Tag: Mental Health

Why men won’t discuss their mental health

9+ reasons why men won’t discuss their mental health:

Grey scale image of man standing close to the edge of a cliff, contemplating suicide.
Man contemplating suicide — alamy.com

I’ve chosen to post this article Learn why men won’t discuss their mental health for a close family member. He lives with bipolar disorder and it breaks my heart seeing him struggle.

The Priory (A Private Care Group 2015) commissioned a survey in 2015 to uncover men’s attitudes to their own mental health. It concluded that 40% of men won’t talk to anyone about their mental health. Some of the reasons given were:

  1. Some say they just deal with it, or they’ve learnt how to ignore it
  2. Many would say they’re too embarrassed to admit to it
  3. They’re afraid of the stigma
  4. They don’t want to burden anyone i.e. wife, partner, best friend
  5. Some don’t want to admit they need support or don’t want to come across as weak and
  6. some say they don’t have anyone to talk to
  7. They don’t feel comfortable even talking to their GP, worried they’re wasting their Doctors’ time
  8. Afraid if they mention it, they’ll lose their job or their partner
  9. Worry that by displaying their vulnerability, they’ll lose the respect of others.

Mental illness is ‘living hell’

Grey scale image of a young man struggling with emotional imbalance.
Man who can’t talk about his mental health – Image by
Talkspace.com

Mental illness is at best, very unpleasant and at worst, it’s absolute hell. In the western world, it’s a major reason for people having to take time off work. Yet many men still don’t like to admit to their bosses that they’re stressed or that they have a mental illness, they’d rather invent some other excuse.

As a mental health nurse, I had the honour of working with hundreds of strong and amazing men. Each had their own humbling story about how they got to where they were, and I shed tears on more than one occasion. However, despite all the care and support in the world, some patients just couldn’t hold on — I know of many male suicides, and it never got any easier to hear.

Fact — There were 6,507 suicides registered in the UK in 2018, according to the Office for National Statistics (ONS). Three-quarters of these deaths (4,903) were among men.

Men’s inability to discuss their mental health

Grey scale image of man holding onto a noose hanging from above
Shadow of sad man hanging – Image by istockphoto.com

Does it come down to the way men were brought up and the messages they learned at home or in the playground? “Don’t be such a cissy” or “You big girl’s blouse”. These are dated and dysfunctional responses to little boys and we have much to do to change all this.

Men need to understand that mental illness isn’t shameful or a sign of weakness. It’s a real and common medical issue, and everyone who suffers deserves help.

Sometimes men cover thing up by using subtle language like they’re down the pub with a pal and say “Oh, you know what it’s like, sometimes you just want to be on your own” instead of “I feel really down, can I talk to you?” Perhaps they snap at their partner “You wouldn’t know how damn hard my job is” when maybe they mean “I feel like I’m being picked on at work, can we chat about it?“

Furthermore, tho’ more women are diagnosed with mental health problems, men are less likely to seek help. They’re also more likely to commit suicide, mainly before the age of 50. Because men don’t like to admit to having a mental illness, they’re not accessing mental health services, and so — they go undiagnosed and untreated.

Some symptoms you might notice

Mental health signs and symptoms can vary, depending on the diagnosis, and can affect your thoughts, feelings and behaviors. Being able to recognize and accept the signs that you or someone you know might have a mental health disorder is the first step. Symptoms might include:

Grey scale image of man's face, tears running down. Men's mental health matters!
Sad and crying – Image by
pixabay.com
  1. Extreme mood changes of highs and lows — different from your ‘normal’ mental state and for more than two weeks
  2. Hopelessness, or anhedonia (a loss of pleasure from things that used to provide enjoyment)
  3. Confused thinking, unable to make simple decisions and reduced ability to concentrate
  4. Significant low energy, tiredness, or problems sleeping, constantly waking up early i.e. 3-4 a.m.
  5. Constant restlessness, can’t sit still, fidgeting
  6. Detachment from reality (delusions), paranoia or hallucinations (hearing voices or seeing things that other people can’t see).
  7. Excessive fears or worries, or extreme feelings of guilt/shame
  8. Unable to understand and relate to situations and to people – might come across as confused when they try to interact
  9. Inability to cope with activities of daily living i.e. not eating or drinking (non-alcoholic) enough and inability to tend self-care
  10. Displaying excessive hostility, anger, or violence — masking underlying physical or mental disorders
  11. Changes in alcohol or drug intake — they could be self-medicating
  12. Withdrawal from friends and activities
  13. Major changes in sex drive
  14. Suicidal thoughts and ideation

While lots of people have some of these symptoms some of the time, it’s very different to mental health symptoms. With depression for example, your GP would expect you to have a cluster of symptoms, all at the same time and for more than 2 weeks.

