Does Mental Health Rehabilitation really work?

Early shift

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As I parked up my first morning, even above Slade’s Noddy Holder screaming “It’s Chriiiiiistmass”, I could hear a female screeching “Medication. I want my medication. Where’s my medication? I need my medication.” The poor neighbours either side of the building must have been well p’d off. It was six forty-five, pitch black outside and the streets were eerily quiet — other than the high pitched screeching coming from the Mental Health Rehab Unit piercing the air.

Someone in the office by the front door pressed a button to let me in and I was greeted by this tiny little lady who grabbed both my hands and panted “Help me. Help me please. I need my medication. You’re new. Are you an Agency Nurse?” Will you help me? Please?”

I spoke calmly but firmly, “Listen to me, I can’t help you right now…” I was trying to placate her enough so that she could hear me and take in what I was saying. At the same time I was trying to get her to take a breath as she was panicking and was as white as a sheet. I really felt for her.

“Please, please. I’m begging you,” she continued to screech, now in my face, as I tried to disentangle myself from the tight grip she had on my wrists. The office door opened and a nurse yelled “Cindy, stop it, leave her alone. Cindy!” I’d now managed to get myself free but Cindy had grabbed the nurse and was pulling on her cardigan, all the while screeching “You’re a bitch. You’re a fucking bitch! Get my medication you fucking black bitch.”

The nurse eventually pushed me into the office and she followed, turning to slam the door in Cindy’s face with a kiss of her teeth “Oh Lordy Lord. That Cindy. She will be the death of me. I am Ayo. Who are you?”

I breathed a sigh of relief and introduced myself as the Student Nurse. “I don’t know. See how it is here. I pray to God for her sins,” humphed Ayo. “Hmmm. Take a seat. Ah! Here come the staff.” and I turned to see two females and one male puffing away outside, the ciggie smoke belching through the office window. “Tsk, Tut. I don’t know. Smokers, heh!” moaned Ayo as she reached to slam the offending window shut.

Seven o’clock on the dot the three members of staff traipsed in, throwing their coats on top of a filing cabinet. Lisa was first to introduce herself as the RMN, the shift coordinator and my supervisor, and said “That’s Lorna, she’s a qualified (RMN) and that’s Graham the NA (Nursing Assistant).” Where’s the fourth member of staff? I thought to myself.

Morning handover

“Okay.” started Ayo, above Cindy’s screeching. “The lady herself. Cindy, she slept and now she has been shouting before six thirty. Lord help me! Everybody still in bed. Only Sasha, she awakes all night but she stay in her room. Somebody needs to clear her room. I saw the mouse there.” My feet moved on their own, up off the floor as I sat on a desk, and I shuddered involuntarily when I was looking around for the said mouse.

Ayo continued and ended with “Moses needs to see a Doctor and his toenails need to be cut. It’s in the diary for this morning. Now I’m going home. Goodbye!” She pulled off her slippers and put them in her bag then huffed and puffed as she bent down to put her shoes on. She grabbed a large woollen blanket and shuffled out of the door.

Lisa went through the diary, handed out tasks to the other two and said she was doing medication and that I should shadow her. Lorna went off to wake up the other nine patients that lived in the ten bedded unit and Graham wandered off to the kitchen to prepare for breakfast.

Medication

With our coffee, Lisa and I went to the medication room, we were met with Cindy who was still gulping in great lumps of air, wringing her hands and saying “Thank you Lisa.” and “Thank you nurse.” to me. Yes, I could get quite used to being called Nurse.

“Right Cindy. You know we start titrating down your Diazepam today.”

“No, please Lisa. Not today. I can’t cope. I can’t cope!” Cindy screamed.

“Nought point five milligrams Mandy. You won’t even notice it.” Lisa tutted and turned to me. “She’s been on thirty milligrams three times a day for years and you can see it doesn’t reduce her anxiety. So we’re going to try titrating down while she’s in Rehab.” Cindy lived in a one bedroom flat and had apparently relapsed over a period of six months prior to admission to an acute ward. Once stabilised she was transferred to rehab.

