Mental health patient dragged to the floor

I never expected to witness a mental health patient dragged to the floor

Mental Health patient being dragged to the floor
Mental Health patient being ‘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?

Police involved when mental health patients go AWOL
Police involved when mental health patients go AWOL

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

Patients often have to be returned to hospital by the police

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

Ciggies are currency on mental health wards

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

Rapid Response Team restraining

“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

Nurse administering antipsychotics
Nurse administering Haloperidol and Lorazepam – Photo from

“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

Patient with paranoid schizophrenia running from hospital
Patient with paranoid schizophrenia running from hospital

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.


(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.

Update – Poor standards at 28 mental health units

Neglect is one of the consequences of poor standards at 28 mental health units
Old mental health Asylum

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!


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.”


Mental Health Nurse training

Little white character of a man holding a large poster saying Staff training
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

What do you think about poor mental health standards?

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

Patients are more depressed because of poor mental health standards.
Mental health patients bedroom. Design Pics Inc/REX

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

Coloured image lady sitting at lap top and on the telephone
Nursing administration —Photo by

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

Poor standards in mental health causes incidents
Overdose of medication — mental health nursing

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?

Coloured image of black man sitting at his desk in front of a computer
Mental health nurse playing online games – Photo:

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).

Are modern matrons needed in mental health?

Why are modern matrons needed in mental health?

Psychiatrist wonders if modern matrons needed in mental health
PsycMental health nurse — Image from

Okay, so we’ve already looked at The ugly truth about mental health nurses here and The curse of ward managers here. Now let’s take a look at Modern Matrons needed in mental health. And do we actually need them? Like me, perhaps you’ve thought there must be alternatives to the way we work? And have you ever been frustrated or concerned that patient care is not as good as it should be? I know I was.

While I was working for the NHS on an acute inpatient mental health ward, we had 6-7 modern matrons (MM’s). Each one oversaw two wards. You read that right, two wards and two only managers to oversee! Upwards of 60k in London — that’s a dream role; one where you could literally sleep on the job.

The job spec for Modern Matrons might look something like this:

Colour image lady in black jacket and scarf covering most of her hair
Are modern matrons needed in mental health —Image by
  1. must have skills in leadership, clinical competence, and the mentoring and development of nursing staff.
  2. implement and maintain standards
  3. be able to identify needs and opportunities to further develop clinical practice according to the needs of patients.
  4. combine strong clinical credibility with the ability to inspire and influence change.
  5. will have direct operational and clinical responsibilities for two acute admission wards.
  6. will have overall responsibility for the management of resources within the area of responsibility.
  7. The Matron’s role is crucial in improving the quality of patient care. To do this through visible inclusive leadership and engagement with patients and families, frontline staff and senior management teams.

Now lets think about some of the above in more detail and see how it all works in practice:

Leadership, mentoring and developing nursing staff in mental health

Coloured image of ladies sitting round a table with laptops in front of them
Ward staff meeting meeting– – Sunsplash

Most of our MM’s either clean forgot or misunderstood the importance of these tasks. They never went further than the ward manager’s office and rarely spoke to nursing staff. Nor did they offer any input into communicating with, mentoring or developing any staff, other than their ward managers. But even then, as a ward manager, my MM didn’t have supervision with me, let alone mentoring or anything else in her job description.

What I did as ward manager initially was to check that all staff statutory and mandatory training was up to date. If not, staff were sent reminder to attend. Once everyone had updated this training, we identified what skills staff lacked and what skills were needed on the ward so we could organise relevant training courses to suit both ours and patient needs.

We organised a clinical supervision tree to ensure that each member of staff had a supervisor and would have supervision each month. Clinical supervision underpins the very essence of good care, and without it clinicians cannot develop their knowledge, skills and abilities, Nursing in Practice, 2013.

We also made a chart to show which specific skills staff had, and where they could use them to take the lead on various aspects of nursing care i.e. Fire Officer. This made it easier to identify areas that needed improvement or change and also gave staff the sense of responsibility and belonging.

Modern Matrons need to identify needs and opportunities to further develop clinical practice (for patients)

Because they didn’t engage with patients or nursing staff, our MM’s wouldn’t have known how to identify our patient needs, and were therefore unable to develop our clinical practice. Furthermore, they clearly lacked any skills and confidence to try different approaches to improving patient care. Seemingly, as long as they saw smiling patients on the wards, they were happy and their job was done.

