Archive for mental health


Posted in Biographies and Inside Stories, Blogging, mental health, social work and social policy with tags , , on September 3, 2013 by leovineknight

Many of the patients were in the habit of going to bed directly after tea, so we decided to invite them downstairs again for one of our rare community meetings. In times gone by, when the unit had followed a ‘therapeutic community’ model, we used to hold these meetings every evening to sort out the domestic jobs allocation, receive feedback on the day’s events, discuss any complaints and ideas that people might have, and give credit where it was due. These, of course, had slowly fizzled out as the patients became older, the staff got tired of doing it, and the unit reverted to form as a continuing care hospital ward again.
Occasionally, though, the community meeting idea was reintroduced by either industrious students or ‘new broom’ managers, who would both employ short-lived democratic outlooks, and then move on. Indeed, just as the staff were becoming more ‘unwell’ than the residents (e.g. judging by psychotherapy appointments), so was the turnover of nurses becoming much greater than the throughput of patients. This sometimes led to an illusion of progress on the unit, because new staff would launch ‘fresh initiatives’ which were actually recycled old and failed ideas, while the overall decline from community care unit to hospital ward was too slow for the rapidly changing staff to notice. Therefore we had the paradox of patients becoming less and less able, at the same time as temporary managers deluded themselves that things were getting better and better. A radio in one of the patient’s rooms, announced:
“Buses ground to a halt yesterday as drivers walked out over a colleague who was dismissed for winning a martial arts competition while off work sick.”
“Oh well, there’s always a job for him here” I thought. “I hope he’s got plenty of storage space for the manager’s ‘get well soon’ chocolates and flowers.”


Patient Rites

Posted in Biographies and Inside Stories, Blogging, jobs, careers and work, mental health with tags , , on August 27, 2013 by leovineknight

One of the patients asked me for access to his huge stock of sweeties. Although on a diet care plan, he had recently returned from a shopping trip with two large bags of jelly babies, two bags of sugared bon bons, four tubes of mints, two cream cakes, and a lot of receipts for the cash book. He had preceded these purchases with a fish and chip lunch, one can of non-diet coke, and a ‘ninety-nine’ ice cream with extra “sprinkles”. His laboured breathing now followed me down the corridor and after five minutes of key juggling I was able to release the requested items into his sticky grasp. I had a pang of conscience as I observed the folds of his painfully obese form rock and roll back to the lounge, but I knew that to refuse him access to ‘his own property’ would have brought opprobrium down on me from all sides. I was even more regretful that we continued to treat many of the patients like children, and wondered if it was strictly necessary to unload sack loads of sugar and fat on them every week, and then foolishly remark on their disappearing teeth and scale-breaking weight.
As part of this approach, all the patients received a large ‘Walt Disney’ type of birthday cake every year, which was usually so sickly and garish it would have turned the stomach of Billy Bunter. Unfortunately, staff seemed to forget that the recipients of these cakes were often forty to fifty years old, and that the patients were already keen enough to see themselves as life long dependants without the staff reinforcing it with organised puerility. Some of the patients were actually suffering from a psychotic ‘regression’ which had taken them back to their adolescence, and in their cases it was even harder to see how Walt Disney icing was going to reverse the process. Often the patients in question were in need of a new electric razor, a hairbrush or even a basic clock, suggesting perhaps that a more constructive approach to gift selection was well overdue. Anyway, at least I always knew what the key workers wanted for their birthdays; but would it be a cheeky Donald Duck or a cuddly Minnie Mouse this year?


Posted in Blogging, jobs, careers and work, mental health, social work and social policy with tags , , on August 1, 2013 by leovineknight

“Are there any other comments?” said one of the inspectors, looking directly at me.
I turned instinctively away, but found myself surrounded by gimlet eyes, and an atmosphere of curious expectation. For a moment, I was mesmerised by this concert of stares and glares, and then like a cornered rat making a last desperate spitting bid for freedom, I blurted out:
“Frankly, I’m surprised we’ve got off so lightly…. In my opinion, the patients are steadily deteriorating because they’re needlessly hospitalised, and they don’t have any meaningful way of spending their time. They’ve lost all self-respect because they can’t contribute to anything, and they’re left with nothing to do but spend their benefits, or sleep on sofas. The unit is bed-blocked because the patients are incapable of moving on within the present system, and insufficient money is available to ‘warehouse’ them outside the hospital. Management is paralysed by fear of confrontation with individuals, unions and the public, and we’re being buried alive in mindless bureaucracy, just so that we can demonstrate paper progress to auditors and ourselves. Many of our nurses have joined the circus by spending a large proportion of their time at home on fully paid sick leave, correctly anticipating that management will send them boxes of chocolates for doing so.
“Hmmm…Hmmmm….Thank you very much for your views…..” interceded Richard.
“And” I continued “In my opinion, this is nothing short of a scandalous and disgraceful waste of public funds.”
A stunned silence followed my reckless outburst, and in the interim I cast a careless glance around the table, waiting for my nemesis. Like a group of assassins at a Mafia wedding, they eyed their target, toyed with their guns, and twitched their lips; the apoplectic manager on the verge of a stroke, the chairman’s chilling cold weasel look, the black coated ranks of inspectors with their ice hockey masks, turning me over like a beetle on a pin……..


