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 😷😞

@CoffeeIsMyOnlyJoy - I'm not talking about the normal 'smoke free' attempts. Of course all are 'smoke free' - this doesn't mean patients are unable to smoke. One acute I was at we smoked on the benches outside the entrance but were told to look out for 'managers'.Another unit we smoked outside the front of the unit in front of the 'no smoking signs'. I went on a trip to a hospital for a conference - I asked where I could go to smoke and the manager made a big fuss about it being a 'smoke free' hospital and no one smoked there. My OT and I went into the grounds to find a way off where I could smoke. We found a make shift smoking shelter where the patients were smoking. So I tend to take with a pinch of salt 'smoke free' hospitals. Obviously once off the grounds you can smoke anyway. At my current hospital we smoke at the gates to the car park - still makes it a 'smoke free' hospital of course. What I'm refering to patients all of a sudden being unable to get fresh air or smoke.

@batvixen123 - I have also been stuggling as all contact with therapists became by phone and obviously is now at home. It really doesn't replace face to face for me.

@EL8888 - so psych unit patients shouldn't be allowed any fresh air whatsoever? What is the risk of someone sitting on a bench in the grounds or standing at the gate? How is this risk higher than staff going into shops, going for walks, being around lots of others, then going home to family and then bringing that back to the unit? Are we really at a point where a psych patient isn't even allowed a breath of fresh air a day (not even the daily exercise others are allowed)!?

@EL8888 - and no all informal patients haven't been discharged. I can't imagine it would be a very safe discharge in these circumstances.

Oh just a note - the PPE at my hospital has been excellent.

i know in my trust some places are struggling with covering the shifts due to so many staff being off

I’m not aware of any patients/residents not being able to go out on the grounds maybe escorted leave may have been cancelled due to staff shortages ?

For what it's worth, I'm a CMHN and we are HATING being restricted from seeing our patients face to face. It's just not the same over the phone for so many people. You can't see expression, mannerisms, assess their home environment and so much more.

In addition to this, we are very worried about our patients who don't pick up the phone to call us and are often the most vulnerable.

I didn’t say that, l said leave. In 10 years l haven’t known a ward to not have access to a garden so fresh air can be obtained there. The guidelines are going out for essential things, smoking outside isn’t essential. Even if hospitals allow smoking, usually they are smoke free sites. It’s encouraging mixing of people that isn’t needed

I didn't receive mental health provision before the pandemic, let alone now. I couldn't even interest the GP in helping me. I tried to do something I shouldn't have two days ago, but dh found me and stopped me. There's no help. There never was and there never will be. One day, dh won't be there.

EL888 - lots of wards have no outdoor space - especially space to be able to exercise. As for essential reasons to go out this includes shopping for food and cigarettes and exercise. A smoker can also smoke in their house or garden or balcony - obviously not available to a psych patient.

@rosiethehen - 💐

I have never seen a mental health ward with no garden access. No one has officially said cigarette are essential, that’s something you’ve decided

Why should a ward or the NHS devote resources to smoking?! Let’s imagine it’s a 16 bedded ward for example and all patients smoke. Obviously you can’t escort one patient and not others. So let’s assume it’s 15 -20 minutes per smoke break once patients have signed out, walked off the ward, smoked and returned. So that’s 5 hours of a staff members time spent and still not everyone has smoked. The ones who have smoked only did it once and shortly will want to go again. So hundreds of pound are spent of staff members time for smoking. The NHS has literally no money especially at the moment

If l am physically unwell tonight and get admitted to hospital. No way would l be taken outside to smoke if l asked, it’s a waste of time and resources after all. Ward staff are busy after all, caring for sick people whether it’s for physical or mental health. Let’s not forget patients who are sectioned are deemed too unwell to be at home

You asked if you are being unreasonable and yes you most definitely are. Everyone has to compromise and make sacrifices, everyone else has.

You are not unreasonable voicing your concerns about mental health services, as they are under-funded and over-whelmed

YABU. We are in a countrywide 'lockdown/quarantine/whatever you want to call it' and everyone is struggling. Everyone. I haven't been able to see my MH care coordinator, Social Worker, Recovery Key Worker; no-one. They're all doing the best they can to adapt. You are at home, with family. I'm totally on my own and haven't seen my twin toddlers for 6 weeks, due to CoVid. But, I don't feel the world owes me a living just because I have MH issues. I'm really sorry to hear you're struggling, but we are all fucking struggling and just have to do the best we can to get through this.

I am a mental health liaison nurse, we are seeing people in A&E as usual doing face to face contacts ( wearing PPE). I personally think it's ridiculous that most CMHTs are only doing telephone calls, people are coming to A&E very mentally unwell where liaison have to organize a discharge plan when if the person had been seen earlier they may not have deteriorated.

You are not really helping tbh. People with loved ones as inpatients do not want to have their anxiety and fear heightened with your “story” atm. One establishment will be different to another, staff levels, facilities all vary. At least they are being treated and are safe. In the community there is very little and what there is takes time.

I have a family memeber I cant visit as they ought to be sheilding and we are shielding as high risk without a letter. I know they are on a downward spiral. She used to have a cpn every 2 weeks and I don't think has even had a phone call that often. She's on her own and I think will end up potentially at risk from.covid on a psyhc unit when it could be prevented. I feel so helpless.