What we did was to ensure the weekly team meeting actually happened and that all available staff attended. Staff were encouraged to speak out by asking questions of them i.e. “How do you feel about the new strategy to reduce our team from 2 to 1.5 on night shifts?” And, “What are the risks?” or “How can we implement the latest directives from the Audit Team?” Key points from discussions that followed would be documented in the minutes. These would then be copied to all ward staff, our manager, MM’s and Clinical Nurse Director (CND).

When the discussion around the risk of working with 1.5 nurses at night was raised, there were many hands in the air. So, we invited our MM, the Clinical Nurse Director (you might have read elsewhere on my blog, that we certainly weren’t bff’s). Staff asked had many questions but the last questions was “How long will this go on?” MM and CND shrugged their shoulders, “Who knows,” mumbled our CND. You can read about the near-death outcome of this action here.

We also held a patient and staff meeting 2-3 mornings a week, where everyone got a chance to discuss any concerns or say what was good about the ward. Again, this was minuted and sent to the same powers that be.

Possess clinical credibility with the ability to inspire and influence change

Modern Matron relaxing in work time

Clinical credibility, ha! Influence change; ha ha, rolling on the floor laughing. Our MM’s whole disposition was about control, knowing your place, keep smiling and don’t rock her boat. The only time we’d see her trying to influence change was if someone from PALS mentioned a patient’s dissatisfaction with the broken toilets.

She’d pull out some dog-eared policy on health and safety, trying to find a clause to suit her dilemma. After which, she’d draw up another useless appendix on who ought to report the broken toilets and how quickly they should be fixed. This was duly filed away for staff to read, well — never.

She’d obviously forgotten her time as a nurse, where you report the problem and wait for anything up to 7 days for the outsourced plumber to arrive. He’d take one look and shake his head, “Oooh, these cisterns are out of date now. I’m not sure what I can do.” And, pen behind his ear, off he shuffled back to his workshop for a nice cuppa.

What we did was ensure our patients knew about PALS; a place to discuss things like concerns about the ward, their care or leave status. We also had someone from PALS hold a morning clinic on the ward so even patients without leave could attend. Of course, (you getting the gist here?) this was all documented and minuted, to be shared in team meetings, where the minutes would be cc’d to our masters.

Modern Matrons need visible leadership in mental health

Black and white image of lady with long hair sitting at computer in an office with huge windows
Image by Andrew Neel @

Just for the record, all you current modern matrons, I don’t think that sitting in your office with the door shut makes you visible to anyone. And sitting at your computer looking at used cars and campervans is certainly not included in the job spec. Trust me, my modern matron, whose office I could see into through the one way mirror in my office, stared at her screen most days.

To my boss (MM): “Didn’t you realise I could see you? All that time, you always kept two screens up so you could shut one down if anyone came into your office. Me and our charge nurse often giggled, gobsmacked as you read The Sun online. Could you feel my envy whenever you surfed stunning holiday sites, knowing you could afford such luxuries on an NHS salary? And were you aware that I drooled over your ridiculously high heel, red soled, Louboutins plonked carelessly on your desk?”

Ooops, I digress, “Could you not sense my fatigue as you fell asleep rested in your big ergonomically designed office chair? Didn’t you think that I, or our nurses might need a break or a cuppa? Why did you just pop your head out of your door when there was an altercation on the ward? We could have done with another body helping at times, when we were restraining a patient. Perhaps your Whistles suit was too posh to adorn the grubby floor we all rolled around on?

What I did as a ward manager, was keep an open door policy, which meant anyone could drop in if they needed help or support. Moreover, I was able to see what was happening on our ward, pre-empt any patient disagreements and de-escalate potential risk.

Fortunately for me, I was a Human Resources Manager prior to nursing, so it didn’t take long to get through admin and paperwork side of my job. This left quality time to spend with staff and patients, where I could anticipate and address specific problems. These were always my favourite times, chatting socially with patients and engaging with their families outside of those pesky wardrounds.

Change and improvement

Are modern matrons needed in mental health?
Patients and staff meeting — Image from

That change needs to come from our MM’s, who would normally have the skills, knowledge, tools and confidence to lead and effect change. Our MM’s ought to understand the need for and how trying different approaches can make practical improvements for patients and ward staff.

