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.