Working with people with enduring and severe mental illness is challenging and can be difficult, but can also be extremely rewarding. The staff at Uplands work hard and are committed to making the lives of the residents as fulfilling and happy as possible. Not an easy task.
Last week I attended a Positive Risk Assessment training day which was facilitated by Peter Kaye, an experienced RMN and a talented trainer. Below are his thoughts on the difficulties and challenges faced by those of us who work with people in this client group and the care provided at Uplands Independent Mental Hospital.
"I've been providing the occasional training course for Uplands Independent Hospital for about two years, on mental health issues, risk management and staff management skills. I work throughout the country with care homes, hospitals, housing services, charities, social services departments etc and sometimes I go into care services which look very "posh" but when I scrape below the surface I find that the care is not as good as one might imagine it would be, and that, once you get beyond the chandeliers, care is negligent or, and this I often find in these "posh" services, the area set aside for the staff (rest rooms, training rooms etc) is downright grim. If staff are treated badly by their managers, you can guarantee that this will be reflected in the care given.
"Uplands provides care for some of the most mentally ill people in our society, and, whilst we must always strive to help people to mesh effectively with the expectations of the wider society, it is unrealistic to expect that such unwell people will always be able to maintain the standards that our society may expect regarding personal conduct, dress or cleanliness of oneself or one's personal space.
"From the perspective of service users such as those at Uplands, many of whom are likely to have experienced terrible traumas in their lives and who may well be tormented by horrific delusions or hallucinations, keeping oneself smartly attired or keeping one's room immaculately tidy may be low in the list of priorities. What may be far more important is to feel safe and respected in what we might think of as a refuge from a wider world which can seem overwhelmingly frightening. One of the great skills needed in working with such traumatised people is to build up their trust by being sensitive, gentle and supportive. If staff were very directive about tidiness or grooming of the service users they would alienate them. Indeed, such over-prescriptive care would be abuse in itself. The dilemma in mental health work is always how much do we allow people to be self-managing - even if that means the client may not conform to wider social norms - and how much do we intervene and "manage" (or over-manage) the client.
"I believe that the management and staff at Uplands understand this dilemma and generally get the balance right. Why do I believe this? It's obvious: when I visit, I watch the clients: they have easy-going relationships with the staff, they do not look afraid, they come to the staff with their difficulties. These are signs of well-being despite the ravages of chronic mental illness. Yes, Uplands may not have the smartest of decor, but that's not important. It's the spirit of the place which counts, and on that crucial matter, I believe Uplands is very healthy.
"When visiting any care service, I watch the way that staff interact with each other and with the residents. I have learnt over my 35 years in this business that anxious, withdrawn staff are a marker of an abusive care environment. But at Uplands, there is an easy-going, relaxed atmosphere. Staff do not look frightened, controlled or inhibited. One specific example: sometimes clients come into the training session to see what is happening. In many care services when such things happen, clients are ushered out by the staff in a fairly brusque way. At Uplands when this happens, staff talk to the residents politely and genuinely take time to explain to them that the room is in use for staff training. A little thing maybe, but it says a lot. Uplands provides a high standard of care to very unwell people and I am always pleased to work with the hospital in developing the staff's skills even more.
BSc(Soc) RMN RGN DPS-CPN AIfL
The Kaye Partnership