The following post is written by mental health nurse Karen Taylor. It is possible that some readers will know something of Karen already, although others will not. She has been interested in this network for a long time and as you read on you will see the hopes that she has for it.
We feel it is a privilege to hear anyone’s story. Karen’s tangible mixture of care, energy, anger and hope seems to leap out and we are very grateful to be able to share it. There are some vivid images of nursing work and of service users; real people whom we also want to honour with this story.
We hope that Karen’s story will be the first of many such pieces. It raises a lot of different questions. We hope that you will use Karen’s story in conversations. We hope that you will write comments below (which Karen will read). If you would like to tell your story too, then please be in touch.
What led you to decide to be a mental health nurse? What attracted you to the role? Where did you train and when?
I spent most of my childhood wanting to be an actress, but at 19 decided this wasn’t to be my path. After three years of different jobs I saw an advert for psychiatric nursing students, thought that it sounded different, applied and got accepted.
I started training in Coney Hill Hospital on April 30th 1984. It was certificate training and I was paid a wage right from the start. We had six weeks of induction in the nursing school and then went straight onto acute wards for 16 weeks. We weren’t supernumerary and were expected to work like everyone else. I loved it straight away, yes there was lots to change, but I felt at home and madness didn’t scare me.
Have you always had questions about mental health nursing and psychiatry? Or did they grow over time? What were the key moments, issues or people in that journey?
I had a wonderful nursing tutor called David Blackmore. He was very human and compassionate. Our student group was small and we did most of our training sitting on beanbags. The group process was most important, we weren’t allowed to talk about diagnosis – our job was to help people. On the wards I saw many upsetting things, particularly the use of seclusion, which was little more than punishment. I tried always to be kind and sit with people in distress, I played pool very well and could produce a good roll up cigarette – both great ways to engage!
My first clash came when out with patients on a Sunday outing with the mini-bus. We all went out to the Forest of Dean, on the way back we passed my house which was on the edge of a wood. We all sat in the back garden drinking tea. I just remember everyone being so normal. Then as everyone trailed back on the ward, they became mad again and I got a bollicking for taking them to my home, something I have never regretted.
One West-Indian woman still haunts me, she came in distressed and was put straight into seclusion. She started to menstruate but nobody went in to clean her up. I remember sitting with her for a long time afterwards as if I was trying to communicate I was different, I wasn’t like them. I am absolutely convinced something traumatic had happened to her in the months leading up to her admission and we compounded that.
Older people’s care was appalling then; tea, milk and sugar in same cup, bed bath with the same water down the Nightingale ward, women bathed side by side with no privacy, the long queue when everyone was toileted together. I remember persuading the manger to let me do a training day with the NA’s. I got them to sit with incontinence nappies on for the whole session.
When I qualified I worked in older peoples’ care for the first 5 years, I became a charge-nurse after 18 months and worked as a CPN for 3 years. This was at a great time when we closed the big hospital and moved to small community unit. As a CPN I loved working with families. There was also a nurse in Yorkshire who was becoming well known for his work with older people called ‘Star Wards’. He inspired me. He argued that nursing wasn’t just scientific but involved intuition, something I still believe now. What does using intuition mean to me? When I am with someone and we are getting to the heart of the matter, quite often a question will come into my mind along with the hairs on the back of my neck rising, or my stomach churning and I know this is a question I have to ask, sometimes something doesn’t “smell” right or look right or feel right, maybe you could put it down to body changes and facial expressions… but I see it much more of an Art and a feeling event than a scientific rational event.
I then became charge-nurse of an acute day hospital in Gloucester. It was at the time we were told to concentrate on “severe and persistent mental illness”. I created the day-hospital with a wonderful team as a place where people with psychosis would want to be. The biggest influence was a Mind conference I attended in Blackpool – I think in 1992. Here I saw psychiatrists and service users present together, people wanting their rights, people arguing about diagnosis and treatment. Everyone was all together. This was followed up by a thirst for knowledge on working differently with people who were psychotic. There were some wonderful conferences held in Derbyshire on schizophrenia, but they were very positive and were the early attempts to look past the medical model. It was the beginning of the Thorn initiative; nursing was very radical then, there were some great thinkers, movers and shakers. The day hospital was a haven, it was brightly coloured, no locked doors, the office was always open. We had an organic garden, made food together, ate together and everyone was respectful. We had service-users on our interview panels and service users ran a Sunday service and had a key to use the day hospital. We had African drumming, Yoga, singing, art (not as therapy – it was the doing that was important). No one was turned away and women with borderline diagnosis were welcome. It was a fantastic place to work and I am very proud of that time. Yes, we got lots wrong by my knowledge now, but it was a respectful place where people’s dignity and hope was embraced. This was the period 1993 to 1998.
