I never expected to witness a mental health patient dragged to the floor
What I didn’t expect to see within my first couple of days, was a mental health patient dragged to the floor. I was on my first mental health placement and had just returned from a short coffee break. Derry had given me a bunch of keys and a swipe card, so I let myself in.
Derry, being the nurse in charge, had gone into what’s called Management Round. I learned that this happens each Monday morning. Apparently, this is where the Doctors plan their weekly ward round allocation; picking which patients to see.
Warning: foul language ahead
An angry sister startled me
The phone was ringing off the hook and there was no one else around to answer it. I picked it up and sang ‘Good morning, Lavender ….’ A female interrupted and spoke urgently “Why is my brother off the ward? He’s banging on my front door and all the bloody neighbours are out on their doorsteps. Jesus Christ! What’s going on?”
“Uumm, good morning. I’m a student nurse. Do you know who you want to speak to, which nurse?”
“Someone who knows what they’re fucking doing would be good.”
“Erm, Ok, what’s your name and your brother’s name …..” I stuttered.
“It’s Pauline Kennedy calling, and my fucking dick of a brother is John. John Kennedy. You know he’s on Section, right? He’s screaming through the letterbox now, can you hear him? Fucking arse”
Ouch! “Okay Pauline, hold on a second.”
“Not you, him, I’m sorry.”
“Ok, Pauline, give me a second, would you like to hold on or shall I call you back?”
“No, I’ll hold…” she tutted.
Have you called the police?
I dashed up the corridor, knocked the door to the meeting room and popped my head in to tell Derry and the Doctors. “For fuck sake.” Derry’s Irish brogue rang out and “Has she called the police?” enquired one Doctor, the elder out of two. But Derry was out the door, heading for the office and I followed.
“How’d he get out?” Derry muttered to no one in particular. “Hello Pauline, it’s Derry here. Is he still there? Have you called the police? Derry’s nodding at me, indicating that John is there. “Aye, I know but okay, I’ll do that,” he continued, “You just keep yourself safe and I’ll call you back in a wee minute.”
“Here, you call the police on this number and let them know what’s going on.” Derry pointed to a page in Johns file, “Pauline’s address is there,” he urged. Alison had just come into the office and I could hear Derry filling her in while I spoke with the police. I was a bit nervous, but I was able to give them all the necessary details.
Paranoid and can be dangerous
“Jesus, we’re in trouble now,” said Gerry. “This guy used to live with his sister and he’s paranoid about men wanting her, that they want to have sex with her. He’s already done time for smashing the electricity man in the face with a brick after the poor man went to check the meter. John’s on a Restriction Order (1) so he is.”
The two doctors; the Consultant Psychiatrist and an SHO (2) appeared at the office door. “Everything alright Derry, Nancy? Oh, hello Nancy. Sorry, I’m Doctor Shand and this is Doctor Wiles. Do we know what’s happening?” He smiled, “Let me know when he’s back on the ward please,” and left.
Derry winked and gave me the thumbs up while he was on the other line to Pauline, letting her know the police were on their way. At the same time, she’d told Derry that John was quietening down a bit.
“Good job there Nancy. Will you just write in his notes; what happened?” Derry asked.
Police and rapid response team
It wasn’t long before the ward door opened and I could see John being led in by the police and half a dozen people who, it turns out, are part of the Hospital Rapid Response Team (RRT), called to assist in emergencies like this. John shuffled in, head down, looking shame-faced, and went off to the day area. One police officer spent a moment with Derry then led his team away.
RRT’s are made up of six-seven people, one member of staff from each ward who were mainly men. They responded when a bleep and the radio sounded, telling them where to go. When the police arrived with John, the RRT met them at the hospital entrance, to help escort him back to the ward.
Fags were the currency of the day
John was still raging, but the police had done their job so they left. The RRT followed Derry into the tiny office and waited for instructions. John marched towards the smoking room, muttering under his breath, and almost took the door off its hinges when he slammed it. I followed John and offered him a cigarette. This was the currency used if you wanted to engage certain patients. And this time was no exception.
However, I felt decidedly uncomfortable, sitting between John and another patient, who’d introduced himself as James before asking for a ciggie. John muttered that he wanted to kill someone and James bounced back and forth in his chair, fists balled tight.
I wondered how I could finish my freshly lit ciggie and make my exit back to the relative safety of the kitchen without bringing attention to myself. Just at that, the door opened and Derry said “Come on John, you need to take your meds.”
