cognitive behavioural therapy; psychology; relationship counselling

Diary of a care assistant working in a mental health secure unit (1)

Diary of a care assistant working in a mental health secure unit (1)

Post 1 (more to follow in the future)

More than ten years ago I worked in a secure forensic institution that housed people who had committed crimes. These people had subsequently been shown to be mentally ill and they were sent to the mental health institution where I worked. Due to a confidentiality clause, I am unable to name the institution but I have decided to share some of my diary entries during this time.

I was placed on a female ward as a care assistant back then and all the females on the ward had murdered someone. Those that had murdered a man were congratulated but those that had murdered a child or infant were looked upon far less favourably.

Here are my original diary entries:

Easter Sunday, 31 March 2002

My 6th shift today, working from 1.40pm to 9.20pm.Days seem long as there is little to do and the environment isn’t the happiest (no surprises there). On my first shift I was introduced to the 10 females on the ward. They all seemed guarded and distrustful of (don’t blame them) and I couldn’t help but look at them and wonder why they were here. What had they done?

The ward that I had been placed on was particularly colourful and not what I expected. No iron bars and peeling paint that looks cracked on the walls. Besides the constant clattering of keys (we all have a huge bunch on us to open all the various doors between here and the entrance to the institution) opening and shutting doors it wasn’t obvious that I was in a high secure setting. The ward has recently been refurbished and the drab colours were replaced by brighter tones.

Each patient has their own room (albeit small) and the small window in each door is covered by a colourful curtain. Brightly coloured curtains hang in the lounge, dining room and long corridor. I often wish the windows were slightly lower to enable a peek at the beautiful surroundings. This can only be achieved by standing on tip-toes to look out. I should probably mention that I am only 5ft, as that comes into the equation. Being petite was a concern of mine and even though part of my intensive three week training included learning break-away techniques as well as control and restraint techniques, I still wondered if my size would be a disadvantage.

In fact, so far, I have found the staff to be more intimidating than the patients…Politics abound and this is not conducive to effective teamwork which really is essential in this type of work. High staff turnover seems to be another issue – the working environment can be negative and I am surprised at the seeming lack of support for staff. I have often thought that team building should be organised but it seems once you are on the ward, you are on your own. A triple whammy exists: Politics between staff, between patients and staff as well as between patients.

Nine out of the ten female patients smoke and a smoking room is allocated for this purpose. Only two women are allowed in at one time and it is rare to find the smoking room empty during the day. Those that smoke all roll their own cigarettes and a lighter exists in a hole in the wall.

There seem to be many contradictions on this ward. This ward houses women with personality disorders and one of their key traits is self-harm. Despite this, there is a notice board up with pins on it. Ceramic mugs are used and a flask of boiled water is made available in the day room for making tea and coffee.

Only plastic cutlery is used when patients are unsupervised but metal cutlery is used in the dining room which is always supervised. Cutlery is counted before and after each meal to avoid security risks. I was amazed to learn that chewing gum isn’t allowed on the ward as this can be used to form a key impression!

When each shift ends and new staff arrive, security checks are performed by one member of the existing team as well as one member of the new team taking over. Fire extinguishers are checked, cutlery is checked and certain cupboards containing patient’s personal items are checked. Room checks and personal locker checks are also performed, just not as regularly.

My first shift was pretty uneventful, although the second shift certainly made up for that!

While on a reconnaisance trip to two nearby wards, an alarm bell was raised back on my ward. We raced back as fast as we could, locking and unlocking numerous doors as we went to be presented by a scene of total chaos. Many strange new faces were on the ward (staff responding from other wards) and at the far end of the long central corridor was one of the female patients, on the floor, being restrained. She was shouting and very angry. While she was being restrained another patient sped passed me and ran into the dayroom. What had transpired was that the first female patient (now on the floor restrained), had smashed her plate on the floor whilst about to be served her lunch. She then grabbed a broken piece of the plate and ran whilst cutting her arms. This particular patient had been on a “level 3” observation schedule (this means continuous observation) after attempting to strangle herself a few weeks earlier.

The second patient who had sped by me en route to the dayroom, had seized the opportunity of confusion, to also grab a broken piece of the plate and cut herself too. This patient had been on “level 2” observations (every 5 minutes) for cutting her arms recently. The situation finally came under control but the experience was stressful and something I will never forget. Alarm bell sounding loudly, an influx of staff onto the ward and atmosphere of pandemonium. No clear procedures were in place. Blood was wiped off the floor without gloves. The broken plate had been left in the dining room unattended instead of someone locking the room. Help arrived late and this wasn’t helped by the fact that we were on the top floor and the ward underneath us on the second floor was empty due to renovation.

You may well ask why patients have access to ceramic plates and mugs and the theory behind this os that patients should be allowed a certain sense of normality. Although I believe this is a moot point.

Next post: More about the female patients and their crimes…

Mandy X

 

Photo by Matthew Ansley on Unsplash