I’m a mental health nurse- AMA

[Tethersend01]

I’ve been a mental hear nurse for 27 years, I’ve worked in inpatient and community, all in adult care but I’ve never worked with Children’s services. I know work in a service thats a bit like a general triage service for everything. Happy to answer questions about my role or any general type of mental health queries!

How often do you have patients with ocd in terms of intrusive thoughts, pure ocd? I'm interested in how common it is. My teenage child has awful ocd and I know lots of people think of ocd as being neat and tidy and don't realise how mentally debilitating it is.

My second question is have you seen people with severe ocd get better and live a normal ish life 🙏

Hi, I see OCD a lot, most days I would say. Pure ‘O’ or intrusive thoughts are a bit less common but I still see it quite a bit. I think it fan get missed more easily as there is little to no obvious behavioural component. CBT type therapy and exposure therapy are generally considered. Effective treatments but change can be tough snd take time so I always advise people to go into it expecting it to be tough and pretty challenging, as. otherwise people can feel treatment isn’t ‘working’ and then drop out before they’ve given themselves a proper chance. Medication can be incredibly helpful too for many people, mainly in providing enough symptom control to enable them to cope with the psychological therapy.

@Lovetocare yes absolutely with the correct therapy and often medication. Xx

Thanks very much for your replies.
Do you think ocd cases have grown in more recent years than when you first started?

This is sensationalist, but what's the most shocking thing you've ever seen?

Do you admit disabled patients with autism because there is nowhere else for them to go?

Have you ever worked with fellow staff who you think were in the job for the wrong reasons? My ex husband was sectioned multiple times and during his stays on the higher security units (as he’d been aggressive) there were some staff who seemed to take a little too much pleasure in the physical restraint/bellowing at/intimidating patients side of things. It made me quite fearful of what might be happening behind closed doors. (This was only in the higher security units - on the regular wards and units every other member of staff I encountered over the years was the very model of long suffering patience and restraint btw - I admire you for doing such a challenging job).

Do you have any tips for weaning off antidepressants? I had post natal depression with terrible insomnia. I've recovered well with counselling, and Mirtazapine 15mg every evening. I'd like to wean myself off eventually but kind of scared that my sleep will be affected!

Just wanted to say thank you.
The NHS mental health team saved my life when I suffered psychosis. So, SO grateful. And so happy mental health is more accepted nowadays and not only to a selected few.

@thepatronsaintofbubblewrap sadly I’ve cared for people who have harmed or damaged themselves in very severe and (even to professionals) shocking ways. I wouldn’t describe these situations in a public forum but memories if those people have stayed with me over decades in some cases.

Thank you for all you do.

1. How much training do you get in trauma informed approaches and formulation now compared to diagnostic categories of the 80s?
2. Do you attend clinical supervision or reflective practice to develop your skills?

@Itisbetter i don’t work in specialist autism or LD services but there is a fantastic purpose built unit on site where I work which caters specifically to people with the more complex or severe presentations of autism/LD. I assess many people with autism/ ADHD/ neurdiversity issues. Not sure if thats answers your question though?

No I was interested in autistic people who had been admitted into non specialist facilities

Sorry if this is a stupid question, but are there sources of support for family or partners of people living with mental health distress such as severe depression?

I'm not in this position personally but close to people who are, and who are struggling.

@Isthisexpected My particular role is formulation based, I have had additional training in formulating and I really enjoy this aspect of my role. And yes nearly all of the nurses in my team have done additional training in trauma awareness/ trauma informed work also.
i would say 75%+ of people i assess have experienced some degree of trauma sadly.
Yes I have both Clinical and Management Supervision and we have formal daily peer supervision, luckily I work in a friendly snd supportive team.

@Ringringringringringringringbananaphone The honest answer is yes I think there is a very small minority of people who are in the wrong job for the wrong reasons and often its not deliberate malice but a lack of personal awareness or empathy. People can also become desensitised or just plain afraid. I’ve had colleagues who have had sustained severe life changing injuries whilst at work.
i would definitely say that they are very few and far between and things have improved greatly over the course of my career.
i personally found inpatient facilities overwhelming and i hated restraining people however sadly sometimes it is necessary but Its a traumatic part of the job and 10 x worse for the patients.

Thanks.

Whilst really sad that is great to read that those people will be identified as having gone through trauma and supported appropriately.

Your team sound lovely!

@Vallmo47 so pleased you have come through your experience, psychosis must be do terrifying! Xxx

@feellikemyselfagain Theres no reason you should struggle to wean off mirtazapine but the main thing is to just take it slow and steady, there is no rush so don’t put yourself under pressure. depending on your current dose and duration of treatment it might take weeks or a few months. Its always a hood idea to discuss a weaning plan with your GP or mental health professional as they will know you best. In terms of when to come off, as a general guide we suggest for first episode depression to remain on your meds for a minimum of six months AFTER your symptoms have resolved or if it’s your second or more episode then two years after symptom resolution.
making sure you address lifestyle factors before starting to wean off is also helpful ( looking at obvious stuff like sleep hygiene, caffeine intake, getting fresh air and exercise) will also set yourself up for success.

Is dissociative disorder (I think it’s called or something similar?) is it caused by a mental health disorder or a physical health condition such a brain tumour for example or even both? Thanks

@JennyForeigner yes all areas should have a carer support service who can offer appropriate help dependent on whats needed. Services can vary in exactly what they offer but anyone can request a carers assessment, often it funded by the local authority so that wound be a good place to start. Some areas also run specific groups for specific issues, for example groups for people supporting a family member with personify disorder.

@jimmyABC dissociative identity disorder is incredibly rare, I’ve never heard of it being caused by a brain tumour, its generally thought to he caused by early trauma.
Dissociation ‘on its own’ is much more common and again its a mental health problem, again closely linked to traumatic experiences.

Do you feel that those who suffer with dual diagnosis of substance misuse+mental health illness are supported enough/recognized?

Do you ever feel that it becomes a battle between CMHT and the drug agency to actually get the service user the support they require?

Thanks for the work you do I know it's tough. My question is about psychiatric hospitals. I've been sectioned a few times to various hospitals across England. Why aren't they more therapeutic? Everytime anyone kicks off horrible alarms go off to get staff to get to inject them making everyone anxious and jumpy. Couldn't pagers be used? TVs are always blaring, there is never any counselling or therapy only drugs and some pretty rubbish activities. I once was offered relaxation classes and that was great but that was 30 years ago. Is it cost? Or lack of understanding of how scary it is to be an inpatient (even as a semi regular!)