I never expected to witness a mental health patient dragged to the floor
What I didn’t expect to see within my first couple of days, was a mental health patient dragged to the floor. I was on my first mental health placement and had just returned from a short coffee break. Derry had given me a bunch of keys and a swipe card, so I let myself in.
Derry, being the nurse in charge, had gone into what’s called Management Round. I learned that this happens each Monday morning. Apparently, this is where the Doctors plan their weekly ward round allocation; picking which patients to see.
Warning: foul language ahead
An angry sister startled me
The phone was ringing off the hook and there was no one else around to answer it. I picked it up and sang ‘Good morning, Lavender ….’ A female interrupted and spoke urgently “Why is my brother off the ward? He’s banging on my front door and all the bloody neighbours are out on their doorsteps. Jesus Christ! What’s going on?”
“Uumm, good morning. I’m a student nurse. Do you know who you want to speak to, which nurse?”
“Someone who knows what they’re fucking doing would be good.”
“Erm, Ok, what’s your name and your brother’s name …..” I stuttered.
“It’s Pauline Kennedy calling, and my fucking dick of a brother is John. John Kennedy. You know he’s on Section, right? He’s screaming through the letterbox now, can you hear him? Fucking arse”
Ouch! “Okay Pauline, hold on a second.”
“Not you, him, I’m sorry.”
“Ok, Pauline, give me a second, would you like to hold on or shall I call you back?”
“No, I’ll hold…” she tutted.
Have you called the police?
I dashed up the corridor, knocked the door to the meeting room and popped my head in to tell Derry and the Doctors. “For fuck sake.” Derry’s Irish brogue rang out and “Has she called the police?” enquired one Doctor, the elder out of two. But Derry was out the door, heading for the office and I followed.
“How’d he get out?” Derry muttered to no one in particular. “Hello Pauline, it’s Derry here. Is he still there? Have you called the police? Derry’s nodding at me, indicating that John is there. “Aye, I know but okay, I’ll do that,” he continued, “You just keep yourself safe and I’ll call you back in a wee minute.”
“Here, you call the police on this number and let them know what’s going on.” Derry pointed to a page in Johns file, “Pauline’s address is there,” he urged. Alison had just come into the office and I could hear Derry filling her in while I spoke with the police. I was a bit nervous, but I was able to give them all the necessary details.
Paranoid and can be dangerous
“Jesus, we’re in trouble now,” said Gerry. “This guy used to live with his sister and he’s paranoid about men wanting her, that they want to have sex with her. He’s already done time for smashing the electricity man in the face with a brick after the poor man went to check the meter. John’s on a Restriction Order (1) so he is.”
The two doctors; the Consultant Psychiatrist and an SHO (2) appeared at the office door. “Everything alright Derry, Nancy? Oh, hello Nancy. Sorry, I’m Doctor Shand and this is Doctor Wiles. Do we know what’s happening?” He smiled, “Let me know when he’s back on the ward please,” and left.
Derry winked and gave me the thumbs up while he was on the other line to Pauline, letting her know the police were on their way. At the same time, she’d told Derry that John was quietening down a bit.
“Good job there Nancy. Will you just write in his notes; what happened?” Derry asked.
Police and rapid response team
It wasn’t long before the ward door opened and I could see John being led in by the police and half a dozen people who, it turns out, are part of the Hospital Rapid Response Team (RRT), called to assist in emergencies like this. John shuffled in, head down, looking shame-faced, and went off to the day area. One police officer spent a moment with Derry then led his team away.
RRT’s are made up of six-seven people, one member of staff from each ward who were mainly men. They responded when a bleep and the radio sounded, telling them where to go. When the police arrived with John, the RRT met them at the hospital entrance, to help escort him back to the ward.
Fags were the currency of the day
John was still raging, but the police had done their job so they left. The RRT followed Derry into the tiny office and waited for instructions. John marched towards the smoking room, muttering under his breath, and almost took the door off its hinges when he slammed it. I followed John and offered him a cigarette. This was the currency used if you wanted to engage certain patients. And this time was no exception.
However, I felt decidedly uncomfortable, sitting between John and another patient, who’d introduced himself as James before asking for a ciggie. John muttered that he wanted to kill someone and James bounced back and forth in his chair, fists balled tight.
I wondered how I could finish my freshly lit ciggie and make my exit back to the relative safety of the kitchen without bringing attention to myself. Just at that, the door opened and Derry said “Come on John, you need to take your meds.”
Rolling around in the the fag ends
“Nope!” John spat back at him. The Rapid Response Team (RRT) had been waiting and burst in before hurling themselves at him. They grabbed him by his elbows and wrists, pulling him up out of the chair, and on an authoritative command “Down!” he was on the floor. Three RRT members were down there with him, and another two soon followed. They dived to the floor to hold onto John’s legs, in an attempt to stop him flailing around and getting hurt.
John was yelling “Fucking bastards. You fucking wait.” and struggling among the fag butts and drink slops, battling against team holding on to him. There was now one on each arm and leg, and one at his head. The lad at his head was calmly telling John what was going to happen, tho I’m guessing he already knew the ‘drill’.
John struggled to spit further obscenities out, because his mouth was dry now. The young lad at his head continued calmy, “John, it’s for your own good. Stay still and it will all be over.”
This might hurt
“That’s it John, your okay. Ssshhh. You’re safe.” At that, Alison came in holding a small cardboard tray that held two half-filled syringes. She yanked John’s belt off and pulled both his jeans and pants down, leaving his right bum cheek exposed.
Alison swabbed an area of John’s right buttock, and squeezed it. “A sharp pinch John,” she calmly popped one needle in, followed by another.
I would later learn that the intramuscular injections they’d administered was what nurses called ten and two. This meant ten mg Haloperidol, and two mg Lorazepam which, used together, creates quick sedation. This combination is normally used to manage acutely disturbed patients. However, if a patient is unknown to the hospital, or if it’s a smaller person i.e. a female, they’d be given a smaller dose i.e. 5 mg of Haloperidol and 1 mg of Lorazepam.
Post incident debrief
RRT held onto John for a few minutes, and he eventually stopped struggling. The medication was taking effect. Derry said “You good John? Come on now. We’ll let you up, easy now.” They helped him to his feet and left the smoking room, one by one. “Into the office boys and girls,” Derry continued, as if nothing had happened, “let’s debrief.”
Nobody was taking responsibility for letting John out. He didn’t leave with me, I knew that, as I’d only been given the keys prior to my ciggie break. However, I was getting knowing glances from everyone in the office. Still, the team agreed that the Control and Restraint (C&R) had gone well and no one got hurt, so the RRT left the ward.
Derry and Alison were both busy documenting the incident in various forms. I offered to help, so they gave me an incident form to complete. They said that John had missed his morning medication, which included ten milligrams (mg) of Diazepam. This has a sedative effect, hence John’s paranoia and visit to his sister’s.
Alison held her hands up as she’d done medication that morning and she’d missed John. She insisted I document this on the incident form but I’d already finished it. “John was seen leaving the hospital at 08.10. just as medication was being administered. Therefore John missed morning medication.” I’d already been down to reception and seen the CCTV footage of John running out the front door.
“Well done Nancy. You checked that yourself, did ye?” I grinned from ear to ear when Derry half-joked “You’ve got the job.”
Over to you
What do you think about mental health patients being restrained? Perhaps you’ve had this happen to you? I look forward to your comments, constructive criticism and any question.
(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.