Cindy had generalised anxiety disorder (GAD) which is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. 

People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue. Titration looked like it would go on forever, reducing her Diazepam by nought point five mg three times a day. However, Cindy eventually accepted the reduced dose and greedily swallowed down all her medication, followed by gulps of water, then scurried off to the dining room.

Breakfast

We continued until each patient had had their medication then joined everyone for breakfast in the dining room because, on rehab, we were encouraged to eat with the patients each mealtime. Lisa waffled something about nurses having a responsibility to role model table manners and eating with the patients was supposed to encourage healthy eating. I wasn’t sure that this was an evidence-based intervention but I went along with it anyway.

Coffee and toast with jam was just what I needed but as I sat to eat I was immediately struck by an offensive odour. One older lady to my left had obviously not washed or brushed her teeth, yet there was another disgusting smell.

Graham screwed his nose up and said “She’s just sat there and shit herself and carried on eating!” to nobody in particular. “That’s Elsa.” he whispered with an Aberdonian accent. “She normally goes to the toilet but she uses her clothes to wipe herself and then hides them down the back of the toilets, eh Elsa?” he now boomed. “Elsa, say hello to Nancy, she’s our new student.” Elsa’s face was buried in the huge breakfast she was picking up with her teeth. She raised her head and gave me a toothless grin.

None of the staff got up to help Elsa so I offered, but Graham told me “No. Wait til after breakfast!” And this is rehab? I wondered — does it really work?

Around the table, there was belching, farting and one young chap was trying to snort back the snot that was threatening to hit his top lip. He eventually gave up and wiped a huge glob on the sleeve of his t-shirt leaving a silvery snail-like trail.

Coffee finished and my toast in the bin, I helped clear the table and took my time in the kitchen. I was hoping someone would deal with Elsa, as I was already feeling queasy. Fortunately, she’d gone by the time it took me to do the dishes but she’d left wet poop dribbling down the chair legs. Gloves and apron on and ten minutes later the chair was scrubbed and left outside in the back garden to dry.

Activities of daily living

To the bedrooms on the first floor now where I tried encouraging patients to wash and dress before attending any appointments or activities. Oh my word! I’d knocked and opened the door to Sasha’s room and was aghast at the cereal boxes piled as high as the ceiling. At a guess I’d say there must have been over two hundred boxes and the only other floor space was filled by her bed and two or three black sacks.

“Get out of my room.” stormed Sasha as she pushed me and slammed the door. I stood for a few seconds, stunned, then knocked and called out “I’m a student nurse Sasha. Is there anything I can do? Would you like me to help you clean your room.”

“Get lost.” Sasha muttered. I went to find Lisa and asked what I could do to help Sasha. “Not a lot,” Lisa laughed. “Her room’s been like that forever. She won’t let us in.” That can’t be right. Surely we have a duty of care? I went to the office to look through Sasha’s file and her painstakingly completed but outdated care plans to see if I could find ways to engage her.

I read that she was single, had no children and had been in care since the age of eleven when her mother couldn’t cope with her chaotic behaviour. She was thirty one and was diagnosed with Schizophrenia at eighteen. Sasha heard voices and was often heard talking back to them when alone in her bedroom. Apparently Sasha had no insight and didn’t believe she had a mental health problem. She’d been on the unit for six months and was awaiting housing but it was proving difficult to find a place that would meet her needs.

I decided then that I’d be really firm with Sasha right from the start, telling her that we have a duty of care to ensure that her environment is habitable. If she wouldn’t clean it herself, then we would have to do it! It annoyed me that staff had let her live like this for months. Even if Sasha had refused to let them clean it, surely the staff could have come up with a plan between them.

It was exhausting and often thankless, but I worked hard with Sasha for the next twelve weeks, updating her care plans and engaging her in meaningful activities; things that would both interest and help her rather drum banging or painting by numbers. I appreciate that one of her care plans previously stated ‘Engage Sasha in activities.’ But, while these particular activities may help with dexterity and fine finger/hand movement, I wasn’t sure they would support her development. It was clear that certain staff had intermittently tried to push Sasha into any activities and wrote in her notes ‘Declined to attend.’ I wondered why!

