What was I supposed to do?

Pat Wylie

A few years ago, I was employed as a sessional nursing assistant for the local health board, mostly working in general hospitals and helping patients with washing, dressing and eating meals. One night, I was offered a night shift in a psychiatric hospital. I needed the money, so I agreed to work the shift.

“You’re in IPCU”, I was told when I reported for duty that night.

Having never set foot in a mental health hospital before, I had to ask what IPCU stood for. I was gruffly informed that “IPCU” stood for Intensive Psychiatric Care Unit: the ward that accommodates the most mentally unwell patients.

I had had no training in the care or safety of mental health patients; I must have worked in psychiatric hospitals on numerous occasions without receiving any formal training in mental health. I now understand that, at a minimum, the health board should have trained me in the safe management of aggressive behaviour by patients before allowing me to work there. I would also have benefited from some training on common mental health conditions and how to support people experiencing mental distress. No such training was offered to me. I was always sent to work as an extra staff member, each time as a one-off, to bring the patient/staff ratio up to a minimum legal standard, so why train me? What could possibly go wrong?

Luckily there were no critical incidents, as far as I recall, during my time working as an occasional staff member in adult mental health hospitals. I would occasionally take part in ‘escorting’ patients in a taxi from one hospital to another in the dead of night. I would often be called upon to supervise patients while they smoked cigarettes, or to serve light meals to patients while observing basic working practices that are designed to reduce incidences of self-harm in hospitals, such as preventing patients from having access to scalding hot water or metal cutlery. But even these working practices were something I picked up on the job, rather than something that was formally discussed or explained to me. As a curious person, I often wanted to ask why some of these working practices were in place; but the answer was often ‘that’s the way it has always been’.

That first night, and other times when I worked occasional shifts in mental health hospitals, I had absolutely no idea how to provide therapeutic care to adults with mental health needs. In all the years I’ve been working in health and social care, I have always felt that there is no substitute for experience, and no training like training on the job. I am broadly in favour of not pathologising or medicalising people experiencing acute distress, and I certainly wouldn’t want to demean or mistreat people experiencing mental distress. But it took me many months to feel as though I was ready to work in mental health hospitals, partly because I had had no training in how to do so safely, and partly because everyone else – patients and staff alike – always seemed far more familiar with the rules and norms of mental health hospitals than I ever was.

Over the following years, I came to enjoy my occasional jaunts to work in psychiatric hospitals. I gradually realised that, while there is no point in generalising people who experience mental illness or distress, they tend to appreciate simple things like being listened to and treated with respect. But I have never entirely shaken off my alarm that I was sent to work in acute mental health care with zilch, diddly squat and zero relevant training or experience behind me.

I was a lowly nursing assistant. What’s worse is my suspicion that a good many newly qualified nurses and doctors, those who have not specialised in mental health, find themselves in similar positions at early stages in their careers, dealing with patients in general hospitals and in the community whose mental health needs may be very complex. Mental health care requires confident staff. A basic level of training in mental health care is the least that patients and staff deserve.