Okay…that was …swifter than I anticipated.
Bear with me here.
Inigo Montoya- It’s a big gear change from acute medicine. I spend a lot of time chatting to people and watching TV, not so much time sticking needles in people.
It’s a big red-brick Victorian building set in lovely parkland with some more modern buildings in the grounds which house our acute wards and the care of the elderly unit. It looks like what it is, but not necessarily in a bad way. It’s quite nice architecturally. I suppose it could be a school or an old people’s home or a medical hospital. It doesn’t look like a hotel or a stately home because it looks a bit…state-owned and governmental, but it’s not surrounded by barbed wire with crazy people screaming all the time or anything.
Swallowed My Cellphone- there are different levels of observation.
At best you can go out on weekend, overnight or week long leave, where you go home for days at a time and just check in once a week with us for a few hours to pick up your meds and see how things are.
I could decide you can go out for the day but have to spend nights on the ward. You might be able to leave the grounds unsupervised for short periods, but stay on the grounds the rest of the time. Then getting more severe I could limit you to free unsupervised periods on the grounds, limited unsupervised time on the grounds, unlimited supervised time on the grounds, limited supervised time on the grounds, ward based (you cannot physically leave your ward) and special observations, which is when you have a dedicated nurse within either eyes sight or arms length at all times.
One step up from special obs is transfer to PICU (locked ward). This is a single sex, locked ward where patients sleep in 6 bedded open bays and there is access to a quiet room (i.e. a padded cell).
I can elaborate further if you want.
Lobsang- our patients don’t wear scrubs or uniforms, we don’t segregate the sexes apart from PICU and while people do wander about, they generally sit and smoke or watch TV. We are not a prison. Generally our patients are less florid than those on TV, obviously because people barking and muttering to themselves makes for better TV than someone just wandering about quietly.
The one thing we absolutely do not do is lock people in small padded cells unless they are so aggressive that we cannot cope any other way, and then only until they are calm enough to move back to their bed. We also don’t use restraints, straps or straightjackets. At all. Ever.
Caricci- How long is a piece of string?
If they are not a danger to themselves or others they are free to leave at any time. We have people who stay for a few days, we have people who have been with us for 10 years. On average I’d say it is about 2 weeks, but it depends on why someone was admitted and how much they like being with us (some people don’t want to go home).
OtakuLoki Yes, we use ECT.
It’s more or less a last resort for depression no-one does it lightly and it’s hardly ever done one people who don’t actively want it.
Short-term…it works and has saved lives.
It’s not like the movies. You get a general anesthetic and a muscle relaxant- the seizure activity is measured on an EEG, not by muscle spasms, and the whole thing is over in about a minute. When you wake up you get tea and a biscuit. We do 2 sessions of up to 8 patients a week, and as most patient get about 10 sessions, you can see that as a proportion it is used pretty rarely.
If someone is mentally unwell then yes, we’ll treat them, awaiting trial or not. A lot of our patients are assessed by the forensic psychiatry team to determine risk beofre discharge. We try to minimise risk for known high-risk patients (e.g male staff members only for personal care, male staff present during interviews, possibly staying in the male locked ward etc) but it’s not a huge issue.
Because mental illness, substance misuse and crime go together, we do have a lot of patients who have forensic histories or who would be at risk of offending on discharge- however, most of them have served their time in jail (it’s quite hard to be legally insane, even if you have a mental illness) and deserve every opportunity to get on with their lives. You can’t lock people away because of what they might do.
My day is a lot quieter than in general medicine, I have to admit I’m still not so comfortable dealing with some of my patients (and in particular, some of my personality disorder patients) but I don’t mind the work. It’s not something I could do happily forever, but short-term, it’s fine.
threemae
Things I like about the NHS- that everyone will get the treatment they need…eventually.
My largest frustration with the NHS is with the way my profession is seen and how the government has totally shafted our training.
I won’t go into details because it is frightfully boring. All I’ll say is MTAS, Tooke Report and PMETB. I am damn lucky to have a job next year, and it is appalling how the system is run.
I’ve never worked in the USA, and, no offense, I don’t want to work there. I have classmates who have gone to work in America, and generally the feeling is that what you earn and your level of insurance cover governs the level of care you receive. That is anathema to me, I’m all for healthcare as a basic human right.
Mr Bus Guy- honestly, it would be nice to feel that, but I rarely feel like I, personally, have made a difference (that goes for general medicine too, not just psych). I’m a small cog in a big machine and we all have to work together to get the job done, often without thanks.
Psychiatry is especially hard because sometimes problems just aren’t fixable- I know you’re sad, but you’re sad because your horrible childhood has left you with a disturbed personality and no coping mechanisms- and no talking therapy or tablet is ever going to fix that. Sometimes all I can do is offer a tiny bandage for a gaping wound…but at least I offer it.
In medicine I could always offer pain relief and dignity, even if there wasn’t anything else I could do. In psych I often can’t even offer that, and I find that quite hard to deal with.
Sorry…feeling sorry for myself now. Keep 'em coming.
