AIBU to draw attention to how mental health patients are being treated/things having to deal with through lockdown.

[UndertheCedartree]

It's not something that I've really seen spoken about but psychiatric wards are obviously in a difficult position right now but it seems they are more interested in covering themselves than thinking of the patients rights/needs.

One unit I know are not allowing any leave whatsoever. Not even for informal patients...not even just outside the front for a smoke. There is no outside space on the wards so literally no fresh air for any of them and as most MH use smoking as a coping strategy that important strategy has been removed. And surely it must be illegal to keep informal patients detained?

I am usualy on a mental health unit for EUPD during the week and home at weekends. Just before all leave was cancelled I got scared and went home. About 3/4. ward had Covid but many without symptoms. I presuably caught it from someone and have been ill for a couple of weeks. I think my DS may now have it. Obviously I couldn't go back to the ward after catching it. But it has been so difficut. I'm stuck at home with my anxiety through the roof, obsessing about my DCs education and feeling very down that I'm not coping well. I've been at home nearly 4 weeks now and I feel so anxious about going back and leaving my children - I don't know when I'll get leave again. The difficult thing is usualy on leave I have support from a volunteer, a charity helping sort my money and my DC SW plus meetings at school. Obviously not happening now. I also have support from my BF and the DC's dad. Don't get me wrong they've been great - the DC dad has been bringing food round and phones me everyday to see how I am. I've isolated upstairs and my BF has been in a couple of times to disinfect the downstairs, feed the kids and get things from the corner shop for us. Even my brother sent us a fruit and veg box which was lovely.

Sorry this is just a ramble/vent - this is so hard and I feel stuck in a world of anxiety, depression, paranoia, obsession and....far too many cigarettes 😷😞

Honestly I dont have a lot of sympathy atm. Not because they deserve it, or its acceptable, they don't and it isn't but at least they are getting treatment. The rest of us have been completely cut off from any kind of support and told if we really want to kill ourselves it's up to us, there's no help available.

Half of us are being unlawfully detained and the other half told to do one, no one cares.

This country should be fucking ashamed of its attitude to mental health services.

Everyone is in a difficult position right now OP. I was on a waiting list for mental health support and got a call just after lockdown where I was immediately discharged because they don't have the capacity to help me - or anyone. It's not just mental health that is being sidelined, it's all medical treatment - cancer treatment, dialysis, prenatal and postnatal care etc etc etc. It's a ticking timebomb for sure and the ramifications will last for decades.

I'm so sorry OP. That sounds very hard. The pandemic has made things very difficult for so many people but especially the vulnerable. It would be terrifying to be stuck on a closed ward with a Covid infection so I can see why they can't risk people coming and going. But under the circumstances, as this is an extraordinary situation, they should have set up a smoking room. Tbh I think they should have this in normal times too. Psychiatric wards are (at least) temporarily home for people, and like you say many patients smoke for the stress relief. Being an inpatient isn't really the best time to quit either. It's a terrible shame there's not enough funding because ideally they'd have capacity to set aside a small ward for Covid cases. I also think they could still be helping you by phone or video call. You should be able to access the care you need. I hope things get a bit better for you. It sounds like it would be really helpful if they got testing in to your ward. I know we still haven't got enough tests (we really messed up ther) but hopefully we're starting to improve in that regard. If two thirds have had it already and that could be confirmed they might be able to safely readmit patients. I really hope things improve for you soon. You must've made massive progress to be at the stage of home leave, which is brilliant.

Yeah, MH provision has been shot to pieces by this. I was seeing my CPN every two weeks and psych once a month. Now all appointments have been cancelled, my care plan makes no sense anymore and when I called up in a state I was basically told that they would fax my GP telling him to up my diazepam and that's it. No other support available. Apparently wards are basically just not taking new patients in my area right now. It's scary as shit.

That's awful @batvixen123
I'm sorry to hear you're struggling. Are they offering you telephone appointments with the CPN? I can't see why they wouldn't be able to do that. It's not the same as in person but would that help you at all? Worrying there's no mental health ward capacity. I can see why they need to protect patients on locked wards but really they should set aside some Covid spaces so psychiatric patients can still receive the care they need. Urgent care for all health problems - mental or physical, should not be stopped. They said things were dire before the pandemic. Mental health has been badly neglected for far too long. I hope things get better for you.