I’d eventually learned more about Sasha, along with the other patients on the unit, and had managed to form a professional bond with each of them. As I got to know them better, often by engaging them in friendly banter, I was better informed about their likes and dislikes. It was easy to see they weren’t interested in particular activities and that they had their own ideas about how to spend their time.

Mark liked football so I’d have a kickabout with him in the gardens – he was quite good – so encouraged him to attend the local leisure centre where he could access different types of exercise and look out for a local football team to join.

Jenny loved knitting so we bought her knitting needles, a few patterns for baby clothes (that she requested), and some wool. She wasn’t great, dropping more than a few stitches, but that wasn’t the point. She enjoyed it. Other staff who could knit helped her unpick and start again. Eventually, with the help of staff, she started her own small weekly knitting group on the unit.

We also got a group of patients to go swimming once a week, with a member of the team. We also went to the local pub once a week so that some of the young lads could have half a pint and a game of pool. They’d never felt comfortable going into a pub previously, because they were worried about what other people thought. We quite often did get some odd looks but as a rule, the regulars were great – helping the lads with their game and showing them trick shots.

At the end of my placement I loved seeing Sasha and the others laughing, smiling, engaging and growing in self-confidence and once again, I was sad to leave.

I would later bump into some these patients in various settings i.e. in the community or on the wards and I was either saddened by their relapse or delighted by their continued improvement.

Note to self: “Public service must be more than doing a job efficiently and honestly. It must be a complete dedication to the people and to the nation.” Margaret Chase Smith.

Not proud of our Community Mental Health Teams

My first placement with a CMHT

A GP might refer an out-patient but in-patients are generally allocated to a Community Mental Health Team (CMHT), prior to hospital discharge, which is normally made up of various multi-disciplinary professionals such as:

  • Community Mental Health Nurses (CMHN) and unqualified support staff
  • Social workers and Approved Social Workers (ASW’s) – Same as social workers, but ASW’s have undergone specific training in mental health law; the Mental Health Act 1983, which enables them to carry out Mental Health Act assessments with other professionals.
  • Consultant Psychiatrist, Senior Registrar and/or SHO’s (Senior House Officers) who are Doctors undergoing their six months training in a particular area of medicine. In this case, Psychiatry.

The CMHT works with a person who may get help from one or two of the above professionals, depending on their needs.

As a Mental Health Nurse student, I was allocated to Alan, a CMHN who would be my supervisor for the duration of this placement. I was five minutes early so I had a coffee and introduced myself to a few of the team while waiting for Alan. It was eight fifty-five and their overall mood matched the weather on that stormy Monday morning. Had they not been sitting at desks, behind the flexy plastic window, I might have thought they were patients waiting to be told they’re being placed on Section 3 of the Mental Health Act 1983 (1) and are due to have medication — injected into their eyes.

I smiled as the front door opened and an older gentleman walked in. He was wearing a tatty tweed jacket, a moth-eaten jumper and a shirt so old, the collar was frayed. His well-creased trousers looked as though they’d had an argument with his ankles and his black plastic slip-ons squeaked as he walked. Still, his gappy-toothed smile was welcoming and as he stuck out his hand, he pushed open the inner door with his backside and he introduced himself as Javid, a Social Worker.

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I explained who I was and Javid took me down to what looked and felt like a fusty old storeroom. He pointed out his desk, Alan’s desk and the one opposite that I could use and off he went.

I went through my Practice Based Assessment (PBA’s), a list of evidence-based tasks to be carried out at each placement, to see which ones I might be able to meet sooner rather than later. I always liked to get a head start and not leave the PBA’s right til the end of placements.