However, that change and improvement doesn’t always have to come from the top down. It also needs to come from the shop floor, up, where patients and frontline staff know exactly what’s required to improve care, and can take the necessary action, however small.

Improvement and change is all about continually working together; nursing staff and multi-disciplinary teams together with patients and their families. Talking, questioning and sharing ideas is the best way to make changes and improve the health and social care we offer to patients.

What we also did was to ensure all ideas and concerns were documented. Minutes of all meetings were delivered to all ward staff, the manager, MM and the CND. That way, nobody had any excuse whatsoever to say, “I didn’t know,” or “I wasn’t aware staff felt they were at risk,” and “Are you sure you told me?”

As a team, I think we always went over and above what was expected of us. And where someone; patient, carer or staff, was able to effect change, they got the credit for it, which was as always, documented. No sneaky manager or MM got to steal that well-deserved credit.

Over to you

What do you think?

Do you think we need modern matrons in mental health? Did tales of our MM’s remind you of your bosses in some way? Of course my lovely readers, you might have other ideas of what we could have done differently? So, as always I look forward to your comments and any questions.

Related: Measuring the impact of modern matrons in the ward setting (1)

The ugly truths about mental health nurses

Shocking ugly truths about our Mental Health Nurses

Coloured image of the Nursing & midwifery Council's The Code
Ugly truths about our mental health
nurses who neither meet nor maintain
expected standards

I discovered many shocking ugly truths about some of our mental health nurses. What was more appalling however, was the response (or lack of) of their managers and modern matrons. I wasn’t a patient. I was a nurse, and a ward manager.

Have you ever been an inpatient on a mental health ward? Have you come across washed out nurses who’ve either lost the ability to care, or they never cared in the first place?

Our Nursing and Midwifery Council’s (NMC) The Code (2018) contains the professional standards that registered nurses must uphold. This is a nurse’s bible, whatever your faith or religion, and all standards ought to be reached by the end of your three years pre-reg training. Moreover, you should be committed to upholding these standards throughout your nursing career. Essentially, through revalidation, nurses provide evidence of their continued ability to practice safely and effectively.

“The Code provides a clear, consistent and positive message to patients, service users and colleagues about what they can expect of those who provide nursing care.”

NMC, 2018

Who oversees our mental health nursing standards?

Black and white image of man with hands on a wall, head down
A patient experiencing mental illness
ugly truths about our Mental Health Nurses

Now, I’m not sure the above-mentioned patients and service users ever get to see this Code; it’s not given to them on admission. Therefore, I don’t believe they know what to expect.

Okay, imagine for a second that they’ve seen The Code and the standards of care they’d received don’t match up.

Do you think patients are in any fit state to ensure nursing staff uphold these standards? No? Me neither and I think it’s up to the profession itself to effect, maintain and monitor these standards.

Our inpatients suffer from a wide range of mental illnesses including bipolar, schizophrenia, personality disorders, anxiety, and depression So while I agree that patients ought to be able to expect certain standards, they’re often too unwell to notice or they might be confused or drowsy due to the effects of medication.

Many inpatients are on a section of the Mental Health Act (MHA 1983); a law that requires patients to remain on the ward for assessment and, depending on which Section they are on, for treatment. However, some patients are informal, which means they gave consent for admission and can come and go as they please.

Nurses could be doing more

As a new nurse, I was excited and couldn’t wait to work with patients while upholding the standards, and expected the same from my colleagues. Patient care and safety were, as expected, my (our) main concern. It was up to me (us) to ensure patients’ needs were recognised and assessed. However, how can patient needs be recognised if staff don’t actually spend any time with them?

While well aware that our wards were often oversubscribed and our patients could be chaotic, it p’d me off seeing how little time some nurses spent with their allocated patients. Moreover, their half-hearted attempts at engaging with patients were sadly reduced to the odd casual nod or fake smiles.

It wound me up no end when I shared my concerns with my managers and all they’d say was “Oh, that’s just how they are.” Or “Don’t report it, you’ll just cause problems for yourself.”

No wiggle room to meet everyone’s every need

Coloured image of lady in jeans and blue jumper taking notes. Female with pae trousers sitting with her hands on her lap
Mental health nurses — Image from

Each shift on the wards, we’d be allocated five patients to look after, on top of which, one nurse would coordinate that shift. One nurse might be in Ward Round and one nursing assistant (NA) would hold the Rapid Response radio (attending to crises elsewhere). The fourth member of staff, an NA, would be on the floor, and completing the hourly checks (ensuring patients are safe).

