Mental Health Nursing - my ramble/perspective.

I admit it, I miss blogging, I like writing. This week I was struggling to think of a topic to ramble about so I asked on twitter, a couple of people said my job. But I don’t want to come across as pretentious, as I chose my career with its ups and downs, and I’m sure there are a lot of easier and harder jobs than mine, I am not looking for extra thanks or praise in any way for what I do. Oh, and if you didn’t know I am a mental health nurse.

I do feel the need after reading that last paragraph back to point out that “we” (meaning mental health nurses in general) don’t actually get as much thanks as you may expect. I see it all the time on general medical wards. But I understand that we are not always liked by our patients (especially those detained under the Mental Health Act meaning we restrict their activities) and often there is a huge sense of relief for people when they leave a mental health ward, they are not very happy places to be (I am aware hospital isn’t in general but you know what I mean here I’m sure). I assume (possibly wrongly, feel free to correct me) that it may also be due to the fact that hospital is a tiny part of the journey, people don’t usually leave “cured” there is a long way to go, sometimes they still do not have insight as to why the hospital stay was so necessary. Of course there are people who make remarkable steps whilst in hospital, and are often very grateful for the help they received, I thank those people (as I say, we don’t get it very often). Now I work in clinics (currently Clozapine and ECT) so I am a tiny part of people’s journey through mental health services. My team does get a few Xmas cards from patients, but we are a small piece of a big puzzle; our thanks is seeing people well and not in hospital anymore.

[Sorry for that digression but i had to get it off my chest]

As I pointed out at the beginning I am not meaning to be pretentious in any way. I know that even within mental health nursing people deal with the job in different ways. I must admit I have become a lot more cynical in the last 7 years, I try to make sure this doesn’t make me any less caring or empathetic with my patients. Unfortunately I have seen some nurses “burn out” in that way over the years. I personally believe this may be because some people just don’t switch off. I’m not saying it is always easy, but as in many jobs there needs to be a work-life balance. It saddens me to see some people who need the money working extra hours all the time and not truly switching off from the day’s events. I used to be guilty of it, often ringing work when I got home to tell them something I had forgot but thought it was important (it usually wasn’t and could have waited until the next day when I got back) or to check on a patient. I have been qualified long enough now to have a bit of a thicker skin. Oddly, I feel guilty about this sometimes. But it is needed, work has to stay at work. I have to try to remain detached from my patients (to a certain extent), even though I have known some of them for a few years. I have learnt to deal with this by trying to care about the job as a whole, rather than individuals. I have standards I work to, where patient care comes first and I try to change how I and my colleagues do things for the better. You can make changes within the healthcare system for the better, it is about sharing good practice and listening to patients (while understanding the budgetary constraints).

I guess this blog should be more light hearted than this. What do you want to know about mental health nursing? I will go through the top questions I am usually asked.

1. Is it a scary job?

- The short answer is most of the time, no. I’m not saying there aren’t scary moments on the wards, there are sometimes. But with the right training, a good team and adrenaline kicking in those moments usually pass without too much trauma. I can think of maybe a handful of times when I have felt really intimidated by a patient. I have never been seriously hurt at work, and injuries during restraint are rare for both patient and staff. Part of it, (for me) is that you have to build your own persona, my work persona is much braver than I am in the street and more assertive. At the end of the day, you are a part of a team. If a team works well together you can deal with anything. It does not “kick off” every day, there are really boring shifts like in any job, where nothing seems to happen.

2. What are patients like?

They are mostly like your friends and family, nice people who have become unwell. Just because someone has a mental health problem it does not mean their personality vanishes. Yes, when people are psychotic it can be hard to recognise the person you may have known before, but you have to remember that they are still in there. I laugh and joke with patients if I know them well enough. It depends how unwell they are, there are patients who you have to build trust with or may have thought disorder which makes conversation difficult. It doesn’t mean we don’t try. Every patient is different. It depends on which kind of mental illness they have, how ill they are and their underlying personality. You have to listen to what they want/need, whether it is to talk or be left alone, it is all about balance between what they want and what they need. Yes, there is sometimes odd behaviour, but there is also a lot of “normal” behaviour on a psychiatric ward, watching TV, playing games, having a chat. You can’t see everyone’s mental health problem from afar.

3. Are you psychoanalysing me?

NO! Firstly, I have not trained in psychoanalysis. Secondly, I am not a mind reader (psychics do not exist). I don’t want to know about all of your troubles (unless I ask, or you are my friend, even then sometimes I don’t want to know). It is my job to care for people, not my mission in life to care for everyone I meet. Just as a doctor at a party does not want to hear every medical complaint in the room, I don’t want to find out how scary you all are (joke). In reality, training to be a mental health nurse may make you more observant of behaviours, give you some insight into common behaviours and hopefully make you an empathetic listener. It does not make you everyone’s counsellor. Of course I talk to friends who have problems, they just need to realise I don’t have all the answers. It is much harder to offer that kind of advice to someone you know than to a stranger. Objectivity is often needed, this is difficult to achieve with people you feel close to.

Anymore questions?