12 Things I Want Mental Health Professionals to Know — From an Ex-Patient

Almost four years ago I was admitted to a psychiatric unit where I would spend almost a year detained in the hospital, I was told I would be a “revolving door” patient, and in a way I guess I am because I am going back soon, as a mental health support worker.

Support staff are the backbone of psychiatric units — they have the most contact with patients, up to or over 12 hours a day, it is their responsibility to observe them, support them and keep them safe. Their attitude and competence can make or break a ward.

So from an ex-patient to current or future support workers, these are the 12 things I learned in my admission from the staff and from my experiences that proved invaluable to my recovery; the principles and values I aim to stick to during my career, the principles I hope my colleagues agree with and principles that hopefully one day become standard practice.

1. Treat every person equally, with dignity and respect.

No matter who they are, where they come from, how they treat you and what they’ve done. You’re allowed to have favorites, it’s natural; but you are not allowed to make that obvious

2. Treat everybody as an individual.

What works for one may be harmful to another. Get to know your patients, learn what works best for them and share this information with other staff. You can’t be on shift 24/7 and everybody needs to be aware of patients individual needs to be able to effectively work as a team to treat that person

3. Listen to understand.

Don’t argue, blame or assume you know how they feel because you probably don’t. Pay very close attention to what they are saying as they may casually drop crucial bits of information into conversation because they don’t know how to bring up the topic, to see if you are really paying attention or they may not see it as significant. You must also respect their boundaries; do not pressure them into speaking about something they are not ready to speak about, they will open up when they feel safe and comfortable enough to do so.

4. Don’t take anything personally.

You are working with unwell people in an alien environment, often detained there against their will. They may feel confused, angry, scared, trapped — they will be feeling emotions you may not be able to imagine. They may be hearing or seeing things you cannot. 90 percent of the time patients don’t want to hurt staff physically or emotionally. They are feeling intense emotions that can cause them to lose control — it may be a result of a symptom of their illness, it may be a fight or flight reaction. Which brings me to my next point…

5. Every day is a fresh start.

You can never hold a grudge on a psychiatric unit. If a patient has done or said something to you in a previous shift, the next time you see them you greet them by name, with a smile, as you always would. Remember they are unwell, they are most likely feeling unbelievably guilty and ashamed, so go about your day as if nothing happened. Don’t bring up the incident unless they do. If they do, acknowledge their apology, let them know you understand it was a symptom of their illness, let them know that as far as you are concerned. It’s in the past and do not blame them, don’t dwell on it. Change the conversation by asking about their day/plans for the day, etc.

6. Expect the unexpected.

Be attentive — always. If they have a plan A, they most likely have a plan B and C as well. Just because you have removed a known risk doesn’t mean they won’t find something else to possibly harm themselves with. Mental health patients can be some of the most intelligent and creative people you will ever meet, however, when unwell this can create additional risks. Think outside the box, because they probably are — they know what we know and if they are determined enough they might search for new ways to harm themselves that are unbeknown to staff.

7. You can use it until you abuse it.

While maintaining patient safety, try to be as least restrictive as possible. Remember it is staffs responsibility to keep patients safe, not patients. Even if the patient has gone somewhere they shouldn’t or accessed something they shouldn’t have, you must never react in anger. If a patient has a restricted item or is in a restricted area it is often due to an oversight or even neglect by staff. They are under your care, they are in there because they cannot keep themselves safe and it is your responsibility to do everything you can to ensure they are safe.

8. Trust.

Trust is essential in building a meaningful therapeutic relationship where your patients have confidence in you. Trust is a building block of recovery. If you say you are going to do something, do it. If circumstances mean you can’t, explain why, apologize and see if there is an alternative time or activity that can be facilitated. Never lie to your patients. If you have to do something or tell somebody something, make that clear to them and explain the reasons why. Trust is important but secrets can be detrimental.

9. Deescalation, deescalation, deescalation.

Alarms, response, restraint, etc. should be your last resort. Most situations can be verbally deescalated if staff have the right skills. More often than not it makes the situation worse for the individual and causes distress to others on the ward. However, do not be ashamed to ask for help if you feel you’re in over your head — patient care is more important than your pride. If your presence is causing more distress and it is safe for other staff and patients, remove yourself from the situation. You can address the reasons why when the patient has calmed down.