While thumbing through a patient file, gathering information for one of my PBA’s, I happened to look up saw a rickety old bike being chained to the railings. I watched as a pair of green wellies marched up the few steps to the front door then heard them thumping down towards the basement. The office door bashed open and there Alan stood. He pulled himself up to his full six foot plus, puffed out his chest and glared at me, demanding “What do you think you’re doing?” in a broad Scottish accent. Think Billy Connolly!

“Javid said I could look through……..”

“Is Javid your supervisor? No, he’s not. I am. Javid is an ASW and you. are. a. mental health student. Are you not?”

I almost stood to attention. Instead, I raised my eyebrows and stared back at him for what seemed like an age. He turned on his heels saying “I’ll get myself a coffee and see you when I come back!”

This was the way Alan continued over the next few weeks, barking orders at me and ignoring any questions, feeding me snippets about his patients – when he saw fit.

He told me he was married and had two children and that he was an ex-police officer, something I should have guessed. Either that or the Armed Forces. He was not a nice man. Rather, he was an egoistical, belligerent and manipulative git.

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I was surprised one morning when Alan told me I was to run his Depot Clinic (2) under his supervision. Patients come to the clinic bi-weekly or four-weekly to have their antipsychotic medication via intramuscular injection. “You do know how give give injections, I presume?” he snapped “And don’t forget to check which side. I’ll countersign the medication charts when you’ve done.” I had observed several injections during my in-patient placement but I’d never actually administered one.

My first patient was due in soon so I checked her medication chart and spotted the small letter ‘L’ underneath the signature box, which I gathered meant that was the side the last injection was given. Injections sites were alternated to stop the buildup of scar tissue on one side.

Sally, my first patient, appeared sullen and I wasn’t sure I’d be able to engage her in idle chit chat before inserting the needle, something I hoped would help take the patient’s mind off the injection. However, she chatted amiably about me being a new student and asked whether I liked football. The needle was out and I told her that I was an Arsenal fan. “Blinding. Me too. I ain’t never been myself tho’, ave you?”

“Yes, I’m lucky. I’ve been to quite a few games.” I was scribbling my signature on her meds form when she turned her head to me and said “Come on, ‘urry up girl!”

“All done Sally.” Ha! I’d given my first real injection and she didn’t even notice. Her eyebrows shot up then I got a wink and a brief smile of approval as she buckled up her jeans. “You’re alright you are. She can come ‘ere again Alan.” She gave me a knowing look and glared at him as she left the clinic. Not a word from him, just another of his withering looks as I passed him the meds chart to countersign.

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A month passed and Alan continued to arrive late every day. One morning, Javid asked if I’d like to go out and visit some of his patients with him and I jumped at the chance. We arrived at Anne’s house to see her in the front garden wearing a flimsy kaftan and barefoot. She twirled around on the grass, arms outstretched and head thrown back as she sang – Julie Andrews popped into my head. In fact, as I sit here typing, the classic film, The sound of music, has just started on t.v. and every time I see it, I remember Anne.

Anne grinned when she saw Javid and waved him in with a dramatic curtsey, telling us she was calling the children in for lunch. Four skinny under-twelves trooped into the living room and hungrily snatched up huge doorstep sandwiches. They danced, skipped and jumped all over the two mismatched sofas as they munched. They sang silly songs and clapped loudly, dropping crumbs everywhere. Their likeness to the much loved Von Trapp family didn’t go unnoticed.

They were clean, wearing all manner of clothing; some too big and some to small, all bare foot, but they looked happy and were both well spoken and well mannered.

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Anne had a diagnosis of bipolar disorder which used to be known as manic-depression, where a person has episodes of depression (feeling very low and lethargic) and mania (feeling very high and overactive). Unlike simple mood swings, each extreme episode (high or low) of bipolar disorder can last for several weeks, or even longer, and some people might not experience a normal mood very often. Bipolar disorder is treated with mood stabilisers such as Lithium or Valproate, which is actually an anticonvulsant medication (also known as antiepileptic medication), which were all originally made for treating epilepsy. Epilepsy is a neurological disorder that can cause seizures.

