To think people in mental health units

[Tellmelies65]

Aren’t being thought about. My dsis is currently in one after being moved there from a medical ward. She’s allowed no leave from the hospital and no Visits. She struggles in there a lot with the noise and can’t get any rest bite from it.

We are allowing walks around the grounds escorted by staff but not to have contact with family (because we can't guarantee people will distance effectively. Many unwell patients just would not understand or be able to respect that.) however it is a break from the ward.

We are also facilitating video calls which I know is not like a real visit but maybe second best.

If someone is not detained they can discharge themselves if they feel the admission is no longer of benefit with the restrictions and some people have done that. For some people who are detained because of high risk there is no alternative to being in hospital and they do have to put up with restrictions until we can get cases lower again or get access to the vaccine.

It's sounds really hard, but there are many struggling groups unfortunately. We've had recent threads about how people are forgetting young people, old people, disabled people, single people living alone, poor people, unemployed people, single parents with SN kids, teachers, etc. I think most people are just too worried about their own situation and probably don't think about the issues that don't immediately impact them.

Yanbu. Some of these posts smack of more concern for staff than patients. Staff will be mixing with the wider community outside work and are no less likely to bring infection to the ward than patients. A socially distanced walk outdoors with a hug at the end is very, very unlikely to transmit the virus. The virus is transmitted by being in close contact with an infectious person for longer than 15 minutes

There was a documentary on TV and one of the London hospitals had a doctor come down with covid. He had been having lunch with other staff members at a table, but with the chairs pulled back so there was more distance. It was deemed that this was a safe distance and the colleagues he had been sat with were allowed to continue to come to work.

A blanket ban on all visits is lazy.

@CausingChaos2

Yanbu. Some of these posts smack of more concern for staff than patients. Staff will be mixing with the wider community outside work and are no less likely to bring infection to the ward than patients. A socially distanced walk outdoors with a hug at the end is very, very unlikely to transmit the virus. The virus is transmitted by being in close contact with an infectious person for longer than 15 minutes

There was a documentary on TV and one of the London hospitals had a doctor come down with covid. He had been having lunch with other staff members at a table, but with the chairs pulled back so there was more distance. It was deemed that this was a safe distance and the colleagues he had been sat with were allowed to continue to come to work.

A blanket ban on all visits is lazy.

A blanket ban on all visits is lazy

You do know that even in good times mental health services are heavily reliant on agency staff and that a lot of staff are unwell or juggling caring responsibilities?

Why don't you share your ideas to sort out this NHS laziness when it comes to keeping really unwell people safe? Not being sarcastic, I'd like to hear some if it means I can visit my sectioned friend (I'm her nok)

It’s awful, yes, but it’s to minimise the risk of a patient going on leave and bringing covid back, or a visitor bringing it in.

Imagine if all the patients and staff on her ward got covid?

If she’s Informal she could always ask for overnight leave then discharge from leave (that’s what a lot of units are doing).

But staff have to be there and visitors don't. Staff are not optional visitors are.
It's a risk benefit balance. Staff do cause a risk but they are essential to run the ward. Visitors are not essential. This is such an obvious basic point that I am amazed you can't understand it.

How in the hell is it lazy? How does no visiting benefit staff. It doesn't at all. It makes our lives worse too. It's more work dealing with cross patients and relatives than allowing walks tbh. There is no reason apart from safety. No hidden agenda at all.

The hug is a violation of Tier 4 rules which tells me instantly that you have no respect for rules and that your socially distanced walk would be nothing of the kind.

The only thing Tier 4 rules would allow is a distanced walk with 1 family member. If you are in fact well enough to go on a distanced walk with a family member unsupervised by staff then you are probably well enough to just go home.

I work in a community MH

The medium secure units have had to suspend leave due to covid outbreaks they had to as the virus spread so quickly between patients and staff (it’s impossible to maintain social distancing staff are working with people who are often very unwell and lack capacity to retain what some may think are very simple guidelines to follow)

I work in a hostel we haven’t had leave suspended, covid cases are isolated and we support them, but only have essential visitors (clinical staff)

I would be interested in hearing some ideas

And plus the increase in substance misuse, anxiety, being cut off from families, lack of motivation (few engagement activities available) that workers in mh are having to manage along with covid risk (which adds a whole new layer of work)

And then dealing with so many staff having to self isolate

I wouldn’t hug her. I would wear a mask and keep my distance from her. She’s in there for suicidal thoughts isolating her from her support system is hardly going to help her. Unfortunately due to COVID day hospital are closed and that’s where she probably would have been if it wasn’t for COVID.

It also varies completely the setting. Here locally same level of units/care/need can either be an amazing house in the country with gardens etc, or a new modern unit with no outside space and no longer having simply things like OT craft sessions that aren’t deemed therapeutic.

I really feel for you Tellmelies65 and your dd and the many many others in similar situations

It’s a really difficult situation to manage and unfortunately decisions are having to be made that we are also aware can have a detrimental impact, on MH wards it’s far more difficult to contain Covid than for example on a hospital ward where patients are in bed recovering or receiving treatment

Its certainly not done to make staff lives easier it’s the only way that risk can be managed. It’s very very difficult for staff to manage

It sounds extremely difficult for everyone involved.

