The Patient Client

Our patients were generally frightened of re-entering mainstream life, remaining frozen between ‘improved’ behaviour that might see them move on, and ‘deteriorated’ behaviour that might see them return to more restrictive regimes. Nurses preferred a predictable working day, and quite enjoyed complaining about the stagnation, while some didn’t particularly want their skills challenged by new circumstances. Many relatives would accept the inertia, as long as the patient didn’t land on their doorstep, and our managers were quite happy to leave clinical matters alone as long as the meeting room had plenty of sandwiches and some paper progress was being made with the latest government initiative. Their unofficial motto was ‘ignorance is power’.

The unit was supposed to provide psychiatric rehabilitation services for a local population of 100.000 people, but over a period of ten years it had catered for no more than 30 largely intractable individuals, who had soaked up the taxpayers subscription between them. They were effectively a private ‘club’ of career clients who either remained indefinitely, or returned invariably. Deaths accounted for more movement through the system, than successful onward referrals……


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