Once we were on our own, Javid asked Anne if it was okay for me to complete a mental health assessment, done by observation and direct questions, assessing things like:

  • mood, behaviour and appearance
  • thought form for speed and coherence
  • thought content for delusions, suicide, homicidal or violent thoughts, obsessions and perception
  • cognition for orientation to time, place and person, attention and concentration

Finally, I assessed her insight to gauge whether Anne knew her incessant chatter, thought disorder and her behaviour wasn’t normal, given the weather and both her and the children’s appearance. However, she didn’t believe she was currently unwell “This is nothing.” she chirped. “You’ve seen me worse Javid.”

Javid smiled, then stood to bid our goodbyes and I couldn’t help but giggle when Anne and the children burst into song “So long, farewell, Auf Wiedersehen, adieu. Adieu, adieu. To you and you and you.”

Sitting in his car, Javid talked me through the visit and agreed that yes, he had seen Anne worse? “Really?” I asked. He nodded and chortled. However, he said he would check to see if there was a bed so that he could plan a voluntary admission over the next few days. He said that Anne would use all kinds of delaying tactics but would eventually agree to voluntary admission. “She knows she has a chronic (long-term) diagnosis and she’s well known to services. She’s aware that if she doesn’t go voluntarily, she would be admitted under Section 3 of the MHA 1983. This means patients can undergo coercive interventions, such as enforced medication, seclusion and restraint.

After a few more less-exciting home visits Javid and I returned to the CMHT, around four fifteen. We were just in time to complete our documentation and to see Alan snap his briefcase shut, throw me a look of utter disdain and head for the door. Thank God for the weekend.

Alan’s lateness carried on, his behaviour remained erratic and his lack of interest or guidance was getting me down. There were days I was in tears, despite the admin girls telling me to ignore him and making me laugh, saying he just needs a good shag!

Every day Alan was late I went out on visits with Javid or other staff who’d asked if I’d like to accompany them. I was gaining so much experience as the team were supportive and fed back to me my strengths and small areas that I could build on.

Most of my PBA’s had been completed I and was pleased with the necessary evidence I had attached, having made sure there were no names or numbers that could identify individual patients. The staff I’d worked with wrote on my PBA’s that I was really intuitive and empathic, that I had excellent communication skills, and had been proactive in achieving the high standards I’d set myself. Over all they said they were impressed. All I needed now was for Alan to sign them off as having been completed.

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The arrogant shit refused! He hadn’t seen me complete any of the tasks listed on my PBA’s so he would not sign them! He couldn’t possibly!

Long story short, I had to involve his superior who agreed that other senior staff I’d worked with could sign them off for me!

The admin girls mychieviously phoned me to ask about my results and I boasted – I only got a huge 94% for these PBA’s. Guess who they couldn’t wait to tell!

Note to self: I might have lost a battle but I certainly won the war.

(1) Section 3 allows for a person to be admitted to hospital for treatment if their mental disorder is of a nature and/or degree that requires treatment in hospital.  In addition, it must be necessary for their health, their safety or for the protection of other people that they receive treatment in hospital.  Section 3 is used where the person is already well known to psychiatric services or following an initial assessment under Section 2. 

Under a Section 3 you can be detained for up to six months in the first instance.  This could be renewed for a further six months and then for periods of one year at a time.  Section 3 can only be renewed following an assessment by the doctor responsible for your care (Responsible Clinician or RC).  Each time the Section 3 is renewed, a review of your current care and treatment is carried out by the Mental Health Act Managers.

(2) A depot injection is a slow-release, slow-acting form of medication. It isn’t a different drug – it’s the same medication as the antipsychotic taken in tablet or liquid form. But it’s administered by injection, and it is given in a carrier liquid that releases it slowly so it lasts a lot longer.

Patients loved good student nurses

Patients loved good student nurses cos we had time to chat with them

Patients and nurses loved good student nurses
Everyone loves good student nurses

Good student nurses might not be as skilled or knowledgeable as the professionals, but they’re very much loved by patients. They’re a breath of fresh air. Most of them want to help, whether it’s plumping up your pillows or making you that longed for cup of tea.

