When I was 21 years old I started a 6 month placement on an acute mental health ward. I was inspired and enchanted by many of the people I met.
The ward manager
When I first arrived on the ward I was approached by a smartly dressed man who shook my hand and welcomed me on to the ward. He introduced himself as the ward manager and told me I could contact him if I had any questions or concerns. He seemed to know a lot about the place but his lack of an ID badge concerned me. He must have seen me looking for it because he explained that he lost his ID and they were sending out a new one.
Once he said goodbye and started to walk across the ward, I approached another member of staff to check whether he was actually manager. They explained that he was a patient with schizophrenia who had been on the ward for about a year and often had delusions of grandeur; some days he was God but most of the time he believed he was the ward manager. The staff always let him know when someone new was arriving so he could greet them. It was their version of an initiation process and thankfully I had passed.
The catatonic man
A young man was admitted to the ward in a catatonic state. He appeared to be unable to move, eat, talk or respond in any way. He was immediately put onto medication and a nutritional supplement. Staff regularly tried to engage him in conversation and support him with basic tasks, but there was little progress until they took him to the Creative Group.
The group involved drawing and painting while listening to music. Within a few minutes of being there the catatonic man began to respond to the music. His hand was tapping along to the beat and his head began to move too. With each session he responded more and more to the music, until he was moving most of his body and making eye contact with others.
At the same time his engagement outside of the group began to improve and he began to eat with support from staff. He occasionally had lapses, where he would return to his catatonic state, but on the whole he seemed to be doing well. He even got up to say goodbye to me when I finished my placement on the ward.
The football father
This was one of the first patients I noticed when I started working on the ward because of his unusual appearance. He was walking around in the garden area with about nine balls tied to his waist. They were all of varying sizes and in stretchy fabric bags, which hung down to his ankles.
When I asked the other staff about him they explained that he thought the balls were his babies and carried them with him all the time. You could always tell how ill he was by how many balls he was carrying. The bigger they got, the more concerned people became.
Towards the end of my placement I went into the garden to say goodbye to everyone and I noticed him walking around with just one football under his arm. The rest of the balls were gone and I felt relieved to know that he was making progress in his recovery.
The expectant mother
There was a woman on the ward who was several months pregnant and experiencing Puerperal Psychosis. This mostly presented in the form of paranoid delusions; she believed that people were trying to kill her.
Her medication had to be carefully monitored because of her pregnancy and she was kept under close observation to make sure that she was safe.
After about a month it emerged that the expectant mother had been forced into marriage by her aunts and that her relationship with her partner might be abusive. Staff therefore had a difficult time trying to determine which of her reports were the result of her paranoid delusions and which were actually true.
The safety of the expectant mother and her baby were discussed at great length in safeguarding meetings, involving staff from all disciplines. It was decided that she would be sent to a mother and baby unit when the baby was born, so that staff could monitor her condition, her ability to care for the baby and her relationship with her partner.
The expectant mother eventually gave birth to a baby boy. I was on duty at the time and supported her through part of the labour; this was difficult because at times her psychosis was so bad that she didn’t even realise she was pregnant. It was hard to convince her to stay in bed.
After the birth she was transferred from the acute mental health ward to the mother and baby unit. I worked a few shifts at the new unit about a month later and was pleased to see her progress. Although there were still some concerns about the nature of her relationship with her partner, she was no longer experiencing delusions and was being supported by staff to care for the baby.
We had a very charismatic patient on the ward, who always dressed in white clothes and wore a white band around his head. He believed that he was the messiah of all the religions and went out of his way to preach to people and spread his story.
He also believed that his ex-girlfriend’s dad had implanted a device in his head, which he desperately wanted removed. He explained that he got nose bleeds a lot and that this was a side effect of the device.
One day he met two other people on the ward, who also believed that they were the Messiah. It was interesting to listen to them talk together and express surprise towards each other. After the conversation I approached him to find out if talking to the others had made him question his delusion. He simply stated ‘those other people are crazy….they all think they’re me’.
One of my favourite memories of him is when he got out his guitar and played songs in the corridor to cheer up all of the patients. Several of them joined in singing and I could tell that it was the highlight of their day.
The smoking woman
There was a small elderly woman on the ward who had been admitted because she was having a manic episode. Apparently she had spent thousands of pounds within a few days and had been smoking over 100 cigarettes in a day. She ended up collapsing on the ward after a few days because she was having difficulty breathing.
Whilst on the ward, staff encouraged her to ration her cigarettes and monitored her physical health closely. Staff also kept her credit card in the safe and supervised her when using it, because otherwise other patients would take advantage of her generosity.
