there was no ”s’ on the end of ‘people’ on the sheet I have, probably because this was a gathering mostly for professionals who work with and around the Children and Adolescent Mental Health Service. It was not an event for the direct attendance of service users, but it was certainly a day with young people completely central in all points of discussion. Sitting at the tables were the people who can actually change things.

It started at *Cheery Lodge a few weeks ago with a group of patients and a pretty awesome storyteller. We were told about an enquiry into the CAMHS service which is currently taking place in our region. It is called Discover and we spent a very long session discussing the imagery used to represent the process. This was a logo of a missing puzzle piece being slotted into place within a silhouetted head. Is it too simplistic? Is it implying that there is just a missing piece that we as services users need to be given in order to be cured? Does it imply that we are broken? We weren’t sure.

Our awesome storyteller asked us to create a character together to use as an Everyman in all of our stories. We came up with the name of Robyn (unisex) and formulated the average age of sixteen. We left it at that and then set to telling our own stories through the life of the elusive Robyn. Poor Robyn had a multitude of lives- in some making a full recovery, winning the lottery and beating the system and in others being homeless and ending up stuck in an adult inpatient facility. We audio recorded our stories and then added pictures in order to create a presentation.

Myself and *Izzy decided we would quite like to go to present what we had made to the big fishes of CAMHS and other services. A room smelling of coffee and pens was the venue for all the big bosses. As Izzy said: “Adults talking adult stuff”. “They’re just people. Just like you and me.” I whispered back before suggesting we get involved in whatever they were discussing in order to prove this point.

A minor crisis occurred at the start when the audio part of our presentation refused to co-operate with us and despite our increasingly desperate pleas it continued to make demands for a file type we had never even heard of. Having only a first draft of the recording on paper we had to improvise big style by reading the transcript out and improvising the bits we had added in after it had been printed.

Unable to read the tiny words of our notes I had to reduce my non-existent professional image somewhat by borrowing a very kind gentleman’s iPhone, hastily panorama photographing some paragraphs and blowing them up. My own iPhone camera had been disabled on admission to *Cheery Lodge in order to protect patient confidentiality on the unit and such. Thank heavens for understanding and generous people because the loan of the phone was what made it possible for me to take part as planned. We made it through the presentation and got really good feedback.

Suddenly these professionals didn’t seem as big and scary. They were just people. Trying to do their best for so many young people who’s stories are so hard to follow. They did truly listen and pick up on the points that were made- early intervention is needed, more awareness and more training for physical health practitioners. We discussed how differently the subject of mental health is treated in comparison to physical health. One is the train platform, common ground and a safety zone to be observed and preserved. A talking point in a classroom and a measurement in the doctor’s office. The other is the railway track- vital but understated and yet live and silently taking casualties. Sadly the gap between the station platform and the railway track is vast. Far too vast.

When I do this kind of thing I always judge how well a presentation has been received by comparing the initial reaction to my guide dog with the end reaction to the talk. No matter how ignored I am in comparison to my furry companion at the beginning of an event I don’t mind as long as by the end people are more interested in the point that I am making than what my dog eats. Judging by this theory I think myself and Izzy pulled it off big time despite huge initial canine interest!

I did give my blog a cheeky plug at the end as the ‘Inpatient’ blogs I have done recently are all about CAMHS and the opinions of myself and others I have met. I hope they can do some good. If you are here for the first time- welcome. Please take a look around and if you like what you see I would encourage you to subscribe and hang about. The truth is that it’s all very well sitting and talking but mistakes need to be learned from and things need  to be improved. The message of today was definitely one of hope and change. One size will never fit all, but we need to stop so many people slipping through the net and I am so honoured to be a small part of trying to make that happen.

BRAIN BLEED. An Unwanted Hospital Adventure for the Very Anxious.

During a dissociative episode this week I hit my head. It was really frightening and once the episode had died down I found myself very, very concussed. The incident happened between six and seven that evening and by half ten the symptoms still hadn’t calmed down so the on call doctor was called out to the unit. The poor Doctor was a little confused over the event and her assessment was complicated by the fact that I do not remember anything from any of my dissociative spells. Therefore it was very hard to tell the severity of my head injury. Likewise my eyes move constantly, making the eye checks very hard to carry out. I’m never an easy patient! After doing the best she could of an examination she left the room to call A&E to get advice. It was nurse *Stan who broke the news- I had to go to A&E if I had been sick more than once… And I had been sick for the second time during the ten minutes that Stan and the doctor had been talking. Cursing the wall in question and very concussed- off to A&E I went. 

Having been promised by Stan that the trip would be just ‘in and out’ I was not overly surprised to find myself in a very slow moving waiting room. Because I am under eighteen I had to be accompanied by a member of staff from *Cheery Lodge so it was *Emma who had the job of trying to keep me awake during the wait. Suffering with fatigue at the best of times; it was way past my bedtime and the bump was making me yawn non-stop. Myself and Noodle seized a bariatric chair at the back of the waiting room because it was easily wide enough for both of us to sit side by side. I don’t know what it is about general hospitals but they make Noodle very protective, refusing to move out of arms reach of me. Of course I don’t mind this at all, feeling vulnerable her care is very much appreciated.