I became clinical service manager of the day service and three mental health teams and a social support team, we worked out of hours and weekends and were the first to introduce support workers and a ‘peer-worker’ – before this term was conceived. I fell in love with Ron Coleman, voice-hearer and previous leader of the UK Hearing Voices Network and the rest is history: www.workingtorecovery.co.uk.
I carried on working for two years with a break to have my son Rory. All of my staff were fantastically supportive, but one nurse – a supposed friend – said, “What are you doing bringing another schizophrenic into the world?” As the months went by I realized that I was outgrowing the NHS with all the learning Ron had given me on recovery and I could do more from outside.
How would you describe your current relationship with mental health nursing?
I feel saddened by what nursing has become. There seems to be little fight left. When I am training I often hear nurses make excuses about having too much paperwork, of being lower down in the hierarchy. Where has our belief about ourselves gone, our value in mental health nursing? There does not seem to be any collective any more. If all mental health nurses in a ward turned round and said something like, “this paperwork is damaging our patient contact time which is precious, we would like to sit down with our patients and for them to write their notes and then we can engage in dialogue about what they say”, would management really not listen? Instead, wherever I go, all that people talk about is nurses in their goldfish-bowl offices, intent on their computers and ignoring patients except at medication rounds.
I felt very angry that we had to introduce protected time into London’s acute units so that staff would be outside of the office talking to patients. Surely that is what our work is – dialoguing with distressed people and helping them make meaning out of usually very distressing life stories? I worry about the over-professionalisation of nurses which seems to have grown with university education. We are in danger of loosing how to relate to people on the same level. We hide behind barriers and boundaries that are of a professional making. We make it much harder to meet as two human beings struggling to make sense of the world. Professionalism grows the sense of ‘us and them’, that some how we are different and don’t have emotionally distressing problems. In a concrete sense we have retreated: back into uniforms in some areas. I worry that we have lost the Art of nursing in the pursuit of science.
What hopes do you have for a critical mental health nurses network?
I hope that we can help nurses regain their power, to believe in themselves and realise what a wonderful contribution they can make in walking alongside distressed people on their journeys of recovery. I want to see the words honesty, integrity, authenticity, curiosity, openness, love and compassion be the everyday language we use.
I want to see us at the forefront of developing alternative ways of working with people in distress, being the leaders in developing trauma-informed practice and dialogical practice.
As I read your story I found myself becoming more and more interested in what you had to say. Who is this Karen Taylor I wondered – she’s a nurse and here she is talking about the need for nurses to show sensitivity and compassion while also describing people as ‘going back to be mad again’. I still don’t like hearing words like mad, lunatic, schizo etc used by anyone – although I am glad to say that I have managed to raise my own very acute sensitivity and reaction to words like this to a level of tolerance – and even acceptance. As I continued to read I found myself thinking “this Karen Taylor knows what she’s talking about – she’s alright”.
One particularly interesting theme that was emerging was the mention of a more holistic approach to treatment. The importance of caring for and treating people as individuals. I have been hearing these same cries for more than 30 years and at one point in the 90’s I thought there were some fairly short, but deep fairy steps being made in that direction. Sadly, my experiences suggest that those fairy steps forward have become giant steps backwards. I say this as someone who has had 5 admissions in the last 7 years. There are a great many reasons I could cite which, I believe would support my view but I don’t feel it is necessary nor appropriate on this occasion. For now I will put forward one particular factor which has had a huge influence regarding the treatment and support that’s provided, particularly in hospital where sensitivity and compassion are becoming rare qualities. My experiences tell me that the present ‘patient population’ is different from that of 1995 and extremely different from my first admission in 1979. The main difference is the number of patients who are now hospitalised as a direct result of drug induced mental ill health – and I can only see these numbers increasing.
I have become more and more critical of mental health services over the years, especially in hospital where so many staff now appear to lack any real human caring qualities. To be fair, I think this is partly due to changes in their roles from caregivers to admin workers just as you say. I do also believe that any sense of ‘vocation’ many nurses may have at the beginning of their journey into psychiatric care is well and truly dismantled over time because of the pressures they face. The wonderful plans put forward in the 90’s for person centred planning to be the cornerstone for psychiatric services never came to fruition. As someone who eventually had no choice but to ‘join’ the services as a hospital patient again in 2008 I can assure you that person centred planning wasn’t in their dictionary. To conclude this section I’d like to mention that from 2008 until present, if I am to include all psychiatrists who have been responsible for my care both in hospital and in the community, I am currently on a second appointment with the 14th psychiatrist. A also know that from July onwards I will have the ‘not so great pleasure’ of meeting No 15.
Hope you’re still with me Karen !