How to help a man experiencing mental illness

Are you or someone you know experiencing mental illness? Are you having suicidal thoughts? Would you know what to do?

This man, like many other, needs mental help.
Lone man – Is he suicidal? -Image Pexel.com
  1. You can be there for them, just listening and I know this is hard but — don’t interrupt, listen actively (for more on listening skills see here).
  2. Tell them they will get through this, they will stay safe and these thoughts will pass.
  3. Ask if they’re having suicidal thoughts and if so, do they have any intent i.e. do they have a plan and the means — if they do, you need to call their GP or other professional. *Asking if someone is suicidal will not make them go and do it! And stay with them ’til help arrives
  4. Do not give advice if you’re not a trained mental health professional, you might give the wrong advice. Instead, offer information and signpost them or take them to the appropriate services.
  5. Try not to ask them why they feel depressed/anxious/suicidal — it’s not helpful right now and all you’ll likely get is a list of reasons — think on, what would you do with all this?
  6. Try not to offer platitudes, rather reflect, paraphrase, summarize. You’ll get more if you ask open-ended rather than closed (yes or no) questions. And don’t be scared about silences or filling the gaps.
  7. Let them know they’re not a burden and tell them that you’ll get through this together but — don’t make promises you can’t keep, if you let them down, that might make them feel worse.
  8. Tell them they’re not alone; many others experience mental illness and lead fulfilling lives — they have good jobs and are contributing towards society, they’re married or dating, they have good social lives and they’re able to carry out their activities of daily living.

What more can you do?

  1. Explain that some mental illnesses are a result of chemical changes in the brain — it’s not about being weak and failing — at times we live in a hostile, stressful, demanding and right now, a scary world.
  2. Some symptoms of a mental illness mimic physical illnesses at times, such as headaches, general aches and pains so they must see a GP to see if there’s any underlying physical problems that need treatment.
  3. You can’t force someone to access professional care, but you can support them in making an appointment with a mental health professional and you can offer to go with them?
  4. If someone has self-harmed or is considering doing so, take the person to the hospital or call for emergency help.
  5. Don’t make throw away statement such as “You can’t be depressed, you’ve got a nice car, a big house etc.” If a man says he’s feeling anxious or depressed — trust me, he is!
  6. If you think someone is showing signs of psychosis and they’re paranoid, try to remain calm, give them reassurances that they’re safe with you and that no harm will come to them — stay with them — only if it’s safe to do so! Otherwise, be aware, stay safe and call for emergency help immediately.

So how can we reduce this gap and improve men’s mental health?

We should be able to openly discuss men's mental health.
Little boys and girls need education
– Image by Pexels.com

Hugh Martin, founder of counselling service Man Enough, says the first step is to encourage conversations within organisations – such as sporting clubs, groups and workplaces – making space available for men to talk about how they’re going.

More than that; we need to be teaching our children about men’s mental health, emotions and how to manage or cope with them.

Let little boys know it’s okay to cry if they’re hurt or sad. Show them pictures of different faces, showing anger, smiles, laughing, shy, happy and sad – get them to point to a face that will explain how they’re feeling right now. Never tell them “big boy’s don’t cry.”

What do you think?
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Would you be able to help a man who’s experiencing mental health problems? What’s your experience of men and their emotional difficulties? I’d love to hear your comments and I’m happy to answer any questions.

You may find the following articles useful:

  • Anxiety in men
  • Reading a previous post 19 free mental health apps just for you here
  • Or Tips to help with your anxiety and panic attacks here
  • Attending a self-help course in person or online
  • There’s A powerful new mental health book featuring personal experiences from men and their partners urges men to open up – not ‘man up’. Big Boys Don’t Cry? contains 60 individual anecdotes from men working in a diverse range of careers from lawyers, postmen and soldiers to construction workers, Big Issue sellers and elite sports stars.

Related: Men’s mental health Monday. The science behind serotonin, dopamine, oxytocin and endorphins (1). 76% of suicides are committed by men (2). Men and mental health (3).

Why self-confidence is important?

Is it the same as self-esteem?

Difference between self-esteem and self-confidence
Difference between self-esteem and self-confidence — Image iStock

We’ve already looked at self-esteem and how to improve it. So, now for self-confidence. But — before we go any further, let’s just clear something up………..

Both terms are often used interchangeably when referring to how we feel about ourselves. While they’re very similar, there are many differences too. It’s important to understand both their roles when we’re looking to improve our overall sense of self.

