Update – Poor standards at 28 mental health units

This post began with an article published in The Guardian: Psychiatrists called for inquiry after report on private units, many occupied by NHS patients. Inspector discovered poor standards at 28 mental health units.

I’d written that this is great news. Not because poor standards were discovered, but because it’s been reported and it’s out there!

Update

According to the NHS

“One in four of us will experience mental health problems, and mental illness is the single largest cause of disability. Yet mental health services have for several decades been the ‘poor relation’ compared to acute hospital services for physical conditions”.

NHS, Five Year Forward View

The NHS goes on to detail — “What’s been achieved in England over the past three years?” and one particular point stood out for me:

“NHS England’s mental health taskforce has agreed a detailed improvement blueprint to 2020, in partnership with patient groups, clinicians and NHS organisations”. See Mental Health Taskforce Report, which states that

“It is therefore essential that all involved in the delivery of mental health services have the knowledge and skills required to deliver high quality care and have access to education and training.”

NHS

Mental Health Nurse training

Now, whether this all means only for NHS staff, it’s still a step in the right directions. However, when I was nursing, it was almost impossible to get staff to attend the Statutory and Mandatory, let alone any other training.

Mandatory and statutory training ought to be undertaken by all staff and is deemed essential for safe and efficient service delivery and personal safety. It reduces organisational risks and ensures organisations are meeting their legislative duties.

The Royal College of Nursing (RCN) write that “Continuing Professional Development (CPD) is additional to any mandatory or statutory training that an organisation may provide.

What does Continuing Professional Development really mean?

While there is no universally agreed definition of CPD, there is a broad
consensus that, in a nursing context, its main purpose is to help staff to
maintain and develop the skills they need to deliver high quality, safe
and effective care across all roles and settings”.

Nurses must stay up to date with the latest developments, continuing to update their skills and competences to meet changing future population health needs effectively and safely.

Refusing to attend training courses is a reason for poor standards in mental health units

Ooh, if I had a £ for every member of staff that refuse to attend any more training courses than is necessary i.e. Statutory and Mandatory……… This still shocks and surprises me. We had access to our local University which offered so many nursing skills and knowledge courses and — all for free!

When I was a ward manager, some staff suggested I was picking on them if I suggested courses such as Verbal and written English. Once we’d ironed out that I wasn’t picking on anybody, I now had to enforce attendance on relevant courses. If staff still refused, they would be placed on what’s called Performance Management for a period of time. It would then be a job for me and the charge nurses to manage that nurse’s performance. What a performance palaver.

I really appreciated that our Trust granted me years of extra training to support some of my specialist roles. This included working with patients and their families, where the patient had schizophrenia and Cognitive Behaviour Therapy (CBT) for Schizophrenia.

Over to you

Is it just me? I loved going on the courses to keep up to date with nursing practice. It made me feel more confident and competent at doing my job. Would you take the extra training if your Trust or company offered it? I look forward to your comments or thoughts and question.

Okay, back to where this first article started:

Patient’s fears about admission are real; an increase in poor standards in mental health units is observed at a national level

I’ve already mentioned some of the poor practices on mental health units I’ve come across in other posts. But there is so much more. Like the way some staff dismiss patients’ fears and anxieties. What appears to be a molehill for us may feel like mountains to patients.

When a patient expresses their fears about admission to an acute mental health ward, it’s extremely important to listen. This way they feel heard and know that you care. It’s particularly difficult for patients who’ve been sectioned under the Mental Health Act 1985 (MHA). Some are almost dragged from their comfortable homes by well-meaning (or not) family, carers, Social Workers and a Psychiatrist.

Patient fears are real for them

During the admission process it’s essential to accept that patient fears are real for them, and not to dismiss them. Some patients are acutely unwell and can be chaotic on admission. This means it’s important to continue the conversation as many times as a patient might need. Nurses that work on mental health units also ought to better communicate with their patients. They should know they have the right to appeal against their Section. And they should be provided with the correct paperwork to do so.

