#WMHD2017 – Why I do what I do

Today is World Mental Health Day, and I thought I would share a story about my work. It’s true, it’s meant to be sad, and it’s meant to be funny too. Because that’s what it was like.

I work with mummies and mummies to be, and I am a mental health nurse. Not a real nurse. A special nurse. A la-la nurse, all tea and sympathy. I say “tea”, you’ve all tasted what we get haven’t you? Whatever that mix of dried fingernails and belly button fluff we’re given to make tea-flavoured drink.

I want to tell you about my day job.

Every year in my city 17,000 babies are born. 17,000 little squidgy bundles of puke and jobbies and chubby happy screaminess. 17,000 lives jolted upside and round in the cyclone of kids. One in five mums – probably way more but that’s another topic – at least one in five mums will have a mental health problem in the perinatal period; so in my city, that’s well over three thousand.

Most get no help. Of those who do, most only see their GP. The ones that are really unwell, they get to see me; a kind of aversion therapy. “Cheer up or we’ll send you to the whiny gobshite, you’ll sit in a sweaty velour armchair while he force-feeds you disappointing biscuits and tea-flavoured drink”. I love my job.

Let me tell you about something that happened; a reason why I do what I do and sometimes wish I didn’t do what I do, and how sometimes those times when I wish I didn’t do what I do make doing what I do even better to do.

Let me tell you about a mummy who wanted to die.

A mummy, and a survivor of a chronic mental illness; my job was to help her understand her head, understand how relapse happens, understand she is not alone, understand that there is hope and a future and love and being wanted and valued, and understand how to talk it through and help her to maybe one day help her baby understand why mummy was a mummy who wanted to die. So I see her every week in the group.

The Group – problem sharing, problem halving, celebrating being a parent and lamenting being a parent, verbalising the relentless, oppressive tsunami of emotions for one mother and naming the null numb nothingness for another, unconditional, compassion-full confessional.

Shed tears proudly, laugh loudly, we get complaints for the noise.

You all seem to be having a lovely time” said one colleague. “Shouldn’t you be working, ha ha” said another.

I replied, smile-fatigued face flushing with rising rage that yes, indeed I thought I was.

Really? Doesn’t sound like work…

You know I have a room full of severe depression, crippling anxiety, dissociation, intrusive thoughts, disturbing dreams, waking nightmares, so suffused with self-doubt to the depths of their bones they haven’t slept in days, aching, scarred, battered and embittered, laden with shame at their supposed shocking shortcomings, grief-stricken, guilt-ridden, partners don’t get it, babies don’t get it, professionals don’t get it, the world all around doesn’t get it because the world all around seems to have it all together and the world all around has so much advice and the world all around has well-meant words but these mums… these mums wish that for one moment of silence that the world all around would just fuck off

And for one hour, we got them to smile.

You’re damn right I’m working.

One day, the mummy who wanted to die turned up unannounced, tears hanging, trembling, handing me her baby and the rhetoric of relapse “She’ll be safe with you, OK? You’ll keep her safe please? There’s somewhere I have to go. Keep her safe, you promise? OK? OK?”

Oh fuck.

“Come and have a cup of tea” I suggest and for twenty minutes this to-and-fro happens before she finally concedes to come in. I break out my emergency stash of Yorkshire teabags and look to rally support.

Everyone else is out. The police don’t want to know, the social work neither “’cos she’s one of yours” they say “’cos she’s got mental health” they say.

Just us – two nurses – and a mug of fucking tea.

Free to walk out any moment, drive to a place to silence the torturing thoughts that have held her hostage her whole life. She knows what to do, she knows how to cure her poorly head.

Hours pass, we tiptoe round, tag-team tempting her to stay, to stay alive, to take her meds, talk to her mates, persuade and encourage, homeopathic hints of hope in the petrified pain-shattered shell she inhabits.

And eventually she is admitted.

And eventually she goes home.

And eventually she smiles again.

And eventually, she’s in the last session of The Group.

On her way out, but this time in a good way.

“We need to talk about your discharge plan” I say to the mummy who had wanted to die.

The mood drops, my words hit the kerb, dry voice, eyes trained on toes, affectless words “Yeah but remember that day? That day I wanted to die. I need to talk about that day. There’s something about that day that won’t leave me alone, is stuck in my head and won’t go away OK? OK?

Oh fuck.

Should have seen your face

She laughs

I laugh

A good day.

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Debate this

It seems a ridiculously long time away, but it’s time to start planning for RCN Congress in May next year.

A big part of what the Mental Health Forum can do is submit items for debate and discussion to the Agenda Committee, and the deadline is 2nd January 2018.

Which leads me to asking our members -all 12,000 of them – to share with us what is going to make a difference in their practice.

Feel free to add comments here: https://padlet.com/edward_freshwater/MHForumAtCongress

Thanks.