Self-esteem is how we value and see ourselves. It’s based on our opinions and beliefs we have about ourselves. It starts to form in childhood, by our experiences with family or friends, and by situations that have shaped how we view ourselves today.

Even if you’re suffering from low self-esteem, you can still be very confident in your skills and certain areas of your life. For example, you might not have high self-confidence in your writing ability but you still “like yourself.” Or you have great confidence in your sporting ability but you still “don’t like yourself.”

As with self-esteem, lots of factors can affect the development of our self-confidence. Parents’ attitudes are crucial to our feelings about ourselves, particularly in the early years. When parents provide acceptance, we receive a solid foundation for good feelings about ourselves.

So, without further ado, let’s explore self-confidence and why it’s important.

What is self-confidence?

Self-confidence is an attitude
Self-confidence is an attitude — Image by devushka-radost-pryzhok

An article from Skills you need suggests, “Confidence is not something that can be learned like a set of rules; it’s a state of mind. It comes from feelings of well-being, self-acceptance, and belief in your own ability, skills, and experience. More than that, self-confidence is an attribute that most people would like to possess.

Your degree of confidence, self-confidence, is the trust or faith that you have in yourself and your abilities. 

Self-confidence is how you feel about your abilities to interact with people around you, deal with challenges, or solve problems. As with self-esteem, self-confidence may be threatened from time to time, and can also vary from situation to situation. For example, you may have high self-confidence in your ability at football but very little in your rugby skills.

Self-confidence is about trusting yourself and your ability to succeed at new challenges, tasks, and opportunities. It comes from knowledge and practice. The more experience you have in any area, the more confident you will become, which further builds your self-confidence.

What happens with self-confidence?

What happens with self-confidence
Image by miguel-bruna-unsplash
  • you believe in yourself, feel good about who you are, what you are, and recognise that you have worth
  • self-confidence allows you to have positive yet realistic views of yourself and the situations in which you are involved
  • it means you accept and trust yourself, and have a sense of control in your life
  • you’ll know your strengths and any weaknesses well, and have a positive view of yourself
  • if you have self-confidence, typically you don’t fear challenges, and you’re able to stand up for what you believe
  • and you have the courage to admit your limitations
  • you’re able to set realistic expectations and goals, communicate assertively, and can handle criticism.
  • you’ll be able to present yourself to others differently, and people will have confidence in you, believe in you, and see your potential
  • with confidence, you’re more likely to succeed, be it in college/university, in sport, at work, or other activities
  • moreover, the way you present yourself can have a profound impact on any new opportunities that might come your way

When we lack of self-confidence

Do you lack self-confidence
Do you lack self-confidence?

The most important thing to know about low self-confidence is that it’s not your fault, says Psychology Today. Your childhood experiences, genes, culture, and other life circumstances all play a role.

If one or both parents were excessively critical or demanding, or they were overprotective, you might have come to believe that you’re inferior, incapable, or inadequate.

And although we can’t change our past experiences, we can rewire our brain, so to speak. With focus and action, we can make changes to maintain and improve our self-confidence.

More possible causes of low self-confidence

Being bullied at work
  • stressful life events – such as a death of someone close, separation or divorce, being bullied at work, or being physically or verbally abused
  • mental illness – like depression, anxiety, schizophrenia, depression phase of Bipolar can impact on how you think or feel about yourself, your skills, abilities or knowledge
  • chronic illness or physical disability – can affect your behaviours and thus impact on how you feel about yourself, your skills and abilities
  • lack of interest or reduction of pleasure in activities – sometimes, due to circumstances, i.e. Covid, you may reduce or stop doing the activities you once enjoyed. After that, you don’t return to these activities and you might forget just how much you benefited from them – you just give up.
  • repeated failure or rejection – if you have tried hard to complete your driving test and you keep failing, or you feel rejected by family or friends, you may develop low self-esteem, knocking your confidence
  • anger – if you struggle to express your feelings, particularly anger, you could find yourself low in self-confidence as a result of not expressing your anger in a safe and responsible way
  • negative thinking – sometimes you start to think negatively due to an event or situation, which can then become a habit and part of your general outlook. You might not even realise you’ve been thinking negatively, or how it’s been impacting on you

Impact of low self-confidence

The impact of low self-confidence varies greatly and can range from only impacting in one specific area, to being very restricting and debilitating. Low self-confidence can result in:

  • anxiety, stress, loneliness, and increased likelihood of depression
  • communication difficulties; inability to speak clearly or listen to and follow instructions
  • shyness to the point it can come across as rude to some i.e. no eye contact, mumbling any greeting, inability to engage with others
  • inability to assert yourself i.e. agreeing to tasks or favours when you really want to say “NO”
  • social anxiety; where you’ll avoid parties, work events or large gatherings, or leave early

Worse still, these negative consequences reinforce your negative self-image and could lead to lower self-confidence. This, in turn, can lessen your ambition to learn, ability to focus, and affect your ability to reach your full potential. You might become increasingly unproductive or even actively turn to self-destructive behavior.