This didn’t make it easy for nursing staff to spend long periods of time with their patients. However, we were fortunate when we had good kind, caring, and interested nursing students to help out.

Students had the time to spend chatting with patients and feeding back to nursing staff. Or they’d help coordinate the shift, releasing the coordinating nurse to spend time with their patients. Students would be answering telephones and constantly unlocking the door to let people in or out of the ward. Patients loved having good students on the ward because they usually had the time to chat.

Nurses could work smarter

Staff ought to have allocated tasks to students which would then free them up. They could have used that time to spend with a patient and to document more than a line or two in their notes.

Still, even with time to spare, we’d see staff flicking through patients’ magazines or settling themself in front of the t.v. Then you’d see a one-line entry in patients’ notes saying “Mary had a quiet day. Stayed in her room throughout the shift.” Did this nurse actually speak to Mary? Had they asked if she wanted breakfast or lunch? Did they ask Mary how she felt or whether she needed any support? Who knows because, if it’s not documented, it didn’t happen. So — not only did they not speak to that patient, they obviously didn’t give any care either.

Not every day you get to see such sights

Coloured image of lady at her computer
Ugly truth about mental health
nurses — planning holidays

I think because I was older than your average new nurse, I got away with tongue-in-cheek remarks directed at lazy staff. “Are you on shift today Monica?” when caught organising her whole year’s holidays on the only nurse computer we had.

“There’s beds to be changed if you’re bored Ade?” I’d say with a grin. That got them off their backsides, and their tutting or heavy sighing never deterred me. “……..and Sidney needs support with his toileting when you’re done,” I’d smile.

Harsh? Maybe, but like I said to my colleagues, if I’m cleaning up sh*t, so are you! I wouldn’t expect staff to do anything I’m not prepared to do myself.

So, to the nurse who said of a patient who’d spent her night rolling around in her own excrement, “No, she did not do it deliberately.”

And nor did she do it, “just to get attention and pee us off?” Duh! Evie had faeces up her nose, in her ears, dangling from her eyelashes, and under her nails. Safe to say, she was covered poo, but I’m certain she would have been horrified to know she’d been rolling around in her own mess all night. The poor girl didn’t know who or where she was.

Yes, I also gagged at the smell as I donned my gloves and tied plastic bags over my feet before rolling Evie onto a sheet so that we could pull her out of the bedroom, and into the shower room as there was no other way. My back also ached but I didn’t make it obvious by heaving, huffing, and puffing dramatically in her face every five seconds.

As for managers

And to our manager “Nice of you to retch theatrically then walk on by when you came in late (again) that morning.” Ha! Now that’s another post — what’s the point of ward managers?

Over to you

Large red question mark with little white character leaning against it - pondering

As a new nurse, what would you have said or done? Would you feel able to call out your colleagues? What might a new nurse learn from this post? I look forward to hearing what you think and any questions are welcome.

This is a true account from my perspective and all names have been changed to protect the lardy-arsed staff and save them from any embarrassment.


 “If you’re looking for a hard-hitting evaluation of the mental health profession with a sharp wit, please stop by Caz’ blog. She writes pieces revealing the challenges and problems in mental hospitals from first-hand experience as well as examining different mental health diagnoses and taking on the myths around them. Not the kind of myths I cover, the kind that hurt. Thank you, Caz. You are an amazing, courageous person.”

Kindly written by Ceridwen at Illuminating the fools mirror, 2020.

Should we use restraint on mental health wards?

What would you think if you were visiting a family member or friend on a mental health ward and you saw someone being physically restrained?

Latest guidance from the Department of Health (DH)

Positive and Proactive Care places an increasing focus on the use of preventive approaches and de-escalation for managing behaviour that services may find challenging. All restrictive interventions should be for the shortest time possible and use the least restrictive means to meet the immediate need based on the fundamental principles in Positive and Proactive Care.

Nursing staff should act within the principles set out in Positive and Proactive Care, and use all restrictive interventions in line with the MHA Code of Practice 2015, Mental Capacity Act 2005, Human Rights Act 1998 and the common law.

What is restraint

Restraint is used by trained healthcare staff to stop or limit a patient’s movement. Restraint may be used without the patient’s consent.