Have you ever been in hospital, maybe bursting to go the loo and you couldn’t get the nurse’s attention? Or your chin was on your chest and your neck had locked because your pillows were skew-whiff? Hmm, me too, on more than one occasion. And I get that nurses are really busy, I know, because I was one. But manys a time I could see them huddled round the nurse’s desk, laughing and stuffing their faces with chocolates.

Seriously, some general nurses work really hard, running up and down their wards, trying to fit in everyone’s needs. And it seems impossible some days. But Hallelujah, several times a year, they get a group of student nurses, many of whom want to learn. Woe betide if you just want to hang around looking like a nurse. You had work to do, and nurses couldn’t be bothered with hangers on.

I’d wanted to become a mental health nurse and this general nursing wasn’t what I’d signed up for. However, if you were a good student, willing to learn and share the teams’ mission, they’d support you, which made it easier. You’d help them with most anything they asked, within your capabilities. Even the most dreaded tasks.

Me and patient’s bodily functions

General nursing student

I wasn’t looking forward to this particular placement because, not only did I dislike East London and that hospital, it was also a general male ward. And generally where you get all men, you get burps, farts, snot and phlegm, in no particular order.

I gagged when I was asked to collect mucus — just at the thought of it. But actually holding a sputum cup half-full with sticky green bodily fluid had me dry-retching and reaching for the ladies. I dreaded the day I had to hold male poo samples.

A lovely elderly chap called Derek was the first patient I saw. He had prostate cancer along with other age-related ailments. Derek chuckled and winked at me when he saw me screwing my nose up. I couldn’t help but show my disgust at the foul smells of half-full bedpans and commodes. I realised I was being unprofessional, and it didn’t take long for me to become accustomed to the odour on the ward.

Patients I adored

General nurses were always busy
General nurses were always busy

Derek loved telling me stories about his life during the war and how, once home with his lovely young wife, they’d never spent a day apart. He also told me that his wife was on another ward down the corridor and he missed her terribly.

Before I went off shift one day, I managed to get Doris’ bed wheeled right next to Derek’s for the afternoon, despite moans from the nurses. I got to see why they never spent time apart; holding hands, whispering and giggling like teenagers and dipping custard creams into each other’s tea. I felt so proud that I was able to help in some small way. I’d honestly never had such a humbling and emotional experience.

Ah! Derek’s bed had been moved the next morning. I asked a male nurse where he was. With a nod and eyes rolling upward, he said: “He’s gone upstairs.” Oh, I thought and before I asked anything more, the nurse said “He’s dead.” Just like that!

I dashed the ladies to dry my eyes before looking in on Doris and her family, to pass on my condolences. I wasn’t sure I was at the right curtains when I heard laughter. So, I stood for a while, then Doris noticed my tiny shiny shoes and called me in. The family thank me for the humanity shown the previous day, and told me how much it had meant to both parents. They’d had their final chuckles and they were both at peace in their own way now.

Students have the time to listen

Most patients love good students on the ward because sometimes they’re the only ones who have time to stop and chat. They’d ask patients about their needs and wants, and try to help. Sometimes patients just wanted someone to listen to them, and students fitted the bill. While nurses ran ragged. They’d administer medication and attend ward rounds, while writing notes, and updating no end of needless care plans.

Phones rang out, begging to be picked up. It might have been someone wanting to speak to a poorly patient, or results from other departments?

Patients had many needs

Nursing students supported their colleagues while learning

See, most patients had more underlying health problems than just the issue came in with. This tends to happen unfortunately, particularly in large cities like London. It then becomes difficult for care teams to discharge patients in a timely manner because:

  • patients who didn’t speak or understand English needed interpreters
  • some patients needed support with housing and benefit issues
  • other patients couldn’t go home because their accommodation had to be repaired of adapted prior to discharge
  • often we had homeless patients who required a lot of input
  • others — just didn’t want to go home either because they were lonely or didn’t have any family around them
  • we also had patients with mental health problems and were awaiting a psych assessment
  • at least 25% of general hospital beds are occupied by people living with dementia. On average people with dementia stay more than twice as long in hospital then other patients aged over 65, said the National Audit Office, 2016.