When we lack confidence, sometimes it’s because we worry what others might think of us. Maybe they’ll laugh at us if we make mistakes. This thinking can stop us from doing things we want or need to do because we believe that the consequences are too painful or embarrassing.

While it’s not always easy to be confident in yourself, particularly if you’re quite self-critical, or if others put you down — do not despair! There are steps that you can take to increase and maintain your self-confidence.

Why self-confidence is important

Improving your self-confidence
Improving your self-confidence — Image by Gerd Altmann from Pixabay

Most people admire self-confident people, and might even envy them a bit! Self-confident people appear to be at ease with themselves, in their role or their work. They invite trust and inspire confidence in others such as bosses, colleagues, customers, friends, or peers. These are attractive characteristics to have, and I think most of us would like to have them too.

Some other benefits of self-confidence:

  • you’ll be more willing to try new things, like signing up for new courses, applying for a new job or promotion and taking up new hobbies
  • with confidence, you can influence others more easily, as well as control your own emotions and behaviors more responsibly
  • you’ll perform better when you feel confident, whether it’s at work, school or say when you have to give a presentation, you’ll stay calm and focused
  • it gives you the ability to thrive in the areas you want to, be able to overcome any obstacles, and know that you can achieve your goals. i.e. as an athlete, a new student or an author
  • helps in making better decisions i.e. to walk away from an abusive relationship or how to discipline your children effectively and appropriately
  • brings freedom from self-doubt and negative thinking about yourself
  • generally happier and more satisfied with your life than people who lack self-confidence
  • more willing to take smart risks and more able to move outside your comfort zone i.e. pack in your job to travel for a year or return to studying
  • helps to adapt and perform well even under pressure i.e at a new job
  • assists in building better professional bonds at work
  • you’ll experience less anxiety and less stress, and more fearlessness
  • reduced social anxiety, allowing you to connect well with others and you’ll generally feel happier
  • more comfortable in social situations and people tend to be attracted to you and your conversation

Your self-confidence will bring you more enthusiasm for life and the future. Also, you’ll transfer your excitement to others through your walk, how you hold yourself, and how you engage. Furthermore, the positive energy you project will be contagious and attractive to others. Just think about how that might feel.

Moving on

Okay, we’ve covered self-confidence, what it is, the lack of and the impact, together with the benefits and the importance. So, in my next post, we’ll explore some ways to maintain and improve our self-confidence.

Over to you

Any questions about self-confidence
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Do you think you’ve gained anything from this post? I feel confident (😜) that I’ve covered the basics of self-confidence but perhaps I’ve forgotten or missed something important and you want to tell me? I’m happy for you to critique my posts, honestly, and I look forward to your feedback, comments, or questions.

What on earth is smiling depression?

I’ve heard it called many things, but “Smiling Depression”? Come on, it can’t be real. Or can it?

Have you ever heard of smiling depression?

Coloured female with psychotic depression smiling at the psychiatrist
Is this smiling depression? Image by Unsplash.com

No, me neither. I came across it while researching for a completely unrelated post. I was actually trying to find the words to describe a mental health professional’s fake smile. However, the more I read about smiling depression, the more it resonated with me, and I thought it might interest you.

What about the lady in the picture (right)? Is this a real smile or is it covering something else? Would you be able to tell the difference?

I remember several occasions, being depressed and so angry with my now ex, and having to put a bright face on for my sons’ birthday parties. Once the soggy streamers were binned, the guests had gone on their merry way and the boys were comatose, my mood immediately plummeted down to my little size three’s. I bet most of you have had something like this occur?

Depressive Disorders

The most common and typical form of depression is the depressive episode, but there are other subtypes of major depressive disorder. When the depressive episode recurs we speak of recurrent depressive disorder. Then there is Dysthymia which is characterized by milder severity of depressive symptomatology compared to depressive episodes or recurrent depressive disorder. We have manic depressive disorder, atypical depression and psychotic depression, and last but not least seasonal affective disorder. And then, of course, there is smiling depression.