Posted in Biographies and Inside Stories, Blogging, jobs, careers and work, mental health with tags , , on February 17, 2013 by leovineknight

A number of residents had crept back to bed after lunch, and I had to brave a battery of objections and excuses before they would reluctantly agree to pay lip service to their care plans, even if these only recommended socialising in the T.V. lounge. Checking inside the wardrobes and beneath the beds for those who were astute enough to play hide and seek, I reflected on how much easier it was to let the residents have their own way. They were extremely persistent in their evasive tactics, and could be both manipulative and aggressive in the pursuit of their objectives. Small wonder, therefore, that the staff often played into their hands by actively colluding with the patients’ hedonistic tendencies. Visits to seaside ice cream parlours and fish and chip restaurants, for example, were usually very popular, even though some of the patients were massively overweight and had diet care plans, while ‘social evenings’ with plentifully flowing wine and lager were equally popular for comparable reasons. Similarly, the daily fixation with television was rarely challenged because staff also liked to spend their time watching football and soap operas, as well as endlessly prattling undercover of repeat films and newscasts. Even when the patients remained square-eyed in front of children’s television, this would still be perceived as a useful distraction from more disruptive activities.
Conversely, when social skills, domestic skills, gardening or personal hygiene interventions were suggested to the residents, these were almost invariably greeted with sabotaging tantrums, increased ‘delusions’ or mute unresponsiveness; so it was not entirely surprising when staff started to take the easy options themselves. This was the point that the unit had reached meltdown; where the day-to-day collusion, the mirror-like reflection of staff-patient lethargy and self-interest, and the obscuring of all things with worthless paper work, had murdered the unit stone dead.

The Consultant

Posted in Uncategorized with tags , , , , on October 3, 2011 by leovineknight

I resisted a gut reaction to rip the letter into shreds or burn it in my crested ashtray, knowing that this would then prevent me from subjecting it to endless dissection and reinterpretation. I was aware from previous experience that short term anger would probably give way to longer term wishful thinking, and that until further information arrived I would paw over every piece of existing evidence with a detective’s eye. Did the letter really mean what it looked like at first sight? Was there any hope between the lines? Did the description of my competitor reveal any weaknesses? The self-flagellation could go on for weeks and months, right down to the bone.
I felt trashed.
Certainly, this wasn’t the best preparation for my weekly meeting with the multidisciplinary team, and when the time came to walk down to the meeting room, I felt more like hitching a horizontal ride in a hearse. But I must have looked better than I felt because the first thing the consultant said was:
“Well Steven, the medication seems to have suited you. The nurses say you haven’t reported any ‘unusual’ sights and sounds for over two weeks. No voices in your head, no radio broadcasts meant just for you, and no feelings that the world was against you. You must be feeling a lot better?”
“Well, I’ve given up the fight against vastly superior odds, if that’s what you mean.”
“Yes, that sounds pretty rational to me.”
“How long do you think it will be before I’m fit for work?”
“Er…well looking at your occupation, it could be quite a while yet, but I’m certainly pleased with your progress.”
“So, what happens now?”
“Well the next step is to reduce your medication towards a maintenance dose. Then the nursing staff will arrange some home leave for you, to see how you get on outside the ward. I’m sure your family are looking forward to having you back.”
“Absolutely” I stupidly said.
” Have you heard of C——- Village?” I hedged.
“Christ! You don’t want to go there do you?” he laughed. “It’s all mumbo jumbo and ‘let’s worship the divine leader’.”
“No different to here then.” I remarked.
“Very good, Steven” the consultant chuckled. “Now. Are you absolutely sure we’ve dealt with all the issues that were troubling you.”
“I think so” came my unconvincing reply.
The consultant had a backlog of ill and ‘ill’ people waiting to be admitted, so in the following days he chose to overlook my increasingly sardonic remarks and my growing interest in religious communities, keeping instead to the agreed discharge care plan. I had received nothing further from Carol, but a preliminary letter had arrived from her solicitor advising me that divorce proceedings were about to begin and that I might want to appoint a ‘legal advisor’ of my own. The day of my home leave was getting nearer, and I was finding it difficult to explain my wife’s ongoing ‘incommunicado’ status to the nurses. Sleep was difficult, and the headaches were returning.