I just want to finish off by saying that towards the end of your piece a bright flash of a light bulb went off in my head as you mentioned how you ‘fell in love’ with Ron Coleman. Well I remember Ron – he may also remember me. I first met him when I worked at the Whitfield Partnership in Dundee as Employment Development Officer. If I remember correctly Ron was to be a partner in a Vegan Restaurant – I think. We met on a few other occasions mid 90’s when I was employed by DAMH as Advocacy Worker at Royal Dundee Liff Hospital and also in my role a few years later as Littlewing Project Co-ordinator (also a mental health advocacy project). My role involved networking and partnership working with local groups and projects including Hearing Voices.
As a result of my own experiences, I have formed my own views and opinions which point to a bleak future for those troubled with mental ill health. Given the option of choosing between the treatment I received in 1979 and what is provided now, it is a no brainer. For as much as we can decry the ‘old asylums’, the one thing that was in good supply were nurses who were sensitive to patient needs and situations, who showed compassion more often than not and most importantly, a genuine wish to encourage and promote the quality of ‘equality’ for all on the ward.
Take care Karen – say Hi to Ron
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Was great to see your story. 🙂 the day hospital is sorely missed.those were fantastic creative days, and I will always be grateful to you for your compassionate lead, and opportunity to train myself.
Everyone mourns the passing of the day hospital..you were an amazing influence xx
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How do you think mental health nurses can re gain power and help people through their journey of recovery? How does this compare with what you experienced when you first started working as a mental health nurse?
Nurses need to find their voice as a collective but also need to offer solutions, ie if a whole team said to their manager this paper work is affecting our ability to form a relationship with our clients, but if we did it this way ……….”draw some maps with the person , digitalise the picture and put in the notes” everyone would be happy or why cant we sit down and write the notes together with our patients, in fact they can write their own notes and we will sign it. The manager is not going to sack a whole team!
We can help people recovery by allowing the person to regain their power, take ownership and lead their own recovery plan.
When i was first working as a nurse, we did not spend much time at all on paperwork but much more time being with people
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Fay, Fiona, Becky, Heather, Raquel, Deanne, Emma and Talisa, BCU MH 04/13 students: We agree with the majority of your views. However, do you recognise there are some nurses who do spend time with patients? We feel it is management who put pressure on nurses to complete care plans etc as opposed to every nurse who ‘sits in the office’ so what can we do to challenge this? What has happened to the day hospital since you left? What are you currently doing? What can you suggest that student nurses do to challenge the future of mental health nursing?
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Of course their are nurses who spend time with their clients, but the pressure is still there which creates stressed burnt out nurses. The day hospital was put back to a sterile environment, locks on the door , garden tarmaced and turned into a resource centre, where people came just for appointments.
Student nurses should learn as much as possible about the effects of trauma and learn about neuroplasticity, they should also see it as everyday work to help people unpack their psychotic experience ie voice dialoguing, voice profiling , using narrative approaches with people with psychosis. They should stop looking at behaviours as the problem-ie self harm and ask the person “what happened too you”. they should fight against any regime that wants to put them back in uniform and further professionalise their role. Most of all they need to remain as human as they can, sharing their own experiences when helpful , being role models in showing taking back power and being compassionate but not afraid to challenge. Cultivate honesty, curiosity, authenticity and empathy.
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All interesting comments and opinions – most of which I agree with. Does bother me though that the focus of this and many other discussions tend to expel an awful lot of energy on what nurses can do to improve the day to day living experiences of those with mental health problems. Unfortunately there is huge resistance from the heavyweight partnership of psychiatry and big pharma to relinquish any measure of power and control they have over the current situation which continues to drive the diagnoses and medication agenda. I wish I could see beyond this gloomy picture I’m painting but for the moment I can’t. Nurses are entering a profession which is dominated by an embedded archaic care and treatment philosophy that offers little opportunity to care with compassion – the most valuable and important quality any practicing nurse could possess. Many come into the profession, genuinely wanting to perform the therapeutic and humane roles that are so desperately required – but sadly, for many that spirit and drive is extinguished, often slowly. A seriously flawed systemic approach to mental health care lacking any forward thinking vision is what we have. After all, there is no need for any forward thinking if it could affect the outcomes of the arrangement that is designed, controlled and delivered to ensure the status quo for the Big 2. Wish I wasn’t so negative – but in the true spirit of recognising that we are all individuals and we interpret our experiences as individuals, then here you have mine.
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the nursing students were asking questions specific for their course to discuss today in their lecture. I do think it is important that we promote nurses to take their power back. That they have a right to their opinion and they are not there just to do what the doctor has ordered and they can disagree and show different evidence based approaches, but also argue to try out new approaches which are often developed from ideas with littel evidence base
We can also argue for nurse led services and many nurses practice autonomously.
personally I left mental health services so I could practice as a human being without the constraints of an organisation, something I have never regretted and has taken me far. one of the areas we should be growing is that of community development and creating recoverys of community that have nothing to do with services and every thing to do with developing a community that cares.
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