I can make a difference - in small ways

Paul Reet

Openmind 122, July/August 2003

As a mental health nurse, Paul Reet knows he is working with people who experience the same issues he once did

While I was a primary school teaching head I became depressed, which eventually led me to retire early from my career at 35. During this time I had four hospital admissions over four years and one psychotic episode.

Going into a psychiatric hospital for the first time was very frightening. I was struck by how little time nurses spent with their patients. Generally we were expected to find them when we needed them, which was very intimidating. We were sent to occupational therapy a good deal of the time and a programme worked out for us, with no choice. I often found this demeaning, as others did. I hardly ever saw my care plans or had any input into them.

On the other hand, many of the professionals I saw during this time were extremely supportive, enabling me to learn about my feelings and respond to them more positively. Certain nurses stand out for me as examples of good care. They gave me alternative ways to express my feelings, time to talk and negotiated aspects of my care with me. Eventually, I began voluntary work for a charity and then became employed as a paid project worker. These people helped to put my life together and enabled me to believe in myself again.

I embarked on nurse training with excitement. I was encouraged to share aspects of my story to help others' understanding, and this was met with enthusiasm and support. I cannot fault my tutors, on the whole, although there were a few times when I sensed old attitudes. The tutors were up-to-date with mental health theory, policy and practice, and recognised the inconsistencies contained within.

On placement, I was determined to understand from both the staff and patients about how the mental healthcare system helped or hindered those who were distressed. I did not shy away from defending patients in front of nurses and other professionals. I learnt how to put patient's needs and views first and how to work

as a partner in care; something I never had as a patient myself. I often came face to face with my own 'ghosts' from the past, but was able to work these issues through with my tutors and the university counsellor.

My placement as a student in an acute setting was more concerning, however. I was often reminded that I was spending too much time with patients, and when I challenged this I was told, 'They will get to you if you let them'. The gap between Trust Policy, national service framework guidelines and practice on the ward was huge. Patients were not consulted, they had hardly any nurse contact and most were left to their own devices. When I tried to access other services for the patients on discharge, I was often told that I was getting too involved.

I have been working as a mental health nurse since I completed my training in 2002. The things I particularly lacked as an inpatient I have tried to change where I work now. Time spent with patients has to be the most important thing a nurse can offer. The people we care for need to be consulted and negotiated with about how they want to be nursed. Working with families is crucial; the pressure hospitalisation puts on relationships should never be underestimated. Educating carers and giving information to patients about the nature of their mental health problem is also important. Respecting and working with a person's religious and spiritual beliefs is a way into their distress and appropriate care. Also, the physical care of patients is often overlooked when they are being nursed in a mental health setting.

Sadly, much of individual patient contact is made with unqualified staff. I have met knowledgeable and inspiring nurses who are often stifled in their growth by external pressures. There must be creative ways found to release and empower qualified nurses to do the job they were trained to do.

I completed my nurse training with mixed feelings. I was well equipped to nurse but unsure how to break through a culture that often does not meet patient needs nor implement policies that would greatly improve the lives of those who become distressed. I feel that I can make a difference in small ways. I am working with people who experience the same issues I once did. I am still vulnerable to past symptoms, but I know more now about how to handle my stresses and feelings than I did before. I hope that my story will inspire and encourage others who are struggling with the pain of mental distress - and a few of my fellow professionals too!