Patients experience low standards in mental health units first hand. They should know about Patients Advice and Liaison (PALS), an important service, which will support them with almost anything. They can make an appointment with the team who will come to the ward if a patient has no leave.

Private sector mental health units

The Guardian reports “Inspectors have found 28 privately run mental health units to be “inadequate”. Regardless, this does not detract from poor standards within the NHS. I only had one elective placement (which I chose) within a private unit and I would never go back. Most of the staff were agency and who probably couldn’t get permanent jobs if they tried. They were rude, authoritarian and antagonistic not just to patients but to families, colleagues and students.

They didn’t like me and the feeling was mutual. I asked too many questions and ‘cared too much’ when I ought to be doing some work. They were referring to i.e. the menial tasks they couldn’t be bothered doing. What they didn’t know was that I had been doing secretarial work for near on twenty years. I loved doing the admin, completing computerised care plans etc. Being quick and quite good (compared to them) at it, I smiled throughout the shift – something that bugged colleagues when they disliked you.

Private sector treating patients badly

One particular famous client (they were called clients in private units) had overdosed on illegal substances many times. She was on methadone, an opiate prescribed by doctors as a substitute for heroin. Today she wanted to eat lunch before medication. When she went to get her medication, the nurse who’d been doling out meds had left the ward.

The other nurses wouldn’t give her the methadone and told her she’d have to wait. When a methadone user doesn’t receive a dose on time, it will trigger debilitating withdrawal symptoms like nausea and insomnia. The patient was agitated by this. I was p’d off because I thought the nurses’ punitive actions were totally unacceptable.

How I dealt with it

I went to the unit Manager who was sitting in his plush office. I then asked him whether it was standard practice to hold medication hostage. He tutted and exhaled heavily, put his muscled arms up behind his dreadlocked head and proffered an uncomfortable smile. “Mmm, Nancy is it? Look, she’s a pain. Man, she always think she can bend the rules.”

“Pfft, rules?” I asked. This is a healthcare facility isn’t it? I am in the right place?”

“Nancy, we only have enough staff to do the basics. Our staff doesn’t have time to run after clients whenever they want.”

“Okay, but Molly’s totally distressed now so I’ll go and talk with her and document all this in her notes.” I said with a sarcastic smile and walked out of his office. He wasn’t long in chasing me down the corridor, apologising profusely; therefore he was just having a bad day, he didn’t realise what staff were doing! He would get the medication now. I still documented this event in Molly’s notes and asked a nurse to co-sign it.

A typical example of an employee with low standards

The nurse who’d declined to give out the medication didn’t speak to me the rest of my placement? Was I bothered? It was one less idiot to listen to as she did nothing but whinge about the job. She would moan about various patients and kiss her teeth throughout her shifts. Spending more time on the computers, googling hairstyles and nail art. She must have not realised that somewhere in Head Office, the tech guys could easily follow what she was doing. They could see exactly how much time she’d spent online, and they could report her for time wasting.

Did no one care about low standards at mental health units?

Much of the time on this elective placement I felt so powerless and could totally empathise with patients. No one wanted to listen and no one cared! Staff appeared to find everything a chore and it seemed they only came in to earn money. See, nursing isn’t just a job. Being a professional nurse means the patients in your care must be able to trust you. It means being up to date with best practice. Always treat patients  and colleagues with dignity, kindness, respect and compassion. It means understanding the NMC code of conduct. It means being accountable. Katrina Michelle Rowan, 2010.

I was able to complete several PBA’s on this placement. And I also learnt more about how not be be a mental health nurse. I saw how poor the team’s communication skills were, both verbal and mainly non-verbal. I saw how badly they treated people, how unprofessional they were and how they lacked empathy for anyone. The staff on this placement tried to hold me back. Little did they know how much I gained and how much I’d grown by watching their indifference. I always say, there’s never a bad lesson.

Related posts: Clapped out: Mental Illnesses, abuse by services and #ClapForCarers (1). Acute care facilities and mental health facilities are below modern design standards (2).