Rolling around in the the fag ends
“Nope!” John spat back at him. The Rapid Response Team (RRT) had been waiting and burst in before hurling themselves at him. They grabbed him by his elbows and wrists, pulling him up out of the chair, and on an authoritative command “Down!” he was on the floor. Three RRT members were down there with him, and another two soon followed. They dived to the floor to hold onto John’s legs, in an attempt to stop him flailing around and getting hurt.
John was yelling “Fucking bastards. You fucking wait.” and struggling among the fag butts and drink slops, battling against team holding on to him. There was now one on each arm and leg, and one at his head. The lad at his head was calmly telling John what was going to happen, tho I’m guessing he already knew the ‘drill’.
John struggled to spit further obscenities out, because his mouth was dry now. The young lad at his head continued calmy, “John, it’s for your own good. Stay still and it will all be over.”
“Fuck you.”
This might hurt
“That’s it John, your okay. Ssshhh. You’re safe.” At that, Alison came in holding a small cardboard tray that held two half-filled syringes. She yanked John’s belt off and pulled both his jeans and pants down, leaving his right bum cheek exposed.
Alison swabbed an area of John’s right buttock, and squeezed it. “A sharp pinch John,” she calmly popped one needle in, followed by another.
I would later learn that the intramuscular injections they’d administered was what nurses called ten and two. This meant ten mg Haloperidol, and two mg Lorazepam which, used together, creates quick sedation. This combination is normally used to manage acutely disturbed patients. However, if a patient is unknown to the hospital, or if it’s a smaller person i.e. a female, they’d be given a smaller dose i.e. 5 mg of Haloperidol and 1 mg of Lorazepam.
Post incident debrief
RRT held onto John for a few minutes, and he eventually stopped struggling. The medication was taking effect. Derry said “You good John? Come on now. We’ll let you up, easy now.” They helped him to his feet and left the smoking room, one by one. “Into the office boys and girls,” Derry continued, as if nothing had happened, “let’s debrief.”
Nobody was taking responsibility for letting John out. He didn’t leave with me, I knew that, as I’d only been given the keys prior to my ciggie break. However, I was getting knowing glances from everyone in the office. Still, the team agreed that the Control and Restraint (C&R) had gone well and no one got hurt, so the RRT left the ward.
Derry and Alison were both busy documenting the incident in various forms. I offered to help, so they gave me an incident form to complete. They said that John had missed his morning medication, which included ten milligrams (mg) of Diazepam. This has a sedative effect, hence John’s paranoia and visit to his sister’s.
Alison held her hands up as she’d done medication that morning and she’d missed John. She insisted I document this on the incident form but I’d already finished it. “John was seen leaving the hospital at 08.10. just as medication was being administered. Therefore John missed morning medication.” I’d already been down to reception and seen the CCTV footage of John running out the front door.
“Well done Nancy. You checked that yourself, did ye?” I grinned from ear to ear when Derry half-joked “You’ve got the job.”
Over to you
What do you think about mental health patients being restrained? Perhaps you’ve had this happen to you? I look forward to your comments, constructive criticism and any question.
Caz
(1) Criminal courts can use section 37 if they think you should be in hospital, instead of prison. Section 41 is a restriction order. If the Crown Court think you are a risk to the public, they can add this order to a section 37 – hence the Section 37/41
A section 41 Restriction Order can be added to a section 37. It is then called a section 37/41. Only a judge in a Crown Court can do this. They will do this if they think you are a risk to the public.6 The restriction order means that there are restrictions on both you and your Responsible Clinician (RC). One restriction is that your RC needs to get permission from the Secretary of State for Justice to discharge you.
(2) A senior house officer (SHO) is a non-consultant hospital doctor. Registrars and consultants oversee their training, and are usually their designated clinical supervisors.
It’s difficult to see what choice they had. If the alternative is the ‘leccy man being smacked in the face… I mean, it sounded like the main problem had happened earlier, when this guy got out in the first place, At least nowadays cctv can take some of the guesswork out of that.
I’m sure as a new student, you would have been prime suspect.
Lol, the leccy man lol. Are you blaming me Pete, all these years later, I’d just got over the guilt too 😉 x
No, as I said, surely the cctv gave strong clues? I can imagine that without cctv, the new studie would have been prime suspect.
Lol, I was teasing you Pete 😉 Yeah! They would have loved it to be me 🙂
That sounds like it was badly handled. There was no reason to do a takedown in the smoking room without even trying to get him into his own room. There was also no reason to do a takedown without giving him options. I found it often worked well to say ok, we need to do this medication, the easy way is this, the hard way is that, it’s your choice how it goes down.
Yep, that was me too, once I’d qualified. It was taking oral medication – you have a choice…….
