In the middle of this unprecedented crisis, the psychiatric ward I work on is among the many frontline services striving to keep people well during these strange and uncertain times.
The key word in that sentence is ‘people’. On our ward, we are looking after individuals, not statistics – and individuals all have different needs. There is no one size fits all in any hospital environment, and our ward is a strong example of this.
At St Andrew’s, we run numerous wards for people needing specialist care for a range of psychiatric problems. The ward I work on is one of a kind in the UK: a deaf specialist medium secure psychiatric ward for men. All our patients are either profoundly deaf or severely hard of hearing, and British Sign Language (BSL) is the first language on the ward.
‘Business as usual’ for us involves supporting people facing debilitating mental health challenges, as well as significant communication barriers. You could, of course, argue that in many ways ‘business as usual’ doesn’t exist in our job, because no day is the same. When it comes to mental health there is no uniform approach; a coping therapy for one person may not work for another, and on a deaf psychiatric ward patients will also have different ways of communicating. Throw the coronavirus threat into the mix and our patients – and our staff – have an awful lot to consider on a day-to-day basis.
“Working with mental health patients means socially distancing, and remote working just isn’t possible.”
If we think about how coronavirus has affected the wider population, we know that anxiety is high, and we know that we need to socially distance or wear PPE if treating members of the general population. Now imagine you live with extreme anxiety or paranoia, as many of our patients do, and you can imagine having your temperature checked regularly or being cared for by someone wearing PPE can fuel that anxiety further.
But PPE isn’t optional in a hospital – working with mental health patients means you often have to come into close contact, so socially distancing, and remote working as part of the nursing team isn’t possible. We’re dealing with people’s wellbeing, and offering them round the clock support – you can’t manage crises by Zoom. So being present, with PPE, is a requirement for us.
For our staff and patients too, the masks add another problem. The masks we wear to protect each other from covid-19 make things like lip reading and facial expressions virtually impossible, cutting off a huge amount of our ability to communicate with our patients – and indeed our staff, half of whom are deaf themselves. That combination of increased anxiety and new barriers to communication gives us a really challenging situation to manage.
Luckily, I’m fortunate to be surrounded by passionate and driven colleagues – people who really care about their work and want to help some of the country’s most vulnerable people.
Having that passionate and driven team is, I think, what led to us managing the covid-19 crisis on our ward effectively. As soon as we heard about the virus affecting other European countries, we knew we needed to be proactive and consider the risks to our patients and practice. We changed hand-washing areas and reduced external visitors in the very early stages before lockdown, so we were able to gradually get patients used to change prior to the Government’s social distancing rules coming into play. We translated news headlines and advice into pictorial guides in the form of posters. And we asked our patients to get involved in the creation of these, to ensure they felt part of the process and really understood the impact. Patient involvement is key because the service exists for them. They must be at the heart of everything we do, to ensure that we are delivering the right support as needed.
“We’re all exhausted, we’re worried about the future, but we know our first duty is to keep our patients safe”
In our line of work, my team are used to adapting quickly to unexpected crises – but the covid-19 pandemic has made that pressure relentless. Going home feeling drained after a difficult day has become the norm. Our team are working on high alert and at full speed every single day – with no idea as to when this might end. Not knowing when the light at the end of the tunnel is likely to appear is incredibly tiring and disheartening and I do worry how this crisis is going to affect the mental health of all people on the frontline.
I know I need to look at post-crisis staff support, but I am so incredibly proud of the team and how they have put the patients first – never complaining, adapting to whatever changes we need to make and rolling their sleeves up. Throughout this outbreak all frontline workers have stepped up – not just on my ward but across the nation. We’re all exhausted, we’re worried about the future, but we know our first duty is to keep our patients safe. That’s why we signed up to this job, to make a difference and help people during their time of need.
But on my ward one of the things that has really kept everyone going is seeing the response from patients. Every Thursday they go out into the yard to clap for us – in BSL this involves waving your hands in the air much like a wave. We’re also extremely grateful for the wonderful thank you letters from patients’ friends and families.
We love what we do, there’s no doubt about it. That’s why I wanted to write this piece: to thank my amazing colleagues, but also as a way of showing that every key worker experiences a different challenge.
And I think it’s good to hear those stories and share our experiences to remind us all that the crisis isn’t about statistics or services. It’s about people.
James Wyatt is a ward manager at St Andrew’s Healthcare
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