It's horrifying me - I've just spent a lot of time working with a clinician who splits time with the role I was shadowing, and a MH unit and the patients are finding the constant changes and uncertainty of it all and the isolation from support networks incredibly difficult to cope with by all accounts.

They really have been forgotten about - as have those in residential settings for learning disabilities as well.

The unit has no activity’s or anything. They open an activity room where they offer colouring and a film about once a week. Which when you’ve got nothing else to do isn’t much.

Well that is a bit shit.
Our units have full time OTs and OT assistants and part time physio and psychology. There is a full timetable of therapeutic groups usually twice daily and we've continued with it even if sometimes the therapist had to be via Zoom.
Over the Christmas holiday period groups would likely be reduced or maybe if a lot of staff are off with COVID or isolating but usually there should be therapy groups daily on weekdays at least.

I'm afraid it is a choice between having support from family at home or having professional support in hospital at present because of the infection risk to all the other patients that I have described.

If she feels the lack of contact with family is not therapeutic then she could ask to have home treatment instead. There will be a home treatment team. You are not cut off from your support network in hospital anyway. You can still phone and video call.

She wanted home treatment support unfortunately due to what the people assessing thought that wasn’t possible. She’s detained she explained why hospital wasn’t right for her and unfortunately wasn’t listened to.

If they're not permitted to return to the ward without a negative test, where do they go while waiting or if they become unwell?

Many wards have ‘covid areas’ now for MH patients. Staff wear full PPE in these areas and dispose of it as biohazards.

If waiting for a test they’re usually confined to their room until they get a negative.

Yes patients are isolated when they are admitted to the ward until they get their test result back.

It’s to protect your daughter and other patients and staff from covid
Staff are in and out, but will be wearing PPE
Following very strict infection control rules
Regular covid tests
Etc etc
It’s sad you can’t visit but she isn’t well,
Think about how you may support by talking / FaceTiming / can you post in things for her to do like crafts, colouring etc...
If she’s suicidal she needs to be in hospital and kept safe

We have an isolation area for new admissions and symptomatic patients but we can't isolate people for 10 days every time they want to go out for a walk. We don't have enough isolation beds for that.

Many people are too unwell to abide by advice to just stay in their rooms (try telling a floridly manic or psychotic person to do that and see how far you get). Even those who could abide by it it would be pretty miserable and not therapeutic to just stay in your room in isolation with no contact with anyone except staff in PPE bringing meals.

Essentially the requirements to keep safe from Covid are the exact opposite of the advice you'd give for treatment of depression. Usually we do not let people stay in their rooms on their own. We encourage social contact and group activities.

It's completely shit for everyone having to work like this but we can't risk having an outbreak and causing deaths.

I'd suggest OPs sister ask her consultant at the next MDT if she can be discharged and have home treatment. If she has improved a bit and is willing to work with the team then it should be considered. She also has the right to appeal her detention as does her nearest relative.

I’ve had four psychiatric hospitalizations in the States. When the ward is short of staff. Walks don’t happen. Quite often, walks were just going outside so patients and staff could smoke.

In normal times if you are not detained you can go for a walk and/ or a smoke any time you like in the U.K.

If you are detained you require specific permission and this will be limited eg to 1hr a day. You might also be required to have a staff escort if you are at risk of absconding or harming yourself and then your ability to leave the ward would be dependent on staffing levels. For the majority of people though this would not be the case or would only be the case for a few weeks at the start.

Currently Covid is meaning that visiting and leave off the ward are being stopped because the ward is essentially a bubble. Patients and staff can still go for a walk but just not with family or in contact with others. If they are allowed to go on their own then their ability/ willingness to abide by Covid rules would be part of the risk assessment. If you are not willing to abide by the rules then you would either be discharged if safe to do so or detained if not safe for discharge and not willing to stay and abide by the rules.

Staff would not be allowed to smoke on shift or on the hospital site. They'd need to be on their break and leave the site to smoke. Smoking with patients would not be allowed in the U.K. on current practice (used to be pretty normal years ago pre smoking ban)

When there was a suggestion that mothers might need to go through labour without a partner there was outrage, yet most are OK with people in mental distress being isolated from their families for months at a time.

It's just a totally different situation

Giving birth you are there for 1 night. You don't interact with the other mothers and partners. You can easily be isolated in 1 room and that room get cleaned afterwards.

As you say on a mental health unit the average stay is 1-2 months. You interact with all the other patients. You do not (and surely would not want) to stay in your room for all that time. Any risk 1 person takes they take it for all 15- 20 on patients on that unit. Many of those people could be older, obese, diabetic, have cardiac issues.

If all 20 patients have a visitor once a week (and they usually want different visitors each week) then that's a huge level of extra contacts, exposures and chances to being COVID to the ward. Once it's in the likelihood is everyone will get it because there is mixing on mental health wards and many unwell people just cannot abide by restrictions.

This policy is for the protection of patients to stop them from dying. You are not going to die from not having a family visit. You can still ring and or video call every day. It will be distressing not to see family. It's not good. It's not what anyone wants but the alternative might be an outbreak in which some people die or are very seriously ill.