I'm really concerned for a relative. They have been sectioned every couple of years for background.

They are having to isolate, ought to be shielding but arent, and getting terrified listening to the radio. The weekly care visit has stopped, the fornightly cpn visit has stopped and isnt even replaced by a phonecall. Im scared they've just been abandoned. They also sound like theyre going downhill towards a place theyd usually be secrioned.

I cant go visit as Im shielding... im v scared for them as to whther the psych unit will take them or if theyd get admitted or help.

MH units have it really tough at the moment. We are doing our best to keep patients safe and manage a serious physical risk to our patients and ourselves.

My ward has a garden in which we are currently allowing smoking and we have no legal option to prevent informal patients using leave but if they insisted on leave we would consider discharge as the risk of bringing the virus back to the ward cannot be ignored.

Community services have been decimated which makes me very frustrated. Discharging people is so much harder when you know they will get no support face to face. Even older persons who need carers are only been offered phone contact.

I am sorry you are having a tough time, it is very tough at the moment.

It's rough on MH patients right now. Lots of MH Trusts have shut all community services to redeploy staff to inpatient and acute general hospitals. It's shit.

I do think the decisions made are reasonable though, if difficult. An informal patient going on leave could socialise with anyone and bring back covid very easily. MH patients are more likely to smoke heavily and be overweight, and are more likely to have hypertension, COPD, heart problems, and diabetes. Many are on sedative medications that can reduce breathing rates. Some patients won't agree to self isolate if they are symptomatic, and some would refuse physical interventions. Many would not be accepted into critical care or ICU.

So while the current situation is totally shit, I can't see a different clear path that will save the most lives.

Let's not forget that at least 9 MH nurses and HCAs have died so far too.

"but it seems they are more interested in covering themselves than thinking of the patients rights/needs."

My DD is committed to her job within MH services. However she is also a person in her own right, who is entitled to be relatively safe at work, as are her Staff. I say relatively because it's accepted that the Staff may be physically assaulted, not only by patients but also the families.

The Staff also have their own families, they have elderly and vulnerable relatives that they care for, many are also active in the community and volunteer etc.

They can also have anxiety, minor mh stuff going on, as well as all the shit that life throws at them. They have to deal with suicides and carry on with their working day.

Everyone's rights have gone out of the window, people with other medical conditions will die because of this. Self identified needs have also taken a back seat. Children attending school can't leave over dinner time.

We don't fund services enough, we know that, but those delivering the care are doing their best. New rules are in place everywhere and that's just how it is. We've all got to get on with it.

I'll be honest and say that while that sounds very tough for you personally, I'm not sure what they could be doing differently in terms of informal patients etc?

@CoffeeIsMyOnlyJoy - if a patient was on escorted leave just to the front of the unit to smoke - they would be mixing with noone else.
@nothingcanhurtmewithmyeyesshut - very little treatment is happening - no psychologists or OT coming onto the ward - no social workers or social therapists - ward round reduced. But an awful claustaphobic feeling...most on my ward are having lots of invidents even those who hadn't for a long time. No support from visiting or leave with loved ones, mothers kept from their children So while you have my sympathies for not getting the help you need...the grass is not always greener on the other side.

@toffeeyogurt - thank you for your kind words. it is hard for the women who are isolated alone - they get very little care and not much food and drink as it is not normal to bring food/drink to rooms. They can't even shower as our rooms have no shower. We were all tested on our ward. Out of 12 - 8 had it. 4 had no symptoms. I was negative at the time but was obviously in close proximity to those with no symptoms. It wouldn't suprise me if we'd all had it now but I don't know about the staff.
@SquashedFlyBiscuit - I hope your relative is ok.

@Ponoka7 - I refer more to management covering themselves rather than grass root staff. By making a blanket ban of noone can leave the ward full stop. There is no reason to take away a psych patient's need of fresh air, no need to stop them having a cigarette now and again. People on the outside can have a smoke to ease the anxiety of the situation whenever they like. They can take exercise outside. Of course staff members come and go wherever they like - potentially spreading the virus. A patient going to their home (and no where else) for a couple of hours would be spreading the virus less, I would think? How would she feel if to protect the patients/staff she must not leave the unit even for food let alone fresh air?