Bed-blockers (hospital speak) are a huge problem for the NHS, and I can’t see it being ‘solved’ any time soon. Patients still need care and support from our busy nurses, while multidisciplinary teams scratch their heads. They too have large caseloads, and no doubt it’s hard to put systems in place so that patients can go ‘home’.

In the meantime, nurses made hundreds of phone calls to the various support agencies and social services, while still caring for patients. This take them away from the very job they trained for; looking after patients. No wonder both patients and staff loved and appreciated good student nurses on their wards.

Over to you

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What’s your experience, if any, of student nurses? Do you think nurses have a tough time on the wards? I’d be interested to hear what you think, and I’m looking forward to your comments or questions.

3 years study to become a mental health nurse

Within weeks of starting Uni, I learned just how stupid some people are! How many lack personal insight and have no idea of personal space or people skills. I was able to study my fellow students as they shoved their way through the doors I was entering and jumping ahead of me to get the seats at the front of lectures or lessons.

Now, I know I was really skinny but trying to get two people through the narrow single doorways at Uni was nigh on impossible and, if they thought I wanted to bring attention to myself by sitting anywhere within a ten-foot radius of any lecturer, they were sadly mistaken. Those lardy arses who bulldozed past me, snorting, kissing their teeth or tutting were welcome to their prime seats.

Having only recently recovered from a lengthy psychotic episode, I still felt really shy, nervous even, and constantly prayed to someone who’d help me stave off the ever-impending anxiety attacks. I’d sit somewhere in the middle of the halls and quickly avert my eyes or pretend I was taking notes if I caught a whiff of a question coming my way from the attending lecturer.

I was so busy monitoring my pulse and breathing, I probably missed half the lectures anyway.  Still, most of the lecturers appeared to be reading straight from books, which meant I could catch up by going through the same book or reading any handouts during breaks or at home.

What I hadn’t bargained for was the seminars and classes, which normally lasted between one or two hours and, where we were expected to work in smaller groups, normally around eighteen to twenty students. We’d be further split up to around 2-4 people, to discuss some topic or other, then complete a written task before presenting our understanding back to the group

Or, because of the sweet packet rustlers, the stupid questions and other disruptors, we often had to complete the task at home then feedback to the larger group. Oh, my word! If I’d known that I would have to stand up. In front of everyone. And speak? I would never have applied for the course.

No way was I making an absolute arse of myself. I practised for hours in front of a full-length mirror at home, where I’d present my findings calmly and with a flourish, maintaining good eye contact and waving my hands theatrically. Cracked it; I could do this.

Huh! For all that, the first time I presented to the class, I dropped the acetates I was relying on to distract my peers as I spoke. Taking in huge gulps of air as I bent down to retrieve said slides, I could feel the heat rising up my neck and hear my heartbeat pulsating in my ears. Then I swayed and felt dizzy, increasing my anxiety tenfold. ‘Please do not let me have a panic attack’! Though not sure who I was asking. By now, I could see my heart leaping out beneath my clothes like Jim Carrey’s character in The Mask and felt sure everyone else could see it.

It felt like an age as I raised my head and saw my well-meaning contemporaries smiling, encouraging me, willing me to get over the finishing line, so I began. With trembling hands, a fake smile and what felt like a massive boulder in my stomach, I managed to stutter my way through my presentation and answer some easy questions.

There was no theatrical waving and no calm, just relief when it was over and I was able to watch my peers presenting. Not sure I should be glad but, I could see I wasn’t the only anxious student in the room. Those following me muttered, mumbled, lacked eye contact, had hives creeping up from their chest and for some, their presentation wasn’t even relevant.

Note to self: “Today I will not stress over things I can’t control.”