Restraint might be needed if a patient is violent or agitated – so that he doesn’t harm himself or others.

Three types of restraint

  • Physical restraint limits specific parts of the patient’s body, such as arms, legs. or head.
  • Chemical restraint is medicines used to quickly sedate a violent patient. This might be given as oral medication (a tablet) or intramuscular (an injection).
  • Seclusion is placing the patient in a room by himself. The room is locked and kept free of items that could cause injury. The walls are padded and there is normally a large rubber bed to reduce risk of harm to the patient. A member of the team will watch him at all times when he is in seclusion.

Control and Restraint training (C&R)

Seated restraint –

As mental health nurses and nursing assistants, we have a full week (9-5pm) of Control and Restraint (C&R) training and let me tell you, it’s exhausting – when you’re only 5′ 4″ and you’re trying to restrain your 6′ 6″ colleague. As well as our mental health nurse training, we are taught de-escalation skills during C&R. You always attempt de-escalation techniques first. You might offer the patient some oral medication to reduce his/her agitation, to stop the violence, stop the voices, bring them down from an extreme high or calm them down enough to speak to them clearly and rationally etc.


While working in any specific area, nurses ought to be visible and taking in what’s going on around the ward, the bathrooms and bedrooms. They should be discreetly observing patients, mindful of any signs of agitation or conflict between patients. It’s always much easier to verbally de-escalate if you intervene quickly; either distract the patients, possibly asking one to move away from the area. Your colleagues should be made aware of possible escalation so that they can help and support you if necessary. Humour is quite useful sometimes – I used to tell the big lads “If you were one of my boys, you’d get my wee size three’s up your backside,” and they’d laugh.

If an incident starts to escalate out of control, someone calls Rapid Response (RRT) to the ward and a team of 7-8 members of staff (one from each ward, and normally men?) will come running. There will a Lead RRT member who ought to take control by first finding out who or what the problem is, if it’s not already visible i.e. two patients fighting.


The RRT will be in the nursing office deciding the plan of action. First might be just to speak to the patient(s) involved. I can understand how the patient might ‘give in easily’ when they see such a big team of people, practically surrounding them, and comply with what’s asked of them i.e. accept some oral medication.

Sometimes a male patient sees this big team as a threat and might challenge them – some male patients have said “I know I can’t get them all, but I’ll effin’ hurt one of them.”

Jason was admitted as a voluntary patient

I was manager on Lilly Ward, a mixed sex acute in-patient ward and a tall and handsome young lad was admitted informally late one afternoon. He came up to the ward with his dad, a Rastafarian who told me that Jason had been smoking cannabis and he’d been hearing voices for a few weeks. “I take the stuff myself. I know the weed. But no. Its no good for him. I don’t want to leave him here but I want him to learn. Its bad, smoking all the days with his new friends.” I told dad to go, Jason would be fine with me.

I took Jason into the nursing office to explain his admission was voluntary and that he would be under observation for a few days to see what’s happening for him. He said he hadn’t slept for three days as the voices wouldn’t let him. The voiced scared him and I could see he was hallucinating as we were speaking. I asked whether he wanted some medication to help him sleep which he declined. As we chatted, I learned that he had a close family who he loved dearly and his mum was his hero. “You’re a bit like her you know. Calm and friendly and smiling. Just like my mum.” He said shyly, which endeared him to me.

I could see the panic rising in Jason and as I’d already explained to him, I’d hate to see him ending up a Section of the Mental Health Act but if he was unwilling to comply, this is what would happen. I’d seen so many young lads come through the system saying that all their friends smoked cannabis and it did them no harm. However, it was my job to explain that while cannabis doesn’t cause Schizophrenia, if you are already vulnerable to mental health problems, the cannabis might trigger it.

By now he was losing focus and I knew he needed medication. Offering oral meds first and an explanation of what they do may help a patient feel more in control of the situation, but I’d tried for over an hour with Jason. I’d also explained that if wouldn’t accept it, we’d have no choice but to give him medication by injection. He was becoming increasingly agitated, banging his head on the wall, and my colleagues were becoming concerned that I was cornered in the office. I wasn’t worried for myself at that point, I felt sure that, following our lengthy discussion, he wouldn’t harm me.