@IndecentFeminist - a minimum of escorted leave for fresh air/smokes and as above.

if a patient was on escorted leave just to the front of the unit to smoke - they would be mixing with noone else.

Most MH Trusts have long stopped escorted leave for smoking years ago. I don't necessarily agree with this, but it is what it is. A person standing outside the ward could very easily make contact with others, perhaps from other wards, to ask a stranger for a cigarette, or even (somewhat understandably) just run off. In the current situation I can't see that a person's want to smoke is worth compromising the safety of other patients and staff in the ward.

MH wards do not have the appropriate facilities to deal with covid, and where it gets in patients will die. It's incredibly shit, but we all need to live with less liberty for now.

@coffeeismyonlyjoy - nowhere around here has stopped it - it is completely normal. Re:flight risk that would have been dealt with as normal in a risk assessment. But an informal patient is of course low flight risk. In order to not mix with those from other wards you just have set times - and there would be no strangers as visitors not allowed. Not allowing patients to smoke also causes an increased risk to staff and patients in particular due to an increase in incidents - something that would be calmed with a cigarette or indeed just the nicotine addicted's need for nicotine will now esculate causing harm to patients and possibly staff too.

As for covid getting on the wards. Most have it/have had it on my ward. None have died. They will be moved to a physical hospital if necessary. And of course there is no way to stop it coming on the wards when the staff can come and go without any of the restrictions placed on patients.

OP a note on the smoking, every time a patient wants to leave the ward a mental state assessment takes place and is documented. The patients clothing has to be documented, as do the times the pateitn enters and exits the ward. This is terribly time consuming if a patient wants to smoke 15 times a day.
In times of unprecedented crisis, such as this, I'd be making the decision to not allow smoking too if I were ward manager, and if an informal patient couldn't live with that they'd be free to go home.
Sometimes we need to look beyond out immediate wants and to the bigger picture.

@puddlejuice - it varies on different wards - on mine no paperwork has to be completed for an informal patient. As for 15× a day - it is very normal to make a restriction (say 4×day) on times etc. No patient on my ward (or any I've been on) goes out 15 x day. Saying the only way to deal with someone going out 15x a day is to say noone can go out atall is not least restrictive practice and just a very lazy blanket ban. And it's all very well you as ward manager making this ban as you're not the one to pick up the pieces/suffer harm from the increase and escalation of incidences. It will be the staff and patients while you sit in your office.

And sending a patient on a long term ward for a complex condition home for wanting to have fresh air and a smoke is very dangerous indeed considering the lack of support that will be available to them ...but then again as ward manager you wouldn't have to deal with the fall out - that would fall to the children's social workers and the community mental health team. Indeed it is times like this the bigger picture must be looked at.

If my hospital is still able to give patients fresh air and smoke breaks with a bit of thinking outside the box - why can't others?

OP you've said that you're experience is that the hospital isn't facilitating smoking. Lots aren't.

I know smoking is widely used as a tool by MH patients, but it is often counter productive as it can become the source of fixation and causes further stress.

My hospital has completely banned smoking, the only time patients can smoke is if they have unescorted community leave, and this is granted a maximum of 3 times a week in normal circumstances.

We've found this has been really helpful, patients aren't frantic when they've run out of tobacco, begging / borrowing /stealing from eachother, and a member of staff isn't constantly required to stand at the garden door with a lighter, so more therapeutic activity can take place.

It is a very difficult time op many are struggling on the wards, in residential and community as how all mh professionals work has had to change

We are in a very difficult position at the moment. We are still supporting our patients/residents yet having to deal with the anxiety of what lockdown brings this is for those we are supporting and staff

At the moment we have had to change how we work completely firstly it was to hopefully prevent anyone becoming ill now it’s to caring with people that have covid (that is extremely stressful as we are at risk, many are at a high risk if they catch it and those with what are considered mild symptoms are at times still very ill they moving them to hospital of necessary is when someone is very ill) and trying to prevent others from becoming ill

The prevention of covid spreading is why changes have had to take place. Supporting someone can be done in various ways. Dealing with prevention of covid spreading can not or how we care for them should they become ill be done on other ways

I do understand that you and many other people are struggling with this op. It’s a very difficult for many

@ToffeeYoghurt - I can call my CMHT who will take a message and my CPN will call me back in due course. Sometimes she calls back in a couple of hours, sometimes in a day or so. The main issue we've had is that I struggle to be clear on the phone when I'm very distressed and she just says she can't understand me and will call back later and see if I'm calmer.

