Saturday, 21 April 2012

The importance of family support

Fourteen years ago, after working  11 years at mental hospital wards  I started working as a community psychiatric nurse. A month later I had to take my partner to a psychiatrist because he was psychotic. An unexpected  experience.

It started on a Saturday. We decided to wait till tuesday  so we could see the GP we knew. Monday was a bank holiday.Things got worse over the  weekend  and I had no idea where it would end. Although I was familiar with psychosis it was like getting hit by an avalanche in mid summer. We only just met a year and a half earlier.

On tuesday the GP referred us to an office for mental health that same day. We were welcomed very friendly by a  CPN who knew I was a colleague from another hospital. He took us to an office. A few minutes later he introduced us to the psychiatrist who seemed  unpleasantly surprised . His words: “ It is not usual that family comes along unannounced” . Then he shook my hand reluctantly.
That is not the best way to introduce yourself  to a highly stressed person with an adrenaline level way beyond that of the average marathon runner. I can’t imagine a doctor of an emergency room would have said the same if my partner would have had a heart problem or an accident. This was an emergency  as well. A psychiatric one. 

During the visit my partner only told about 40 %  of what had happened - being distracted and paranoid. After some time I added a few things to the conversation but I was being ignored  by the psychiatrist.  And when he finally asked me: “Do you have any idea what psychosis is?“ I was so mad that I answered very calm : “ I have read some about it a while ago”   
He wrote a prescription for an anti-psychotic  and handed us the piece of paper. I asked him to add Biperiden in case of side effects.  I guess he had not expected that because he looked a bit confused. He wrote it down and wanted to say something but I felt too reared for further conversations. I felt like yelling  , throwing things around or burst into tears and I didn’t want to do either one of them. If you come for help the last thing  you need is people who make you feel  worse. A few minutes after we got home the phone rang: the  psychiatrist. He asked me if I could come long next time.  I asked him if he would  have called if I had not been a CPN. Later on we talked and things went better. He learned from the experience. 
And so did I. Although I always had a focus on family support : really knowing the despair, fear and frustration helps to keep it on top of the “to do”- list and encourage others to do so. This was just a bad experience, educational though. Many psychiatrists do an excellent job.

Family support is an important thing in mental health care. Ifcourse there are very dysfunctional families  and some people have caused problems our clients are facing now. No need to deny that and very important to take that into account. But most of them have good intentions and are willing to learn and help.And they usually know their ill family member better than we health professionals do. We shouldn't consider ourselves too important but see family members as team members. 

Psycho-educational family interventions and family support can reduce relapses, readmissions and suicide risk. An important part of our work because it benefits to the welbeing of our patients and a better future for them.

Many family members have felt left alone by mental health care in the past on more than one occasion.Imagine yourself in their shoes and do the best you can to make their next experience a better one.
If family  is visiting a hospital ward make them feel welcome and comfortable. That will make it easier for them to visit more often. For mental health workers a mental hospital ward might be an everyday thing but for visitors it’s often a very  unusual scary place to go , especially the inpredictable crisis wards. If possible give them a quiet place to talk and relax. Encourage family and friends to stay in touch. 
Loneliness is a huge problem for people with mental illness. And it is important to prevent that as much as we can.Giving good information and support to friends and family can make an important difference here.


Sunday, 8 April 2012

20 Commandments for Mental Health workers

  1. Thou shalt respect your patient and not judge
  2. Thou shalt increase the well-being, opportunities and happiness of your patient
  3. Thou shalt be in time for appointments and phone calls. It will show your patients that they matter
  4. Thou shalt have a well-chosen and well-timed sense of humour
  5. Thou shalt reconsider your ‘professional distance’ if it makes your patient feel he stands alone; show that you are a person too
  6. Thou shalt not let your bad mood or personal issues influence your professional attitude
  7. Thou shalt have an open conversation if your patient is suicidal and give good support and protection if necessary
  8. Thou shalt not hide behind a newspaper or smartphone on the ward or make any other unapproachable impression otherwise
  9. Thou shalt not hide and chat in the nurses’ offices but be with your patients as much as possible to create a safe and friendly environment
  10. Thou shalt consider family and good friends of your patient as team players (unless it’s impossible) and support them well in the interests of your patient
  11. Thou shalt inspire and support your colleagues to make mental healthcare as good and friendly as possible and ask and give feedback on a regular basis to become a ‘winning team’
  12. Thou shalt inform your patient well about side effects of medication, observe well and help to find solutions if needed
  13. Thou shalt not avoid the subject ‘sexual side effects of medication’
  14. Thou shalt help your patient to get good dental and physical care and support them on doctor and dentist visits if needed
  15. Thou shalt help and support your patient to exercise on a regular basis to increase their health and give support to decrease smoking.
  16. Thou shalt support your patient to overcome financial or housing problems and fight bureaucracy
  17. Thou shalt listen well to the patients' aspirations for their life and give support to achieve them
  18. Thou shalt stand up for the rights of your patient
  19. Thou shalt fight the stigma of mental illness at every opportunity
  20. Thou shalt help your patient to keep up hope

 © Nursewithglasses 2012-2013