A Day Out

Posted in Blogging, books, journals and diaries, jobs, careers and work, life and modern times, mental health, satire and humour with tags , , , , , , , , , , , , on July 29, 2011 by leovineknight

Steven dreamt on…….

“What is it Grandpa?”
“My number’s come up.”
“Oh…..I’m so sorry……I thought you were as fit as a flea for you age and glad to be alive.”
“No. No, Sally. I mean my lottery numbers have come up. I’m rich, rich, rich!”
“Well, Richard is a good stout English name, but I’ll still call you grandpa.”

* * *

Six weeks later, Grandpa had done what most lottery winners do. He’d gone back to work, bought more lottery tickets and lost 90% of his cash to golden-tongued financial leeches. But the few thousand he wisely kept hidden in the allotment shed still enabled him to purchase some new mud flaps for the car, replace his yellowing underpants with silk state-of-the-fart thongs and treat the whole family to a day out in Scarborough.

The sun shone rather shiftily on the agreed day, but grandpa was optimistic as he admired his new mud flaps and waited for the others to join him. The car was always parked outside so it had a cream and black songbird finish, no wing mirrors and a windscreen wallpapered in parking tickets.

“That daft lad’s still pretending to be a policeman” murmured Grandpa to himself, as he raked the windows clear.
“They’re lovely mud flaps grandpa” said Sally. “Why did you choose orange, though?”
“Why, to match the edges of the wheel arches of course.”
“Now. Where have grandma and the others got to?”
“They’re coming now.”
“Hey! None of your internet porn filth here if you don’t mind young lady.”

Eventually grandma, Dad, Toby and the dog appeared. Mum was going to relax with a long thin neighbour who shared her interests in Russian literature, phallic symbology and four-poster beds. Even so, it was a bit of a squeeze in the 1961 Fiat 500 and Grandma didn’t look too happy in the middle rear seat, her face filling the mirror like a pie in an eggcup, eyes of stone fixed on grandpa’s hairy neck.

“Hello playmates!” chortled grandpa.
“Let’s burn rubber, grandpa” said Toby
“Hey! None of your internet porn filth here young man.”

The eyes of stone turned obsidian.

Blistering sunshine quickly turned the car into an oven as they creaked down the street towards the motorway, poisonous deodorant fumes rapidly giving way to armpit ambiance, while Rufus the dog raced around like a dervish in a wall of death show, bouncing off the dashboard, rear window and armrests at the rate of one revolution every two seconds.

“Can’t someone control that dog?” barked grandpa.
“Did you know DOG is GOD in reverse” said Sally.
“And vice versa” said grandma, looking older than her ninety-two years, eyes still fixed on the hairy red neck.
“Nice to see you……” cackled grandpa, looking in the mirror.

Suddenly his false teeth were in the open glove compartment. The car had hit a minefield of sleeping policemen, rumble strips, chicanes and bottomless potholes.

“My Lord! Hold on tight. We’ve hit some turbulence.”
“Didn’t you see the signs grandpa?”
“No, sorry love. I need a telescope on one eye and a microscope on the other to see normally these days.”
“Isn’t that dangerous?”
“No not really. That’s why the roads are fitted with these Braille systems so we older drivers can tell when things are unsafe by all the bumps and shakes.”
“Ooooh. That’s clever.”

Because Rufus had run about a hundred miles by now and was beginning to tire, his judgement was a little faulty. One leg hit the open window and, with a parting grin, he was swept out of the car and into oblivion.

“Stop the car, grandpa!” shrieked Sally.
“Too late, we’re on the motorway now” said Dad.
“I’ll miss him” sobbed Sally.
“Well, the following cars haven’t’” announced Toby, with the forensic interest of a boy at the insect-torturing stage of development.
“All’s well that ends well” said grandma.

Thirty minutes after setting off they hit the twenty-five mile traffic jam approaching Scarborough. This was a difficult time for Grandpa because the ten m.p.h. rate of progress was a good deal faster than his usual pace on the open road. The sun beat down like a Martian death ray and his usual bonhomie slowly gave way to a mumbling delirium.

