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Trigger Warning: This post mentions self-harm, violence, suicidal ideation and experiences of being in an acute mental health ward. Please don't read this if you feel this might make you feel uncomfortable or unsafe. You can find support and information for mental health here or you can call The Samaritans on 116 123.
I've 'ummed and ahhed' about writing about this for a while, because it's an emotionally raw and vulnerable one for me.
The reason I have is because it matters and it is something I am passionate about more people feeling able to speak about. On this mental health awareness week I am in a place where I can finally feel able to speak out about some of the situations that were so 'normalised' as part of my career in mental health; I hope that other nurses recognise through this post that their experiences matter and that they are certainly not 'normal'. I have been questioning more and more the situations and experiences young qualified mental health nurses are put into, raising awareness has always been important to me, but it has taken me several years to be able to even realise that what I have been through in my career has been incredibly traumatic. I chose to study a degree in mental health nursing, like many others, due to personal circumstances that led me to be curious about how I could offer empathy and support to others that had been through similar experiences in life. At the time I was only 19 and I was required to enter clinical placements that, within months challenged my whole outlook on the world. I will never forget the first placement I experienced in a nursing home during which, 6 people died. This was the first time I had ever watched someone pass away, the first time I was told to 'shut down' my own emotional responses to be able to continue to support other patients and family members. The first time I realised that not everyone within caring professions are all that caring. Throughout my 3 years of studying I quickly realised that this profession was eye opening, rewarding and at times incredibly frightening. I qualified as a mental health nurse in 2010 and fresh into my career I worked in a long term rehab unit for chronically mentally ill people, 'thrown in at the deep end' was definitely an under statement. Within hours I was made to be the nurse in charge of the ward, being asked to make decisions on whether to allow clinically unwell and risky patients to go out on leave or not, and liaising with police following fights that had broken out in the unit. On day two of this job I was punched by a 6 foot male who was under a court ordered section of the mental health act. There were 3 staff on shift, covering a ward of 20 unwell men. Throughout my time on this unit I was challenged in many ways, not least as to why I had chosen this career and that it really was not shaping up to be the caring and nurturing role that I had anticipated. I decided to leave the unit after 9 months and started in a post on an inpatient psychiatric unit; it was always seen that newly qualified nurses 'would benefit' from experience on the wards before accessing community positions. I remember my first day like it was yesterday. A young female, experiencing a manic episode was screaming, stripping naked and attempting to abscond from the locked ward, a team of staff were called to the incident and I witnessed my first 'restraint' of a patient, and was asked to administer my first injection to sedate her. This was the start of many 'restraints', that often resulted in patients being secluded in a bare, locked room, stripped of clothing and items, so that they could not attempt to harm themselves in any way. In my time on these wards I was put into many risky situations, observed many seclusions, restraints and serious incidents where staff were hurt (myself included). I have responded to many incidents whereby patients had smuggled drugs onto the unit and overdosed, i have been made to make decisions quickly about which life to save, I sutured self harm wounds so deep that internal organs were damaged, cut down ligatures of countless young people attempting suicide and made decisions over and over again that effect the life and family of young men and women every single day. All of this was 'part of the job', part of being a mental health nurse, 'mucking in' and 'getting on with it'. At times I questioned my own decisions, compassion and empathy for others. I continued to work with my team, being led by doctors who it felt like didn't know what was really happening on the ward floor. I continued to try my best at making every single patient know that they mattered. I worked 12 hour shifts, ran and managed the ward on minimal staff numbers, managed night shifts with just 2 other members of staff (both of which were unqualified nurses). And I was always told, "this is just the way it is." What got me through these shifts were a team who were in it completely with me, who got it, who knew what it was like. There was something special about that, and I am still very good friends with some of these people now, but there were also staff who were tired, exhausted, fatigued of compassion and who made questionable decisions without care for the most mentally unwell people. I witnessed staff squaring up to patients, forcing patients to take medications against their will, shouting at and bullying patients and I couldn't do it anymore. Not because of these staff, or the situations I was being put into, but because I was fearful that I too would eventually lose compassion. I know I am a good nurse. I know that I care deeply and I know that my own experiences have helped me to empathise with others. After 7 years of working within inpatient units I started working within a community setting as part of a specialist team for supporting people experiencing a first episode of psychosis. Within this role I developed a new set of skills, assessing and supporting families through the worst moments of their lives. Again I managed risk on a daily basis and observed patients who were very very unwell. People who experienced real fear when they believed that people were out to harm them, hearing voices, seeing things that were not really there, people truly out of touch with reality. In this job I met people in their own homes, people high on illicit substances, who carried knives, who were unpredictable, but ultimately people who were unwell and struggling. In the last 7 years of my career in the NHS I became more experienced and confident, but I grew to realise that the systems I was working within did not really feel all that supportive. I met Jennifer at Bridge the Gap in 2018 and fell quickly for the idea that proactive support for young people to prevent the need to access secondary services within the NHS was absolutely vital. In time I moved over from the NHS to Bridge the Gap, but it wasn't easy. I felt torn, guilty for leaving patients and colleagues, but ultimately I believed passionately that I wanted to make change. I love being a mental health nurse, and I continue to uphold my registration today, but today is very different. Today I am supported by a wonderful team of people who have worked across various professions, I still make decisions every day, but they feel safer. Today, I realise that my own mental health needs nurturing and that boundaries are important. Today, I put my own staffs wellbeing as a matter of priority. Because that was never provided for me within the systems I worked in. Every day I remind my staff that they matter and that they are not alone in the decisions they are making within work. I make it a priority that they attend monthly clinical supervision for a chance to feel supported by an experienced clinician. Today I realise that what I endured throughout my 16 year career should not ever have been 'just the way it is.' Through support from my own incredible supervisor I have realised that professional trauma can be equally as damaging as personal trauma, that there is a process for me to work through and to not feel alone with it. I talk about more and more experiences every day that I have witnessed but I continue to battle the thoughts that "I should just be getting on with it, and it's just part of the job". I know that this post will resonate with some of you and I hope that you don't feel alone, that you realise that your feelings and experiences matter and that it can be healing to share those stories. There is a way to reduce the trauma that the system generates, there is a different way, there are so many people that could have been in a much better place if they could have accessed early intervention, if they could have had the emotional education and understanding to know what their emotions were telling them, if they knew that there is no shame in reaching out and talking, asking for help and sharing those thoughts. If they could have accessed a naturally more calming and supportive environment. This in turn would also naturally reduce the amount of trauma professionals experience helping to cultivate a different culture.
I'm not naïve, I know it's not an easy fix or solution but surely, surely we have to try? Surely we can look at preventative work and invest in the voluntary sector doing it so that less people, less families have to go through so much heartache and trauma in the future.
I am a mental health nurse and I know I am a good one, I know that I care deeply and I know that my own experiences have helped me to empathise with others, I'm grateful everyday that I get to do that in a space that I love and be part of the change that I wish to see.
