Any psychiatric nurses here? Need info re ward procedures please

[Bloodybridget]

A friend is in a secure ward in a psychiatric hospital - she has suffered from severe mental illness all her adult life and has spent lots of time in hospital. Atm she is very scared and anxious, and is phoning me several times a day with various complaints. I know most of her worries are not based on reality, but obviously mentally ill people are very vulnerable, and I have no idea what safeguarding rules would be in place.

Would male staff be allowed to watch female patients through door hatches or enter their bedrooms alone? Or indeed would any member of staff be on their own with a patient behind closed doors?

I am not next of kin and although I am trying to see her once a week, it doesn't feel easy to ask questions of staff there. I'm not in touch with her family (she doesn't have a partner or children).

I'd be very grateful for information.

I am a psychiatric nurse but not working on the wards now. If your friend is in a secure ward she will be detained under the mental health act. If she is requiring close observation then a male nurse could reasonably observe through a door window. Regarding a male nurse going into her room it would not be impossible but if your friend has difficulties with male staff such as paranoia , history of trauma, it would be very unlikely a male nurse would be unaccompanied in her room for everyone's protection.

Thank you dottycat. AFAIK she does not have a particular history of traumatic events with men, but she is paranoid and delusional when she is ill. I worry that I keep trying to reassure her about everything, but what if she was being abused in some way, and I didn't believe her or try to help her?

It's very unlikely she is being abused , I would mention it to staff when you visit to highlight your concern . Knowing she is paranoid it may be part of a delusional system she has when ill. When you visit observe the general atmosphere and interaction of staff with patients and raise anything that is a worry. There is little point in trying to convince someone who is paranoid their ideas are not reality based, I would suggest trying to acknowledge that it must be scary to have these worries but try to move conversation to neutral topics. Hopefully the symptoms will lessen with treatment.

It sounds like she’s on supportive observations because of risk to self or others. Male staff could be involved in this, but if that’s making her worried let the staff know and ask if they can care plan for it only to be female staff and ensure staff let her know who is observing and why.

Thanks to you both. I don't particularly like the way the staff interact with patients but haven't seen anything to cause concern. I will try to speak to someone about her anxiety re male staff - actually they are probably all well aware of it as she doesn't hide her feelings! She has called the police more than once from the ward.

Hmmm I was in a psych ward a few years ago and the staff were awful, treated the patients like criminals. I would be inclined to believe her.

I'm so sorry you had that experience, Devonshire. To be fair, when my friend is well, she always says how kind the staff are (in various hospitals, not just this one). But this time some of the staff do seem abrupt and impatient, sound as tho' they see the patients as a nuisance. OK I couldn't do that job, but . .

Another one with experience and I would say that it is perfectly possible for abuse from staff to go on. It honestly wouldn't surprise me, which is not to say it is happening, but don't be too easy to dismiss.

Abuse in psychiatric hospitals isn’t uncommon at all. I’d be wary of not believing her.

From experience with an immediate family member who was sectioned, abuse most certainly does go on. My relative was sexually and physically abused whilst in hospital, and although it was by another patient it was in a situation where staff should certainly have been supervising interactions and should have intervened. They didn’t, and wouldn’t report it to the police/safeguarding team as we requested.

I know this will seem like I am being defensive as a psychiatric nurse but honestly there are plenty of good,caring staff. If when your friend is well she reports a different experience then that is in keeping with her current view reflecting mental illness.

Thanks to everyone for your comments and different perspectives. It's very difficult to know how to support my friend. Several times a week she asks me to phone the police; she told me yesterday she had been attacked with nerve gas. I can't possibly give credence to everything she says, but I wish I could see her more often and talk to the staff.

How about writing a record of each allegation, how often and the times she says it’s happened? This would help you to see if there is a pattern.

Just because she’s suffering delusions does not mean that everything she says isn’t true. Sadly, abusers are often drawn to working with vulnerable people.

Fission her narratives aren't clear enough for me to do that - when we speak on the phone there's a lot of background noise, I find it hard to hear what she says and her words are confused/confusing. She leaves voicemail messages throughout the day and night on my mobile and landline which are also hard to follow, and I can't tell if one "incident" is being reported to me several times.

Obviously she has some persistent anxieties which could be due to actual events and conditions on the ward. I started the thread to try and find out if there are generally established safeguarding procedures in acute wards which would mean some of her allegations, if true, would mean rules were being contravened; then I would have grounds to ask staff about what's going on - for example "X says male staff are coming into her bedroom without knocking, I believe that shouldn't happen so can you confirm what procedures are followed here?"

I have found male staff in the local unit where I have been many times, very good. If they are going to talk with somebody esp females on their own, they take the person into one of the sitting rooms, the courtyard, the OT room, the foyer with armchairs quietly this means they are not entirely alone with someone but they have the privacy to speak with someone but are within view of other staff and cctv.

They dont enter the female bedrooms to speak to patients alone. However the bedroom door has to be wedged open with a shoe at night so they can do their obs, or when on specials 1-2-1 they have switched over with female staff when it came to personal stuff like having a shower (usually after an argument about having it).

Otherwise they will sit at the doorway of the room and watch the patient, only entering if absolutely needed if the patient is about to harm themselves and by that point will hit the buzzer 1st so there is staff hot on their heels to help diffuse the situation.

The obs window in the door has to be open during the day except when changing clothes or getting dressed and patients are encouraged to do that in the en-suites so that there is no reason to touch the obs windows.

However, there is still the potential that your friend may be abused. I would as pp advised, for now, take as many notes of what your friend says as you can.

Wait until she is well and let her tell you how things are or if she wants to touch back on that subject. Support her then to access other help and report as needed.

It also means she is out of the situation and while her potential abuser might be suspended the fall out may impact her while in the unit from the other staff.

If she is also paranoid and delusional right now, then she may not be listened to properly while she is ill as it may be put down to aspects of her illness and when she is well, she can take the actions as needed and gain support for this without impacts from other staff affecting her.

Hugs to you as it is hard to watch your friend be so ill and trying to support her as best you can, be sure to take best self-care of you too.

Thanks very much for your advice and information, Smurfy. That's a good idea to try and talk to her about experience on the ward, when she's better. She is never what I would see as completely "normal", but hopefully I can get a reasonable picture of conditions then.

It is sad and upsetting, of course, to see her in this situation. She is an incredibly kind, generous-minded person.

I work in a mh hospital in the social work team. We look into safeguarding concern s on a daily basis, so if you made contact with us and told us what your friend is alleging we wouldn't ignore it.

Male staff can be on female patient's obs, although if this distressess her the nursing team need to know that so they can try to only allocate female staff. This won't always be possible though. Staff should only be alone in a bedroom/bathroom with a patient in an emergency, of the kind that would mean they had pulled their alarm or otherwise called for help.

I'm a bit confused about what sort of ward she's on but have probably misread your posts- you mention both secure and acute, which are different types of ward. In any case it doesn't really matter much. She has a right to an advocate who can raise her concerns with the ward staff, if she doesn't know about this, getting staff to ensure she has access to one is something you cab do to support her.

Just because someone is ill is no reason to discount everything they say. We take every allegation and concern seriously and investigate properly regardless of mental state, because for too long people abused the mentally ill knowing they'd get away with it as no one believed patients.