Response to “The future of the mental health workforce”

This blog post first appeared on the RCN website here https://www.rcn.org.uk/news-and-events/blogs/response-to-the-future-of-the-mental-health-workforce-report

The Centre for Mental Health was commissioned by the NHS Confederation to explore future mental health workforce needs. The RCN Mental Health Forum welcomes the recognition that mental health nurses have important skills, and that the profession has experienced significant upheaval in recent years.

The 22 recommendations for health leaders are appreciated at a time when low morale, high absence and rapid staff turnover threaten nurses and service users alike. Our members are not disposable commodities; they are trusted professionals best placed to provide therapeutic interventions for those experiencing mental illness.

Mentoring and supervision are key elements in supporting the nursing workforce, but are often the first casualty of staff shortages and clinical crises. We have seen nursing numbers decimated since 2009, with a detrimental effect on caseloads and care. For our members it is concerning that rather than address issues of supervision and therapeutic levels of staffing, the Department of Health has chosen to tinker with new roles, untested training routes, disruptive reorganisation, and slashing beds. Nurses are being expected to do more with less in an unsustainable cycle of cuts.

There is a desire to develop skills and careers, and calls for radical redesign of services. . The recognition that communities, families, housing, and employment have a role in safeguarding mental health is a welcome shift from a biomedical tradition. The value of the therapeutic relationship between nurses and service users has long been overlooked. Collaboration using the expertise of those with lived experience (including professionals) is key to this process. New models of care should, at the very least, include nurses at the design, planning, implementation and evaluation stages. Nurses deserve to be at the forefront of meeting future demand.

The RCN Mental Health Forum committee and newly-appointed professional leads look forward to working with all stakeholders in delivering positive change. However, such change requires time, support, funding, long-term views and a motivated workforce to achieve. If services continue to lurch from one crisis to another, this vision will remain a distant utopia.

Ed Freshwater

Chair, RCN Mental Health Forum

The report can be viewed here: http://www.nhsconfed.org/resources/2017/09/the-future-of-the-mental-health-workforce

RCN members can join the Mental Health Forum here: https://www.rcn.org.uk/get-involved/forums

Follow us on Twitter @RCNMHForum and @EdFreshwater

Shock news: police are not nurses.

A reflection on the following article: 

https://www.theguardian.com/society/2017/aug/28/police-phone-calls-mental-health-nhs

There is a lot to consider from the perspective of those in contact with services, but there are others more qualified to comment on that with their own lives experience. I can imagine that for some in crisis, being met by uniformed officers might only exacerbate their distress.

I do, however, have a concern as a clinician of how this is symptomatic of a broad political and policy problem. The increased reliance on police officers illustrates the systemic failings of a system that, despite repeated pledges and promises of action, is woefully misunderstood and mismanaged by those who are running it.
I value our police force, as a mental health professional as well as a member of the public. They were helpful when my bike was stolen, when a friend was assaulted in the street and when there were concerns over a particularly loud street party getting out of hand.

I would expect them to be on hand for these cases. I don’t however expect them to have to do my job.

I, and many of my colleagues, have dealt with people in the acute phase of a crisis. It’s our vocation, what we are trained for and what we’re passionate to provide.

And yet, thanks to years of mismanagement, cuts to services, ignored warnings, failed initiatives and empty platitudes, we see now that more and more often the police are called on to plug gaps in mental health services.

Nobody should be happy about this.

The answer is not more training or role expansion for police officers. It isn’t really solved by increasing funding for crisis services either. Crisis teams only work when there’s a crisis, when things have become too hard for service users to manage.

Instead, a major investment in preventative programmes, long term community support and effective pathways between services (including crisis management) is required.

The money can be made available, the staff I’m sure would be delighted to work towards this ( and arguably shifting focus to prevention and management might address some of the issues of burnout among nursing staff).

The problem is a lack of political will, from government on down, to spend the time and money required. We know that the current crop of Tories are in favour of ruining social healthcare in this country, and we know that the promises of politicians rarely translate into action, let alone improvement.

Services are clearly not being commissioned appropriately either. We’ve seen in recent months multiple examples of funding promised for mental health instead being siphoned off to prop up overstretched acute general hospitals, further reinforcing the futility of government rhetoric.

Everyone wants to save money, and the soft targets of community services and mental health professionals inpatient beds are  the easy victims. Simply because it’s an easy target doesn’t make it right though. 
What’s better – to have an amazing respiratory support team, or to prevent people developing lung problems in the first place?
It’s really not that difficult if the vision is there. So I don’t think this is only about money (though the cash helps), but a failure of leaders political and professional to have the best interests of service users at heart.

Nurse training in the UK

As if the constant erosion of skills, pay and benefits wasn’t enough, we had the removal of the student nurse bursary which the inexplicably-employed Jeremy Hunt assured would result in a great increase in training places and therefore numbers of new nurses.

Many, including individual professionals and bodies, warned that recruitment would drop.

It turns out that the professionals were correct. And Jeremy Hunt was wrong. Again.

Student numbers dropped 23% for the new intake.

[slow hand clap]