billiambabble:

Behold my mighty new Thermos flask! I defy this ward and it’s verboten kitchen facilities! #visitinghours

This was the table by the my partner’s bed on Ashby Ward a few months back at the Bradgate Unit, Leicestershire - her stay before last.  Thankfully I was allowed in my partner’s room (quite rare at the BMHU).  At the time J was pretty scared of the rest of the ward and so maybe it was in sympathy with this that I would be allowed to sit in her room. 

Flask aside (which was mine - no breakable ceramic parts by the way), everything could be stripped from the room in an instant if the staff identified a risk and then she would have haggle for safer possessions to be given back to her (shampoo, and a notepad, for example). I’ll probably write more about inconsistent approaches to risk regarding patient possessions at the Bradgate in another post.  This post however is about access to the patient’s kitchen. They didn’t mind so much on that ward about visitors using the patients kitchen, which is fortunate because the nearest coffee machine was usually through a locked door and was often broken.  Some wards are strict on this, and I’m not sure why.  Naturally, the coffee and tea were both decaffeinated on the ward, which always made me laugh because of the huge doses of tranquilizers patients can be given in these environments would probably discount any coffee induced mania or psychosis, but it makes sense I you think like an institution, where you remember the policy but forget the specific reason.

On this ward at this time they were providing wooden cutlery for drinks and snacks.  Unfortunately staff (nursing and domestic) were not good at replacing them, and so two to three stained wooden spoons would be reused, which is unhygienic.  When a handful of (very cheap) spoons went missing (because a patient decided to make a model), staff stopped putting out new ones at all. My partner had also stashed a few perhaps she had discovered that she could break them in half and self-harm by vigorous skin scraping.  As a result, she was able to have a clean stirrer from her private stash for her luke-warm tea (the urn was always set to well below boiling). 

It turns out that the different wards were experimenting with different disposable cutlery, in order to cut down on the use of metal cutlery (which were counted in and out at mealtimes).  On Beaumont Ward they had a similar problem. The patients were recycling the same plastic spoons and staff had to be prompted to restock the plastic cutlery.  Okay, no big deal, just not ideal. Remember: sometimes it’s hard to ask for things when you have a mental health problem which may include acute anxiety, very low self esteem and so on. 

Now, here’s the thing that got to me:  During mealtimes and at night, both the kitchen and garden (smoking area) would be locked.  When I asked staff why this was they all gave different reasons, from “incentives” for patients to behave in a certain way or that patients to be “discouraged” from staying up all night - by socializing in those areas; also there was a shortage of staff to monitor the area during those times. Different staff interpreted the policies in different ways - if you asked staff nurse so-and-so in the middle of the night if you could have a hot drink they might open the door to the kitchen in the night, but as a sort of favor, whereas another member of staff would deny all access and state that these were absolute rules.  I asked why an explanation was not given in the form of a sign as to why the door was locked (there were signs stating that doors will be locked, just no reasons given) and a head-of-wards matron explained to me that any patient could ask staff open the door but the that the risk to that patient was assessed on the spot and it could be refused.  I think I sympathize with how that would be difficult to explain in a clear notice, but not impossible.  As a patient you would pretty much feel at the mercy of whimsy fickle staff.

If I smoked and I awoke from a nightmare (bearing in mind, nightmares can be a side effect of medication and my mental distress) in a dorm with strangers on all sides, a cigarette and a warm drink might be enough to calm me down, generally, both would be out of the question.  Lie in bed until 8.00 am, lots of time to reflect upon suicidal thoughts and feelings of being trapped.

Night-time staff can behave in a way that is sometimes inconsistent with the day staff - it’s an easy, no-nonsense shift, for the night part, that is - and maybe the agency workers haven’t read the patient notes or even know the ward’s policies.  One night (this was a while back on Beaumont Ward), my partner was loitering by her doorway, something she used to do when unable to ask for help.  A nurse at the “station” (a desk) basically threatened her with “seclusion” if she didn’t go back into her room.  Nice.  Wo betide patients who wander about a ward at night.

Anyhow, different unspoken rules of behavior in the day and at night - assumed by staff but unknown to the patients can be very unsettling. The patients have to work all this out for themselves.  Other people control their world, and a lot of the time it’s the first time they’ve ever met those staff.