Think about someone with depression for a few moments

Typical example of seasonal depression. Crying and blowing nose.
Sad and crying —Image by dlpng.com

Did you imagine someone who always looks miserable, down or sad? Someone who’s sat in their pj’s, wrapped in a duvet, crying on the sofa all day? Someone who can’t be bothered to attend to their hygiene needs or their scraggy bed hair? You might have thought any of that.

However, and unfortunately, some people with what’s known as smiling depression don’t have those obvious symptoms of depression. They often come across as happy, upbeat, and look cheerful or even on top of the world, on the outside. Yet, they might feel dreadful, like they’re just treading water, sad, hopeless or worthless on the inside.

So, what is smiling depression?

Severely depressed subject hides face behind cardboard while struggling with feelings of sadness.
Struggling with sadness Image by Pixabay.com

According to Medical News Today, smiling depression is a term doctors use to describe when a person masks their depression behind a smile.

While smiling depression isn’t a technical term that psychologists use, it’s definitely possible to be depressed and to successfully mask your symptoms. Also, though it’s not a clinical diagnosis, trust me, smiling depression is real. Surprisingly, it affects more people than you might think.

Likewise, people living with smiling depression are in all probability, perfectionists, high achievers and very successful. Their mood is likely to worsen considerably if they don’t meet their own impossibly high standards.

What are the risks of having smiling depression?

.Despite the worldwide prevalence of mental ill health, it’s still really difficult for some people to open up and ask for help. Furthermore, current research shows that harmful stereotypes about mental illness often prevent people from seeking treatment or speaking out at all (Olivia Singh, Insider, 2020).

Sadly, these people who can’t or don’t talk about their feelings might be more vulnerable to suicidal ideation. And because spotting the signs of smiling depression isn’t easy, it can be missed.

People with a major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through (T.J. Legg, Insider, 2018)

Who might have smiling depression?

Quote saying Sometimes the prettiest smiles hide the deepest secrets
Quote of the day

Absolutely anyone! It could be someone you know who, when you greet them, they smile brightly and engage in conversation.

It might be a family member who when you call, they sound chipper and tell you everything’s going well. How about that annoying colleague who’s always, always cheerful, who brings in homemade goodies for everyone and tells you how wonderful life is?

Despite how they appear or sound, you might want to watch and listen just that little bit closer. You could notice that the lips smile but there are no creases around the eyes, or that their smile fades too quickly. Maybe their body is tense or their shoulders are up round their ears. And you could get the “Oh, yes, I’m fine.” with a great big hearty grin but would you be smiling if you just felt fine?

Someone with smiling depression might sound ecstatic but does it sound over the top, cos we quite often overcompensate for feeling down by trying too hard? Listen for the heavy huff or puff at the end of their sentences which may be incongruent with their cheerful quips. Pay attention if they’re less interested in spending time together or they don’t communicate as much as they used to, despite what they tell you.

Do I have smiling depression?

Alcoholism is a common mental illness among subjects with chronic depression
Image by mgg-vitchakorn at Unsplash.com

It’s possible? Only yesterday we were visiting friends for a bbq and all morning I felt absolutely awful, almost to the point of cancelling. Even throughout the drive there I was having suicidal ideation.

Yet as soon as I walked in the door and saw my friends I was all smiles and hugs (okay, I get the social distancing thing). The afternoon was terrific, with scintillating conversation, food that was amazingly different and cold sparkling wine to wash it all down with.

Then crash, and without warning, my mood nosedived. I felt it immediately I put my first foot out the door, amidst the goodbyes and more hugs. Then I cried silent tear all the way home and I remain low, tearful and hopeless today as I type. I know this particular bout of my persistent depressive disorder is situational and reactive so hopefully it will pass, soon.

Final thoughts

I know that we can’t all be happy every minute of every day, it’s almost impossible, but it’s certainly not normal to feel blue or sad all the time either. It feels excruciatingly exhausting and it’s where I am right now. It’s taken around seven hours to write this post, reread and edit lol.

Over to you

Large red question mark with white character of a man leaning against it
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What do you think about the term smiling depression. Is it just another elaborate term dreamt up by our silver-spooned or pretentious psychologists? Do you think maybe you or someone you know is experiencing smiling depression? I look forward to reading your comments and will answer any questions.

You might want to read about depression, 10 thinking errors of depression here. Or a guest post about a fellow blogger’s depression and anxiety here.

Related: Data-driven subtypes of major depressive disorder (1). The dangers of smiling depression (2). Let’s talk depression (3).

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

Unknown
  • 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 – Twitter.com

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.

De-escalation

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 health.com

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.

Twitter.com

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 – BBC.co.uk

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)

Telegraph.co.uk

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?

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