Rapid Response Team to Lilly Ward, please

The noise of his head cracking the wall was unbearable and RRT were called as this boy was going to really hurt himself. Jason saw them running in and jumped to his feet. I told him needed to leave the office as the Team would be coming in, so he let me past. As soon as I’d left the office three of the Team went in to restrain Jason. It was awful because it was such a tiny space and as they all went down to the floor, I could hear Jason calling out for me, crying and apologising. I was distraught for him, but I still had to get the medication drawn up quickly and to inject Jason, for his own safety. He was given 2 mg Lorazepam which has a sedative effect and 5 mg Haloperidol, an antipsychotic.

Once the medication took effect, after a couple of minutes, the Team helped Jason up and walked him to his bedroom, where he’d sleep for some hours. The Team met to debrief, to ensure nobody was injured and to discuss whether there was anything we could have done differently. We believed we had done the right things and that there was no need for seclusion on this occasion. The ward Doctor placed Jason on Section 2 of the MHA (1983) which meant he would detained for up to twenty eight days and could be treated without his agreement.

Face down restraint –

To restrain someone, you would initially use three members of the Team; one to take each arm and one to direct the patient’s head. If the patient cannot be held like this, the next step would be to go down to your knees then onto the floor where two other Team members would hold the legs. The patient’s safety is always uppermost in your mind. Really and truthfully, if anyone gets hurt during a restraint, it’s generally staff as your knees and elbows hit the floor.

Risks of restraint

There are risks, of course. Patients often struggle against physical restraint, which could cause skin wounds or block the blood flow. It can also increase the patient’s heart rate and breathing rate which again, can be life-threatening. Medication could cause low blood pressure, shallow breathing or heart rhythm problems. Some antipsychotics can also cause side effects like stiffness and shakiness, restlessness (akathisia), movements of the jaw, lips and tongue (tardive dyskinesia), slowness and sleepiness.

Nursing staff have to regularly assess for side effects as well as:

  • vital signs, such as heart rate, breathing rate, and blood pressure
  • patient’s physical comfort
  • patient’s skin for injury
  • monitor patient’s behavior
  • allow the patient to leave seclusion (if used) as soon as he is calm and cooperative

All necessary paperwork and an incident form must be completed and a care plan put in place.

It’s good practice if the nursing team on the ward go round checking on other patients to see how they are if they’d witnessed the restraint. It can be really frightening and assurances might need to be given.

Mental Health Act (1983)

More often than not, the patient will feel quiet groggy when they wake but will still feel a little calmer. The nursing team will then try to engage the patient and let them know of their Rights under the MHA (1983), letting them know they can appeal against this Section and give them the appropriate paperwork to do so.

Patients would frequently be brought into A&E on Section 136 of the MHA (1983) by the police and RRT would be called to assist if the patient was violent or agitated. This means a restraint may have to take place there instead of on the ward and the patient would then, once sedated, be moved to Seclusion for a period of time.

Most nurses don’t like having to restrain patients – male or female. Just think how a patient who’s been physically or sexually assaulted in the past must feel. They’re already confused, distressed, experiencing delusions or hallucinations or mania then they’re being restrained, having their underwear pulled down and having injections forced upon them.

There have been some unusual restraint situations too. When the RRT arrived at the dining area on our ward, the patient was standing on a table, naked and masturbating. Another young man knew that RRT were on their way to see him, he ran to the bathroom, got naked and smothered himself in shampoo so that the Team wouldn’t be able to get hold of him.

The restraint I hated most, was when we had to get a baby from his mother’s arms; she was psychotic and at risk of hurting her child. I’ll never forget her blood curdling screams as we took the baby away from her.

I always found the females the most difficult to restrain. With the men, you know they’ll punch, kick or headbut, but the women – they’ll do that and kick, scratch, nip, pull hair, spit and bite…… Thankfully, I didn’t have to do many.

Do you think patients should be restrained? Or is there another way?

Why do you blog?

It’s yet another dull day in London but I have a lot to be happy about. I have an amazing partner who’s really looked after me since I was disabled by Transverse Myelitis in 2011. I’m grateful I have an amazing close-knit family and I will be going up to Scotland in November for a niece’s wedding where I’ll get to see everyone. I am delighted with my two amazing sons; one (Ricci) is currently a Research Fellow in the States and the other (Ravi) is a Physiotherapist in London.