I've been semi ok so far but the couple of really bad days I've had, I couldn't talk to anyone because I wasn't making enough sense on the phone apparently.

If my hospital is still able to give patients fresh air and smoke breaks with a bit of thinking outside the box - why can't others?

It's a nationwide push from Public Health England and the CQC for all hospitals. I've worked in 5 Trusts and all are now smokefree. I am shocked there is anywhere left, every Trust I know did this before 2015. I don't agree with a smoking ban in general for essentially the reasons you have given, but these are desperate times and the aim should be to prevent harm and death. Dismissing the infection risk for a patient going missing as being mitigated with a risk assessment doesn't quite cut it in the present circumstances, as the risk is not just to that person but to everyone. It is lucky in your setting that no one has died yet, I personally know one RMN who has died of coronavirus. I'm on mat leave now but bracing myself and crossing fingers for the patients I have known for years who are at huge risk.

It is restrictive and an unhappy situation, but it is important to remember that no one has a right to smoke. Those who live in non-smoking accommodation currently can't currently leave their homes legally to smoke. The priority needs to be keeping vulnerable people alive.

Despite the difficult extraordinary circumstances of a pandemic, the absolute minimum they they could do (with very little financial cost) is set up a smoking room. Even if it's just temporary.It's cruel to expect psychiatric inpatients at a time of particular stress to go without.

It seems to me, reading this, the problems are less to do with the pandemic and lockdown and more to do with the simply shocking lack of support and funds for mental health. It's been reported on for years yet still nothing is done. I'm sorry things are so hard for some of you at the moment.

No access to showers is very wrong. Essential work should be continuing. If B&Q can open and construction work you'd think psychologists and other vital psychiatric staff would be providing vital support.

I'm sorry to hear that batvixen that should count as essential work. She also sounds poorly trained. MH workers should understand the difficulties some patients have with talking - by phone or in person. I think all of us, mental health patient or not, can struggle to speak clearly when we're distressed. Really she should be able to stay on the phone for the call even if you can't say much. I'd have thought just knowing someone is there to listen or support you would help at least a little? Do you think you'd find it easier (and helpful) if you could contact her by online chat? That's a pandemic safe option.

I've been saying on other non MH threads how the government needs to urgently sort out PPE fir frontline staff. They really need to get on with that.

I would love to be able to message or email someone. I often find it easier to put things down in written form - I can write here, for example, even on days when things are very confusing for me. But my local area doesn't do anything like that. Only these phone calls.

Honestly, they've been great in the past so I don't want to slag them off. They've saved my life before - normally they get the crisis team out to your house pretty quickly, for example. But everything has been pretty much shut down since the Pandemic hit.

YABU leave isn't a necessity, too much risk for patient, staff and the general public. Lots of people are having to compromise and miss out on stuff at the moment. Staff have rights as well as patients. Especially leave for smoking, a lot of hospitals don't let escorted patients smoke at all anyway. I thought all informal patients had been discharged?

Oh and for people taking about smoking rooms. Smoking has been banned in hospitals for quite some time?!?! Again staff have rights and secondary smoking is a thing

You definitely express yourself very well in writing. I think it's something that should be offered pandemic or not. So many people find it easier. I wonder if it's just not occurred to them to offer this. It's worth asking even if it's not something they can implement straight away. I'm glad you get good care normally. That's positive. It's really those at the very top who are responsible for any issues. Frontline staff should have been provided enough PPE so that patients like you don't go without urgent care. Essential work is supposed to be going on as usual. MH is more essential than DIY and B&Q is open. I hope things do improve for you and I'm sorry it's so hard now.

@Puddlejuice - if you read my OP - I said one unit I know. Not my unit. I think bringing in a 2 tier system like that - ie. formal can't smoke but informal can - wouldn't be a great idea in the middle of this pandemic when anxiety is sky high and so many freedoms have already been taken away. You don't in general allow your patients daily fresh air/ exercise? Stand at the door with a lighter? Surely smoking isn't allowed within the actual ward? Thought that was banned long ago.