Back to the kitchen.  During her stay on Ashby Ward, there was a disruptive period of building and repair works where patients were forced to go to other wards in the day (where both staff and patients they weren’t particularly welcome - we swapped some stories with other and visitors patients on this, for those weeks all were inter-ward refugees).  Work on the kitchen on Ashby Ward was unfinished and so the door remained locked in the day as well as night. Eventually a dispensing flask for hot drinks was provided (there were two - but apparently the one belonged to the doctors and had to be returned to a meeting room). This was on a battered trolley.  To make matters worse the drinking fountain had been disconnected. This Summer was particularly hot and there were ants collecting on the trolley, drowning in the dark spillages of sugar and water. As always something slightly out of the normal routine was being poorly managed.  Without access to the kitchen, cups could not be washed.  Sometimes staff would take it upon themselves to “freshen-up” the trolley but generally the flask wasn’t being refilled enough for all of the patients on a 20 bed ward.  About this time my partner had a urinary infection - which can be partially brought on by dehydration.  I read an article a while ago which stated a quarter of all NHS related deaths were kidney damaged related and were basically avoidable if patients were provided with adequate hydration.  It goes without saying that J likes her cups of tea.  It is for her one of the few consistent factors in her day to day life, regardless of crisis level or surroundings. 

We made complaints. I’m pretty sure everyone made complaints, but the staff kept shrugging.  The trolley was replaced by an ant free table and this dragged on for a couple of weeks if I remember correctly (maybe a month from the start of the repairs).  Apparently there was an issue of risk, a possible non-collapsible ligature point (i.e. something you can hang yourself on). It may have been relating to an exposed cable, which had been pretty much exposed for most of J’s stay up until that point.  The real reason we were told in response to a letter was a stand-up row between two departments over paying for the workmen to return to finish the task. 

Bear in mind that this is a public area on the ward - not a shower room, not a secret corner behind a wardrobe in bedroom, but in a kitchen where people are coming and going most of the time.  Risk is minimized by observation, and patients can be pretty could at spotting a problem with another patient when staff are not present.  For patients confined to the ward, not having access to the kitchen and drinking fountain, must have been particularly unpleasant.

My flask contained hot water for myself and J, although it was mainly for myself, since she had been getting confident at asking staff to refill the pathetically small dispenser flask.  And yes, we were complaining.  Incidentally I’m pretty sure I wouldn’t be allowed to bring out a flask in some of the wards.  That really hate visitors making themselves comfortable at the Bradgate Unit.

Eventually, whatever the problem was, the offending risk or unfinished work was eventually completed, but this was after much unnecessary disruption to the patient’s day-to-day experience.  As always, the communication of what the problem was and the temporary solution was appalling. 

About a week ago on Bosworth Ward something happened in the garden-yard - I think a patient had attacked a window (most of the windows are plastic, but maybe there was some mesh glass somewhere) and pulled away some fencing (another visitor told me).  The garden then remained locked and out of bounds for the rest of the day.   Again, it was still Summer and the air-conditioning is non-existent.  One patient got themselves so wound up about not going outside that we saw her feint.  Again, on a locked ward, if you are a smoker, not being allowed outside to smoke is a big deal, although I believe the patient in this case just wanted fresh air.  Also please note that on the older wards the windows only open a few centimeters.  It’s all on the ground floor, by the way, in case you thought that windows with restricted aperture was relating to safety from falls.  

I’ve done a few courses on regarding risk assessment and safeguarding vulnerable adults, and I know for a fact that I could have managed that situation much better.  For example, one member of staff (and they all carry alarms) could be present in the garden for short periods, at least allowing some access to the outside.

I think what I’m saying here is that blanket one-size-fits-all-risk decisions are made in the name of patient safety, or an easy running of the ward (like at night) can in fact trigger anxiety in the maximum number of patients at once.  Something has gone wrong with the way safe-guarding policies are applied at the Bradgate Unit, in a building which is unfit for purpose and the staff are unable to adapt to simple problems, to the point that the the quality of life of patients is reduced, and even basic human rights are affected.  It’s also worth remembering that a fair number of patients have absconded from the wards and killed themselves.  I doubt that management at the Leicestershire Partnership Trust would even begin to acknowledge disruption, inflexibility, a inability to management the environment and poor quality of patient day to day life as a contributing factor or trigger to deaths at the Unit.

And that’s before we get into the issue of staff not being available for promised escorted walks or off-ward visits.