I think he was a regular at ‘fighting’ with staff, and they knew it was the only way they could ‘corner’ him.
I’d never seen or expected anything like it – I was bloody terrified.
I have seen a number of incidents handled far differently to this, and with compassion. One of those instances included the “escaped” patient holding a knife. The power to talk someone down cannot be understated, regardless of their mental state. That was my recollection at the time. A dangerous situation handled so calmly. Needless, to say, this incident has has stayed with me over the years and helped me deal with some very difficult people who are prone to extreme behaviour. I suppose what we see in films and TV shows doesn’t help with the perception of this issue either re taking such a fragile person down forcefully.
One incident which I use in my training with local government officers is where a difficult customer was put through to me to handle. I won’t go into the full details of the issue and what transpired throughout the call, but he was that distressed he said to me “I’m going to come in there and cut your x head off and shove it down your neck.” Now, I have handled all sorts of abuse over the years, but as soon as I ended the call, I contacted the police. Once I identified who it was they said, oh yes it’s X, we deal with him often and he is obviously off his meds again, he is an ex-Vietnam vet. It will be alright. I wasn’t necessarily overwhelmed with their level of reassurance, but I do recall thinking I wouldn’t be popping around to see this person anytime soon and go through his complaint. I can’t even recall if the police called me back.
That night (winter, dark), I took the senior ranger’s vehicle home (I was the line manager for the ranger’s department). As I turned into our street and passed the local pub (very handy by the way), a car came tearing out of the pub carpark. Straight away, I had one of those thoughts and my mind flashed back to my rather interesting phone call earlier in the day. So, rather than pull up outside our house, I drove around the block. Sure enough, the car followed me. In the end, I decided to pull up and confront the issue, with quite a bit of trepidation mind you. Sure enough, the car following me pulled up behind me. Then a woman got out the car. Big sigh of relief, I can tell you. The woman then continued to approach me until I told her to stop. She then informed me she had spotted the ranger’s vehicle as she was driving out of the pub carpark and that her dog was locked in the dog pound. She demanded that I release her dog right now. Of course, I said politely, that wouldn’t be possible, but she could talk to the senior ranger in the morning and make the necessary arrangements. I laugh about it now, but at the time, I was trying to say calm the whole time.
Thank you for your well-thought out and informative response Sean.
Lol, that was funny 🙂 the car following you – but I’m sure it wasn’t at the time.
Yes, that incident was awful and me being just a new student, I was terrified and shocked. This guy was what they called a ‘regular’ as he fought with staff often. So they always got ready to do what they did.
When I qualified as a nurse and was trained in Control and Restraint, I’d always tell him that he had the choice. Oral medication or injection. I said “do you really want all these guys jumping on you, holding you down? Come on, let me give you your meds.”
I only ever had one very new and young guy who refused point blank to have any medication. I was in the office alone with him, trying to encourage him and tell him about the various Sections he could be placed on, and which might ruin his career.
He still refused medication and said bring it on, let them try. I’ll kick the crap out of them. Don’t worry, I would never hit a lady.
I managed to get out of the office, the team went in and the poor lad was crying, apologising and asking me to help him. It was awful and I had to explain to his parent the next day. They were okay and said well he needed some intervention.
He never refused meds again.
I’d sit right next to the biggest ‘baddest’ patient and encourage them to take oral medication, and they did. Like you said, it’s about empathy and compassion, and listening.
Many of our staff lacked these attributes! Sadly.
Caz, I take my hat off to you. To have such presence of mind and then to handle these situations in the thoughtful and resourceful way that you did, is amazing.
Yes, if only there was a little more understanding in the world with a hint of professionalism. It doesn’t take much.
One day I might tell you about the dynamite incident, the rotten meat incident and the gun shots incident. People are always interesting 😊
Yikes, what an introduction to the job! 😬 Kudos to you for remaining as calm as possible and sticking with nursing after that.
I’m a little surprised that a whole team leaped on the patient after he just verbally refused to comply with directions, but I suppose there might have been history leading to such a strong response.
Lol, it shook me to the core, first of all being in the room alone with the two paranoid patients.
Then when they ‘jumped’ him. He was apparently a ‘regular’ at this type of response and staff said it’s the only way to get him to have meds when he was so unwell.
I think I still would have tried a different approach. And eventually did, once I was qualified.
That looks painful to me. I’m not sure if you need a group of people to pounce on the guy.
Fortunately, the patient never gets hurt, it tends to be the staff. I was told this guy was a regular at this type of behaviour; he’d normally throw himself at the staff and end up hurting someone. But it still wasn’t nice to see.