#BeTheRippleBlogs - Lockdown, COVID 19 and a Secure Psychiatric Ward

Today’s blog is a contribution from someone who would like to remain anonymous. She is an HR professional in her 40's.

An extremely powerful and insightful post.

Over to our author:

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Lockdown, COVID 19 and a Secure Psychiatric Ward. 

Image is a collection of sheets of puzzles, mindfulness exercises, colouring pens and a plastic wallet. This was the only attempt to offer therapeutic intervention in 2 weeks.

This story looks at when individual kindness gets lost in a system which lacks humanity and mutates to something unintentionally unkind. This makes me wonder if we can accidentally design out kindness, can we rethink and design it in?

The story is primarily about my experience as an inpatient on a secure psychiatric ward during the COVID-19 crisis. I wanted to document some of what I have seen and experienced, not to criticise or to blame, but to understand and learn from. The lessons here can be applied to workspaces too, this environment just amplified them so is a good place to observe and understand. 

The ward had a maximum of 20 patients at any one time and between 6–12 staff depending on time of day and level of need. 

Individually most of the staff showed warmth, kindness and humanity but the stronger collective feel of the environment was different - it lacks humanity- it has no time or space for human emotion. There is no predictable routine to the day, everything is rushed and tempers are often short. I want to understand how it ends up this way - why is kindness not enough to ensure the process is kind? How does the environment and all the processes together create a sense of a forgotten world, a world uncared for, and lacking in basic humanity. 

The examples are small and on their own no more than an irritation, but the cumulative effect is much bigger:

• The staff are busy - when you ask for something it feels like you are an inconvenience, they avoid eye contact for fear of being drawn into a patient’s crazy world. You seem most likely to gain attention if you behave in a way that concerns them, the quiet voice is not heard above the screaming. 

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• I am only ever called the name on my medical record not the name I am known by, despite having corrected people over and over. I stopped in the end as it’s not important, but it’s not the name I use so it is a constant reminder of where I am, and that I am with people who do not know me. I feel like a number. I feel invisible. 

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• On admission I spent 48 hours in an isolation cell - my thoughts were very muddled and I was hallucinating, so many of the things I didn’t have were for my own protection, I get that. The one small thing that stands out - there was no toilet paper, so I remember coming in and out needing to go and being unable, so I just held on. I didn’t drink for much of the 48 hours - these things were most likely linked, but I couldn’t articulate what I needed as I was in a deep psychosis. Every toilet should have paper that’s a basic.

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• My first case review was held after 72 hours - I imagine this is a mandatory timeline but for me it was terrifying. I had no warning, no understanding of the purpose, no idea that it was my only opportunity in each 7 day period to express my thoughts and feelings, to influence what would happen with me. I sat like a rabbit in headlights, the questions were unclear, too big to answer with a fuzzy head, and the only words I remembered were that I should expect to be here for 1–2 weeks. I felt like I’d been punched in the stomach - how can I be away from my babies and my rock for another week or two. I cried and I cried - I was returned to my room without any words of comfort. I was scared. I felt like a child. I cried until dinner and when they brought my meal, I still cried but the tears were invisible, no one seemed to see them.

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• COVID-19 means no organised activities, the only things which provide any structure are three meals and drug rounds. Days are long, I felt like I was being held in a holding pattern awaiting something to make a difference. The culture of medication over talking disturbs me. The only contribution to looking after my mental health was a wallet of leaflets and colouring pages. I feel like a name on a drug chart, the rest of me is invisible.

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• The screaming goes on day and night - some days are worse, some better. The sensory load is high and the bulk of the inpatients struggle with overload already. No one mentions this - there is no visible response to these screams they just go on. The screams are invisible. 

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• The observations are a cursory glance, no humanity, no care much of the time, they are just a voice seeking a verbal response from the other side of a closed door. I have sat crying and again the tears, the distress, are invisible - it just matters that they can tick off I am here. This happens day and night - the lights go on and you are awoken. It is hard to sleep when you are being cared for in this way - it feels cold and just a reminder that you are being managed as a risk, not a person.

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• The items you are and aren’t allowed seem to change and shift - I was allowed my phone from as soon as I moved onto the ward, but not my charger. I had coffee brought in and it was in a small plastic bag - the bag was confiscated?? My nail clippers?? My tweezers?? My pencil sharpener?? The system is not transparent and sometimes it seems easier just to give in. I tried to have a razor brought in so I could shave under my arms as it doesn’t feel nice. I have been told it’s not possible - that feels pretty inhumane, but equally it feels like too big an effort to shift it, it makes me feel a bit dirty and a bit uncared for, so it is important. 

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• We eat alone - throughout the day people mingle without a thought of social distancing (other than during an inspection by a more senior manager where we pretended for ten mins then were told to go back to normal). At mealtimes however the process is we eat alone, this is lonely, I don’t like mealtimes, they make me slump and I have to fight this to not let my mood dip. 

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• I sat talking with a new member of staff, the first conversation with anyone who is not a patient for two days - it was pleasant, a glimpse of normality. The supervisor comes to tell the nurse she is meant to be somewhere else, no excuse me, no acknowledgement of me and again I am reminded I am at times invisible.

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When I tell my family and friends these struggles, they hear me as someone trying to push back at a system or someone resisting help as I’ve done this all my life, but it honestly isn’t. Each thing alone would be no big deal, but cumulatively they present as an utterly crippling environment. I want to trust the process, but I need to be a part of it - I need to be involved and not have it done to me, I need to be seen and heard. 

I am left confused as to why a place filled with people who, by the nature of their profession, care deeply, end up being part of an environment seemingly devoid of humanity. 

I will provide feedback to the ward and they may or may not change because of this, but much of what I feedback would be obvious if they followed the user experience. 

I see many parallels between this and the workplace. It is the small actions and inactions which create organisational culture, where positive intent can be lost in layers of process, where processes dehumanise the person and in doing so cause damage.

What things which are seemingly small do people in your workforce complain about? Can we fix them? Would this have a cumulative positive effect. Why would we not do these things if they have a positive effect. Can we design kindness into our environments.

​How can an organisation's culture shift one ripple at a time?
 

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Thank you so much to our author for sharing such a candid piece. 

This blog really demonstrates the importance of care and kindness in workplaces, for both employees and clients, regardless of setting. Our author gives us some lovely questions on which to reflect on our own work environments, considering whether we are ensuring the best experience for employees and encouraging us to intentionally design kindness into workplaces.

If you are concerned about your own mental health or the mental health of a loved one, the following link will take you to an NHS page with a curated list of helplines and support groups that can offer expert advice:

https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/

Thank you once again to our author for a brave, honest and thought-provoking piece.



If you would like to submit a blog for this series, please send your work via email to: hello@joannasuvarna.co.uk.

See you soon for the next instalment!

Stay safe

Jo 

​#Kindness #BeTheRippleBlogs #BeKind #mentalhealth #workplace #wellbeing