10. Build on the positives.

As I’ve already said, psychiatric patients can be the most intelligent and creative people you will ever meet. Build on this, notice when they’ve done something different that is positive, no matter how insignificant this may seem to you — but don’t patronize them. It doesn’t have to come in the form of praise — this can be seen as patronizing for minor things. A simple statement showing you recognize the change is enough. For example, “I notice you’ve done your hair today, it looks lovely,” or “Your room looks very neat and tidy.” However, if it is a big deal to the patient or a major thing and they are excited about it, get excited with them! Show them you are happy for them, you are proud. Celebrate every success just as you would document any incident. Sit down and work out ways to use their intelligence and creativity in a positive way, and express their energy and negative feelings in non-harmful ways. If they are aggressive they likely have a lot of pent up energy. Take them to the garden and play sports with them or take them to the gym if the hospital has the facilities. If you have noticed they are particularly creative in finding ways to harm themselves, sit them down and find out if there are any sort of creative projects they could do as a distraction. If you have noticed they like to write a lot or are very articulate, suggest they could try creative writing, poetry, letter writing or starting simple things like gratitude lists to get their feelings on paper so they are able to better understand and make sense of them. This can be particularly helpful for patients who aren’t good at expressing their feelings verbally.

11. Your patients need to know you believe in them.

I had comments made to me such as “you’ll be a revolving door patient,” “you’ll never be off medication,” “you’ll end up spending a long time in a secure unit” and more. I’m a very stubborn person — being told I can’t do something makes me determined to do it. For me, this sparked the seed of determination to prove them wrong, to not do what they expect, to make something of myself. It is rare that a comment such as that will ignite such a response from a patient. In most cases, to most people these are crushing comments to hear. You are often devoid of hope in a psychiatric unit, you already believe you will be like this forever or you will die as a result of your illness. Often, you want to die as a result of your illness. Regardless of how long they have been in the hospital, how severe their incidents are or what you personally believe, every patient on your ward must feel as if the whole staff team believes in them and are behind them to support them through their recovery. Sit them down and ask about their plans for the future, ask where they want to be in five years. If they say something self-depreciating or simply say “dead,” ask them again. Ask them where they would like to be in five years if they were still alive, ask them if they had recovered or their symptoms were managed where would they like to be in five years. Phrase it in as many ways as you can think of. Repeat yourself like a broken record, and try not to let them create a self-fulfilling prophecy. No matter how much someone may want to die at that moment in time, there is always a tiny seed inside of what they would like to do if they didn’t struggle with this illness, or a dream from before they were unwell. Remind them of their positive qualities, suggest things they can do with these qualities and skills they can build.

Do not give up, if you have to say it a thousand times, say it a thousand times; and when you have an answer, make them plan. Get them to set goals, encourage them, support them, show them you believe in them. This really works — an amazing support worker did this to me. It took days and most likely a lot of me screaming and shouting to come up with a response to her question of “Where do you want to be in 5 years?” that wasn’t “dead.” Eventually I came up with three goals — move to Manchester, volunteer abroad and work in mental health/become a mental health nurse. She made me print out hundreds of pages of information and things to motivate me. I still have it in a folder and I still look through it whenever I’m feeling low to remind me what I’m fighting for. And guess what? I’ve almost been out of hospital for three years, I’ve volunteered in the Dominican Republic, Tanzania and Jamaica in two hospitals and an orphanage, I’ve just signed my contract to do support work, I still plan on moving to Manchester, but I’m currently living at home to save for six months of traveling next year. I’m living my dream — I’m living proof this works.

12. Patients are people too.

Treat them as you would like to be treated. Treat them as you would like your parents/spouse/children/loved ones to be treated. Think about how you would feel in their situation, and how you would react if someone did to you what you are doing to them. Really think about it, try to understand, try to empathize. A quote I came across in a book, “The Locked Ward,” words this far better than I ever could:

“Patients are not just people like you and me; they are you and me — you and me and the guy next door and the girl you went out with, and your brother and sister, and mother and father, and son and daughter — just people who happen, sometimes once in their lives, sometimes on a chronic basis, to contract psychiatric illness. It’s been estimated that a third of us will meet the criteria for major psychiatric illness at some point in our lives. All of us know stress, anxiety and hopelessness. The fears and concerns, hopes and despairs experienced by patients are experienced by the rest of us. Sometimes it is just a question of degree.”

I am an ex-service user, going back into services on the other side. I have many friends who are also ex-service users who are working their way toward being on the other side of services themselves. Nobody knows the system better than we do. I believe service users of the past will be the best service providers of the future, and can contribute to long-term change in mental health policy and practice; and also contribute to improving the lives of individuals so they too can come out on the other side and see what life has to offer, just as all the support staff did for us.