“No, no! Not the cooler again…… I’ll talk you bastards…… You’ve broken me at last….”
“The heat’s got to him” said Dad.
“He thinks he’s back in the war” said Sally.
“No, he had flat feet and a lots of silk stockings for sale in those days. I think he’s remembering when he was shop steward in the frozen pea factory.”
“He needs some air anyhow.”
“Come on grandpa! Park in the lay-by.”
“What?….oh…..yes….er…….just a minute.”

From the safety of the lay-by they ate a three course meal, urinated in the undergrowth and listened to grandpa playing his trumpet..

“That little road over there looks clear anyway” said grandpa.
“But that’s the cycle path, grandpa.”
“Rubbish! You’ve been filling your head with all that internet porn filth, young man.”
“Although” he added “Shagtube and those weird bandage sites with whips and tassels can be quite useful for research purposes.”
“Oh, yes. I always make sure of my theory, before I apply it” said Grandpa, winking at the mirror.

The obsidian eyes bulged with menace.

“I’ve got a strange ringing sound in my ears” complained grandpa.
“Its the the twenty cyclists behind, trying to get past” said Toby.
“Bang, crash!”
“Lord Sugar! What was that?”
The purple-faced guy with the mountain bike decided to overtake across the roof.”
“I’m going to try second gear in a minute.”
“That was reverse, grandpa.”
“Well, it seems to have slowed them down a bit. I hope they’re all right in the middle of that mountain of twisted metal. Young fools ought to be more careful.”

Stopping at the first set of 32 traffic lights in Scarborough, the family breathed in the familiar seaside scent of road works. They’d read about this new ‘intelligent’ road management system in the ‘Sunday Morning Spurt’. Apparently, each set of lights delayed the traffic by five minutes and after four minutes a camouflaged traffic warden emerged from the bushes writing parking tickets.

“The lights are on green, grandpa! And that man with the black uniform, red spidery armband and a geranium on his head is coming across.”
“Don’t be daft, Toby. Everyone knows that cars don’t move any quicker on green than they do on red. Only amber gets people weaving.”
“It’s amber now! And he’s almost here!”
“Oh! …..Well….er….which is it….maybe if I….better check the mirror…er…still plenty of time to scratch my arse……..1932, that was a good year…. “
“We’re off. We’re off” grandpa laughed.
“It might be something to do with the irate truck driver behind pushing us down the street at 60 m.p.h” said Dad.
“It’s the best way to save petrol” remarked grandpa, tapping the side of his nose.

The obsidian eyes had an eerie glow.

“Well, here we are at last.”
“Let’s start on the sandwiches.”
“Good idea, Sally. We’ve got chicken, ham, tomato, cheese, Marmite, egg, black pudding, kangaroo and jam. All mixed together, actually.”
“What about the cakes and pies?”
“Drinks and nibbles?”
“Wipes and pipes?”
“Flasks and tarts?.”
“Litter and titter?”
“It’s all here. No need to rush. We’ve got all day.”
“But it’s five p.m. Now.”

They’d parked on a dingy side street to save the new 50p a microsecond car park charges recently introduced by the town council, but there was still plenty to see. A normal looking bloke with clean jeans, polo shirt and white trainers came ambling down the path with a plastic shopping bag.

“Well, I’ll be damned. Can you see that?”

The others just gaped, their jaws dropping, mouths opening, food spilling and anuses involuntarily rasping. Heads were cranked around 180 degrees in one instinctive, united movement, following the man’s progress with vital concentration, the feeding frenzy momentarily suspended by sheer shock.

“Ha ha ha”
“Would you believe it?”
“A man with a plastic bag in town.”
“There was another one near the traffic lights, grandpa.”
“Was there? You should have said Sally. We could have all looked.”

The street was getting busier now, as people made their way up from the seafront. A large party of overweight, spotty youths in toddlers’ clothing meandered around, their tattoos and piercings mingling like Medieval armies while their tongues darting out at flies.

“It’s hard to tell the difference between normal people and those that are a bit slow” said Grandpa, diplomatically.
“Yes. I think those are the ones who’ve come thousands of miles for IVF treatment on the NHS”
“A grand idea! It’s every idiot’s human right to have five kids on benefits. No wonder the EC have insisted on it.”
“Hear, here.”
“Hurrah for us.”
“We’re nice people, we are.”
“They call it ‘I.Q. Challenged syndrome’ now grandpa” said Toby.
“Oh. We just used to call them thick bastards when I was at school. But of course we know better these days.”
“In the olden times people used to think intelligence was inherited through genetics.”
“Ha ha. Well, Toby, the I.Q challenged people are having twice as many children as any other group, so it’s lucky for us those old ideas are totally wrong.”
“Yes. In three generations the UK would be overrun with morons otherwise.”
“Ha ha ha.”