Today I’m going to meet Ravi and his new wife for afternoon tea and I’m so excited. I haven’t seen them together since their wedding and they’re going to bring some wedding photos for me to look through.

I’ve been up for an hour now and have been going through my posts’ comments and tried to answer everyone. Somewhere along the way I’ve picked up great blog: Crushed Caramel where she’d answered an interesting set of questions posted by another blogger: Salted Caramel so I thought I’d have a go too.

Do you blog to promote your business?

No. I became disabled and regretfully medically retired from my job as a Mental Health Nurse/Ward Manager, a job I truly loved. I also had to cease running my small business where I worked as and supplied Mental Health First Aid instructors to a variety of organisations. We taught MHFA to a wide range of companies, schools and Armed Forces. I was there at the inception of MHFA England and would love to be able to carry out more training in order to raise aware of mental health issues.

Or is your blog a launching pad for your social life?

What social life? Okay, so I’m exaggerating a little ‘cos I’ve already told you I’m off out this afternoon. We went to see our grandchildren on Thursday and got to stay the night. It was sooo much fun playing games like hide and seek, where when you’re looking for a two year old an you utter to yourself “Now, where’s that Ava?” and she shouts “I’m here.” and her four year old big brother shouts crossly “Aaaava! You’re not supposed to tell her! You’ve spoiled the game now!” and off he stomps, sulking and trying not to laugh when I pretend trip and fall onto the sofa “Ouch, Ouch!”

We’re going back there this Sunday and I’m cooking stew and dumplings (a nod to my Scottish heritage) for everyone together with my brother-in-law and his girlfriends. So far my social life’s been all family but hopefully next week I’ll be able to catch up with a few friends.

Does it exist only to complement your Instagram account?

No. I’ve never had an Instagram account. I’m a complete technophobe and not very computer literate, despite having typed and used computers since the seventies. Oops, just given away my approximate age 😉 When my energy levels reach rock bottom, I sometimes find it hard enough responding to my blog comments, Twitter and my emails, let alone having another account such as Instagram. However, I love picking up my laptop and catching up with everyone’s news – it’s my little window on the world.

Is your blog making you real money (if so please let me into your secret)?

No. Unfortunately not and it never will really. I don’t intend to monetize my blog and only set it up because I wanted to make use of my fifteen years of diaries, kept from when I was nursing. Reading through them reminds me of all the good times I had, the amazing inspiring people I met; both patients and colleagues. However, I was also reminded of the poor standards of practice and that’s really what I wanted to highlight in my blog.

I want people (nursing students, nurses, doctors, social workers, occupational therapists, community psychiatric nurses, the public, MP’s, the government, patients, carers or friends) to be informed and make the necessary changes. Tell your care team you are not happy with the standards of care. Tell your boss,manager, team that standards must be raised. I want Doctors and nurses to continue with their professional development and stay up-to-date with current practices. Ooops! Rant over.

Are you blogging because you are so adept at this craft that you want to teach it to others?

No. I wish I was smart enough tho’. I loved teaching and mental health is my niche, so I’ll stick to it. I can offer lots of information, not unsolicited advice, and point people in the right direction if they are seeking support but I can’t profess to being a teacher or instructor any more.

Or are you like me : blogging just due to the urge to write?

Yes. I’m like you. Yay, we have this one in common. I love reading and also enjoy writing; releasing the pent up frustration that’s been raging inside me for so many years. As a mental health nurse I was used to writing ‘in and on reflection’, hence the lengthy notes in my old work diaries.

As I’m disabled I often have time on my hands and can’t believe how many hours I used to spend on social media i.e. Twitter and Facebook, just to see if anyone had messaged me or liked my comments. Now I’m blogging, the likes, the helpful comments and advice I get is both helpful and constructive. I only started blogging a few months ago and I’ve not even finished with my first work diary yet – so looks like I’ll be here for a few more years.

What are your reasons why you put the proverbial blood sweat tears into your blog posts?

I want people to be aware of the poor standards of practice in mental health units. I want everyone to shout it from the rooftops or from the highest mountain whenever they come across poor practice in mental health nursing and care environments. I want to increase awareness of diagnosis (right or wrong sometimes) the signs, symptoms, causes and effects of mental health disorders. And I want to reduce the stigma. I know I can’t change the world on my own but if my little blog is of use to one person and they have the confidence to speak out, it’s a start.

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