As for not going outside. Are you absolutely certain there is no outside space or just that people are not using it? Some patients have 1-2-1 for outside time and it is accessed every single time. There may not be the resources to facilitate or a person may not be deemed ready to go.

@Outtedagain - so it's better that really vulnerable people on the wards just shut up and suffer and don't talk about problems they are having so their families on the outside don't have to worry? There is so much that is toxic and wrong with that statement. I don't even know where to begin.

Extra comment. I've been an in patient and an out patient. While I'm shit scared right now because I feel so alone, I have never felt so powerless and vulnerable as I did as an in patient. I'm glad I was sectioned because it saved my life but it was a terrible time for me and the thought of going through that in the current circumstances, without visitors, or tiny pleasures like maybe a smoke might be for someone, or the chance to see the sky, with minimal staff and the fear of sickness as well is honestly unimaginable.

I don't think it's fair or right to tell anyone they should be glad to be locked up in there instead of out in the community, or that they should shut up in order to not worry their families.

There's multiple issues to this.

Any outside time or leave requires assessment and supervision in many cases, and right now, there are not enough staff to adequately supervise people due to many staff being off ill or self isolating because a family member has symptoms, or, are working from home where they can. If they give this to one person, they have to ensure it is available as an option for everyone on the ward. A blanket ban is far easier than the arguments and fights that would occur if staff levels allowed some patients to have time to go outside and smoke, but resources didn't allow all patients to go outside.

A large percentage of patients with mental health conditions have physical illnesses too, and the majority of those illnesses are auto immune disorders. With a severe respiratory infection spreading mental health professionals are sensible to be encouraging all patients to look after their lungs at this time.

Resources are extremely low in the community - the police are overstretched, ambulances are overstretched. Have you considered what would happen if any patient legged it?

Was your COVID confirmed? Because I have had it for six weeks and smoking has been the last thing on my fucking mind. There was no way I could have smoked even if I had wanted one.

Just before all leave was cancelled I got scared and went home

We are all fucking scared, yet still going to work in many cases - how the fuck do you think people are meant to have resources to get patients on leave and for smoke breaks if their colleagues aren't actually coming into work for (as I am assuming no reason other than being scared) at this point?

About 3/4. ward had Covid but many without symptoms

Were they tested? I am quite surprised that many people in one ward were a) even tested, and b) then went onto test positive, given that there's certain criteria for being tested in the first place, and, the tests are at best between 30% and 50% reliable.

I've lost three of my closest friends in the last three weeks. It has been truly, truly shit (two not related to Covid, one due to Covid).

I am insanely fucking grateful that mental health services are still operating, supporting, reaching out, checking in - yes it sucks it is not face to face, but for me, they are very much still operating. I am sorry if others aren't getting any support but smoke breaks and leave are not high priority at the moment.

@rosiethehen Please speak to your GP or self refer to your local crisis plan for some additional support.

OP you are muddling 2 issues here, smoking, and fresh air.
Every ward I've ever worked on / visited / heard of has a garden. So patients get fresh air and daylight.
This is a totally separate issue to smoking.
I'm not suggesting a "two tier system" at all. S17 leave is suspended. Therefor sectioned patients can't leave the unit. Informal patients, if they so wish to leave for a fag, will be advised to take their belongings as that will trigger a discharge, informal patients are capicitous to make that decision. Absolutely no two tier system, just people taking responsibility for their decisions.

@EL8888 - well there are plenty - many wards are not on the ground floor for a start. Actually there is no list of 'essential' - it is essential for the person. For many that is cigarettes and why they are still on sale in every corner shop. I'd rather smoke a cigarette than self harm or worse. It's an unhealthy coping strategy but a coping strategy none the less and removing that from a patient is actually quite cruel.

As for your numbers. 16 bed ward - just had lunch. The smokers (say 14) all want a smoke. 6 are informal so no worries can be let out. The other 8 are formal. 4 have unescorted leave - so once risk assessment is done they can go out. That leaves 4 - 3 need 1:1 - the other doesn't. 2 can go out with one support worker for 15 min - then another 30min for the other 2. So 45min and everyone has had a smoke. Smoking is a reality of a mental health ward whether you like it or not. It is a coping strategy. Not allowing patients to smoke causes untold harm to patients and staff.

And yes, people do get taken down for a smoke at a physical health ward too!

And do you really not think those on mental health units are making sacrifices? Not allowed to see their children til who knows when? Not allowed to go out for exercise, not able to go to the shop. Stuck indoors with nothing to do as no OT is provided, therapy only on the phone, no visits from friends or family. All groups cancelled. Worrying about their fellow patients with Covid, worrying if they will be next, worried their family will die without them having seen them? And you begrudge them a cigarette? What happened to compassion? Glad you don't work in my hospital. Yes, everyone has compromised a lot like only going out once to exercise or to the shop - but these things have been completely removed from psych patients.

@CoffeeIsMyOnlyJoy I've told my family that if I get covid & get admitted to hospital for treatment they are not to tell anyone that I have schizoaffective disorder in case the drs use it as an excuse to put me not for resus.

I suppose they may guess something is wrong as I take an anti psychotic.

Apart from that & epilepsy & being a bit overweight I'm a fairly healthy 43 yr old.

And yes, people do get taken down for a smoke at a physical health ward too!

Not always, and most likely not at the moment with staffing levels and redeployment.

You seem intent on telling us how shit mental health provisions are because they are not allowing smoking when there are very sensible and plausible reasons that may be behind it.