The obsidian eyes sparked and flashed with venom.

“Hey! Look at that weird guy.”
Oh, yes. I think it’s it’s that long lost Japanese soldier. You know, the one that’s been occasionally spotted living in the overgrown South Cliff gardens. He’s been there since 1941 waiting for orders.”
“He doesn’t look too happy.”
“No, his armoured car’s got a ticket or two by the look of it.”
“Hey! Look at the size of that.”
“I’ve told you before young man. No more of your internet porno filth.”
“No grandpa. I mean the the size of that black limo coming down the street.”
“It’s Annie Lummox and Bonehead!” cried Toby.
“Is it true that they were secretly married last week?”
“Yes” said Dad. “They’ve decided to arrange the Second Coming biologically.”
“And Simon’s going to be the baby’s manager.” added Sally.

The sun was going down behind the Gothic gables now and the family were getting restless.

“Shall we go for a walk grandpa?”
“No, Sally, there isn’t really enough time I’m afraid. But I’m sure we’ve all enjoyed our day out anyway. We’d better make a start. But before that, I wanna tell you a story…..”
“No, no, no thanks…..”
“It was in 1790 when Monty and Churchill and I were sailing in ‘The Beagle’….”

The obsidian eyes lit up. The hands were white and cold.

“Can you hear me mother?” laughed grandpa, looking in the mirror.

* * *

At a quarter to midnight the car finally rattled into life, but stalled as soon as grandpa let the handbrake off

“That’s funny. I wonder if we threw too much rubbish out of the windows. The car can’t get over it. I’ll have to dig the front wheels out”

Levering himself out, grandpa slowly straightened up and then assumed his beloved 1960’s trade union posture; thumbs behind his braces, head shaking, each knee lifted up to his chin as he circled the car with clicking tongue and large boots.


Unexpectedly, a primordial scream erupted from the car. The engine was gunned, the clutch dropped and………


Grandpa lay under the car, only his khaki shorts, varicose veins and ankle suspenders visible, as Dad rushed to his assistance.

“Why did you do it grandma?” sobbed Sally.
“Yes, why?” said Toby with cheerful interest.
“It was…..”
“It was a mercy killing.”

* * *

Later, at the police station, Toby asked Dad what grandpa’s last words were.

“This car needs under-sealing.” said Dad.

Guest Blog From ‘KL’

Posted in Blogging, jobs, careers and work, mental health with tags , , , , , , , , , , , , on July 26, 2011 by leovineknight

KL says:

Nursing Care Plans Gone Mad

I can’t find this discussion anywhere. To me it is the elephant in the room or a case of the emperor having no clothes. The issue is the relevance of nursing care plans to good patient care in psychiatric nursing units. I don’t argue that nursing care plans are irrelevant just that nurses spend too much time caring for the chart at the cost of patient contact. I have worked on a psychiatric unit for more than 30 years (I’m sure that you guessed that I am not an RN). In the old days there was always a problem list that one charted against. For a while SOAP charting was the norm. Psychiatric care plans are perhaps an improvement but not such an improvement as to justify the enormous time investment that registered nurses spend writing and updating them.

Almost any beginning psych nursing text will say that the therapeutic relationship is the most important part of psychiatric care. Dziopa and Ahern have written about the following nine critical aspects of psychiatric nursing practice: understanding and empathy, individuality, providing support, being there/being available, being ‘genuine’, promoting equality, demonstrating respect, demonstrating clear boundaries, and demonstrating self awareness for the patient. I don’t need a care plan to practice any of these skills. A nursing instructor once told me that psychiatric care plans are a tool to teach skills or interventions, I can buy that, but the pretence on my psychiatric unit is that the psychiatric care plan drives patient care.

It would be an interesting experiment to follow registered nurses around the acute care psychiatric unit that I work at with a stop watch and measure how much time they actually spend talking to patients. Years ago nurses actually led or co-led the majority of group therapies, now this task is done by occupational therapists and unpaid interns. The nursing assessment is frequently a five minute conversation done in conjunction with taking vital signs or passing medications.

I have tried to ‘Goggle’ related topics and in an age when almost any topic generates 100,000+ hits, I find very little. Any insights would be much appreciated. Maybe the emperor’s new clothing really are an improvement, help me understand.

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