At around 1am; myself, Emma and Noodle were put into a side room to wait for a doctor. By this point I was beyond exhausted and feeling the effects of not being given my medication. I was certainly not impressed when a very peculiar junior doctor appeared. First he asked me to follow with my eyes a white pen. Against the white wall this would be impossible for me on the best of days. Confused- he decided to move on to questioning my psychiatric history. At one point myself and Emma were convinced he was going to try and refer me for an inpatient assessment- despite us both telling him repeatedly that I am already a patient on a psych unit. He, like the doctor on call, disappeared to consult somebody else on the medicinal chain. 

On returning he asked to see Emma’s papers for me as if I was some kind of antique he was thinking of buying. A photocopy of my drugs chart and details of my illnesses. 

“What kind of OCD is it?” He asked. A question I dread.

“Erm it’s mostly hygiene and health concern based. But other ruminations and fixations too.” I have learned my lines. It was because I told him this quite so clearly that I was surprised at what he said next.

“Right we are going to get you into a CT scan as there is a possibility you may have a brain bleed.” 

“It could be a brain bleed making the hallucinations worse.”

Brain bleed.

Brain bleed.

Brain bleed.

He honestly then continued to use the phrase ‘brain bleed’ at least six times. Leaving me… Anxious. Very much so. I held onto the belief that if he really thought I was going to turn into a gory waterfall he would have done more checks and probably kept an eye on me… Or possibly have offered me a drink of water.

The CT scan was carried out at about 3am- an odd experience which made me feel like I was in some kind of verticle belidrome with the cylindrical spinning and whirring. It was over very quickly but sadly the results took much longer to arrive, leaving poor Emma to reassure me during the wait again and again that it is unlikely that I would have a brain bleed and, yes, CT scans are 100% safe. She was at the stage of pulling up online evidence when the results came through. My brain was 100% ay-okay! Relief hit me like a tidal wave- if nothing else I was just overjoyed. To be allowed to go to sleep. Myself, Emma and a loudly snoring Noodle headed back to Cheery Lodge.

“In and out?!” I asked Stan as we shuffled through reception at 4am. As way of a commiseration he told me he wouldn’t wake me up at 7am that morning. Of course it is much better to be safe than sorry- but I was absolutely exhausted the following day! Medical staff- if you are treating patients with anxiety disorders please be careful of what you say and how you phrase things! 

 

I Got Reported Missing

I don’t think when *Cheery Lodge accepted a blind kid and her dog that they expected the duo to be a major abscondssion risk. But- always smashing assumptions, I proved them wrong.

My escape wasn’t cleverly planned, or even remotely smart. In fact I didn’t even escape- I was already out on leave. I don’t want to go into the details of why I ran but something had snapped inside of me.

I’ve talked about my problems with Dissociation before, but at the moment it has hit an all time high. I’m finding I lose a lot of time with no memory of what I have done. I drift away and it is incredibly hard to drift back. I’m lucky that my psychiatrist is really on the ball with this kind of thing, he is helping me understand why it happens and helping me get to a more stable place mentally. This will hopefully limit it’s effect on me. Annoyingly I can’t be discharged from hospital until my mind is fully and consciously in control of my body at all times.

It’s because of this that I don’t remember the build up. I don’t remember how fast I ran or if people were shouting me. It’s like when the cinema screen fades to black. When I came back to my body I had no idea where I was apart from it being green and very, very quiet. My phone was dead and even the ever-knowing Noodle had no idea where we were.

Eventually I found what sounded like a sports field. Cars were coming in and out of a concrete area and the sound of whistles and footballs being kicked was nearby.

“Are you okay?” Says a woman.

“No” I reply in tears. “I’ve run away from a hospital”

“What kind of hospital? Who’s dog is this? Where’s the dog from?” She suddenly developed a harsh and panicked tone.

“I can’t see very well.” I mumbled. And then I ran.

Finally I found my way to a road where, what are the chances, the unit manager caught sight of me from her car on her way home. The police had been out looking for me and staff from the unit had been driving round the area all afternoon. It was accepted that the reason I hadn’t been found was that I was in some kind of woodland away from any streets or roads.

When I turned my phone on I had the following text:

a text message reads not protectively marked. you have been reported missing. please ring the police on 101 to let us know you are ok

I also had a similar answer phone message. For some reason I didn’t think the police did things like message missing people. ‘Reported missing’ sounds so scary, it shocked me to read. To me I had just been lost. But I suppose my lost is everyone else’s missing patient.

Turns out that the lady I spoke to works at the local vets practice. They were contacted the following day about getting Noodle a routine check up and the receptionist said that one of the partners had mentioned seeing a distressed girl and a Labrador that could have been a guide dog. It makes me laugh that this made worthy news to tell her colleagues but not the local police!

My disappearance was in no way as dramatic as some of the ones I have witnessed whilst in hospital. I just got lost. I’ve been put on a higher observation level and I’m not allowed out without a member of staff. I feel quite sad about this, but I guess I’m just too ill at the moment.

I’m not proud of that day. But this blog is my story, and I want people to know just how powerful the brain is and how a problem in the brain can affect people.