It’s 5am. An hour ago the bed manager called me and asked me to ask a suicidal woman, who had already been in a busy London A&E department for 11 hours, if she would agree to being admitted to a hospital in Manchester.
I didn’t think it appropriate to wake someone at such a time in the morning but allowing her to sleep was not an option because we need the bed space. I approach the patient; she’s already awake. “I haven’t slept all night, it’s so noisy here” she tells me. “I feel awful; can’t I just go home?” I apologise and explain that the only available psychiatric bed is in Manchester. “No, it’s too far from my family”. I tell her I understand. She starts to cry; I want to cry with her. She feels depressed and worthless and I haven’t been able to help. How am I, as a psychiatric nurse, caring for her and helping lift her out of the awful dark place she finds herself in? I think about people who are in physical pain and ask myself whether we would expect them to wait without any treatment for over 11 hours.
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I remember a recent patient who had been in the department over 24 hours waiting for a psychiatric bed. He was socially isolated and was hearing voices telling him to end his life. We moved him to a noisy cubicle which made the voices worse. He was in distress, I tried to reassure him. He told me: “I just want to go home, it is making me worse being here”.
I was told later that he had left the department. I frantically called him and fortunately he answered to tell me he had returned home. He said he was frightened but that it was worse in the hospital. I felt immense guilt – this isn’t why I became a nurse. What if he becomes ill again in the future? He will feel reluctant to return to A&E, the place that his community mental health team tell him to go to be safe.
A young man with autism, who has been in our mental health assessment room over 24 hours, is suffering from psychosis. The walls are bare, the air conditioning has broken, the lights, which are movement sensitive and without a switch, remain on throughout day and night making rest impossible. He is covered in sweat and he is terrified. The long wait and his surroundings make him increasingly more distressed. He is eventually sedated – not for the treatment of his condition but rather to alleviate the stress we have caused him.
I tell both him and his mother that the nearest psychiatric bed is 200 miles away. His mother starts to cry; due to the nature of his condition, he finds change very difficult.
Some of the other nurses have children and start to cry themselves. The treatment and care we offer is not of the standard we would expect for our own family and loved ones. The patient’s mother tells us she doesn’t want to leave his side. We talk to senior management, but there is nothing that can be done.
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I watch as the young man is separated from his mother and forced into secure transport – a cage in the back of a vehicle, with a narrow sideways facing seat, and without adequate leg room; it’s hardly fit for a brief journey, let alone one of four hours. I feel ashamed. We have failed this young man and his family.
We take a referral for a patient who wants to end their life. My heart sinks because the bed manager has told us there are no beds. I have to look the patient and their family in the eye and apologise over and over again. I see patients who are acutely disturbed, suffering because of our inability to provide them with appropriate care. We try our best, but there are only two of us on duty – sometimes we have four people waiting for an inpatient bed and 10 patients waiting to be seen. We have to rely on security, who try but are not trained in mental healthcare and sometimes add to the patient’s distress.
I witness human suffering every day and am often amazed by patients’ own resilience in the face of such adversity. Hospital staff are their family, their voice and if we don’t raise this issue for them, it will continue because it is those who speak the loudest in the NHS that are often heard. Our patients already feel worthless and as though they are a burden; if we continue to reinforce that, rates of mental illness and suicide will continue to increase.
• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.
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I fail patients in my job as a psychiatric nurse and leave them feeling worse
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