After a couple of weeks her manic episode appeared to subside and she became fairly depressed. She was put on to medication to help improve and stabilise her mood and then discharged. Whilst in the community she was monitored by the Home Treatment Team and her family. Thankfully they were very supportive and kept staff informed whenever her behaviour changed.
The evil man
There was an elderly patient on the ward who used to spend most of the day in bed. He rarely spoke during the day apart from a few whispered replies. However, around 8pm every day he would start to come out of his room and approach staff. Each time he would say over and over ‘I am evil, I am evil, I am evil’. Staff would reassure him that he was a good man and then usher him back to bed. Within about 5 minutes he would be back again, saying the same thing. Sometimes it would last until the early hours of the morning. Staff tried on several occasions to determine why he thought he was evil but he never elaborated on his statement.
The Psychiatrists were continually debating his condition and whether he might have a form of dementia. By the time I left the ward they were transferring him to an older adult ward.
The homeless woman
There was a young homeless woman on the ward who had been diagnosed with Personality Disorder. She was very friendly towards me and we developed a good therapeutic relationship. However I soon realised that she was prone to ‘splitting’; she would tell each member of staff that they were her favourite and that all the other staff were mean to her, which had the effect of dividing up the team.
She also had difficulty regulating her emotions and could become very distressed over things that other people might consider insignificant. It was like she was in constant crisis and providing her with continued reassurance was sometimes very draining for staff.
On one occasion she found out that she had been prescribed medication in tablet form, rather than the liquid form she preferred. Before staff could contact the doctor to have it changed, she stormed off, shouting that she was going to leave the ward and kill herself. I followed her and attempted to calm her down but she became more and more upset. She eventually pulled out a razor blade, which she had been hiding in her bra, and started slashing her arms in front of me. She threatened to cut me if I tried to take the blade away from her.
I eventually managed to calm her down and convince her to drop the blade. She was then supported in cleaning and bandaging her arms. Staff also checked to make sure that the other patients who had witnessed the event were ok.
The next day she approached me and acted as if nothing had happened. She was very friendly and eager to talk about the possibility of her getting a house soon. Sadly, each time she was offered housing she seemed to sabotage it in some way, either by doing something self-destructive to extend her hospital stay or by finding a fault with the housing that was offered.
Staff explained to me that she had spent most of her life on mental health wards and tried to get herself readmitted herself whenever she was discharged. It seemed like an endless cycle. I felt very sad for her and longed for her to find some stability and a life outside of the ward.
The paranoid man
There was a man on the ward who had been diagnosed with manic depressive disorder. He would go through periods of deep depression and then periods of being exceptionally friendly and talkative. He would happily discuss his past and theories about the future for hours on end. After a couple of months he was stabilised on his medication and discharged into the community.
Sadly, he returned 3 weeks later; he’d had a relapse after stopping his medication. This time he appeared to be very paranoid. He was well kept and dressed in a suit but struggling to stand or even maintain a conversation. His wife explained that he was on hunger strike as a protest because he felt that the government were watching him.
Staff repeatedly tried to convince him to eat but he refused. Sadly staff couldn’t force him to eat because he was assessed and found to have the capacity to make the decision as he understood the risks associated with his behaviour. He was able to retain all the relevant information, weigh it up, make a decision and communicate it.
All staff could do was continue to encourage him and monitor his blood pressure, pulse and other physical observations several times a day. He was eventually stabilised on his medication again and released from the ward in time to see the birth of his daughter.
The rainbow woman
Towards the end of my placement, a woman arrived with rainbow threaded dreads and a walking stick. She explained to me that she had difficulty walking after jumping off an 8 storey building. Apparently she’d had several reconstructive surgeries to put her organs back in the right place but there were still issues.
Initially she appeared to be very friendly and co-operative but over time she started to become resistant to being on the ward. She resented being watched by staff and not being able to smoke indoors. She frequently barricaded the door of her room at night by moving her cupboard in front of it.
She had been suicidal for years and stated very clearly to staff that she would attempt to kill herself again if she was released from hospital. She was therefore still on the ward when I finished my placement.
The man who proposed
There was a man on the ward who had been diagnosed with manic depressive disorder. He was very friendly and talked excessively, to the point where it was hard to interrupt him when you needed to leave. He would ask the same questions over and over and didn’t seem to notice when he invaded other people’s personal space.
At one point he was having a particularly bad episode and decided that the wanted to marry me. He repeatedly proposed even though I explained that it was inappropriate. I reported the issue to my supervisor and tried my best to keep my distance. He then switched to threatening to kill me and would hold his hand near me in the shape of a gun. I didn’t believe he actually posed any risk to me but I had to spend most of my shifts on the female section of the ward or in the staff office just in case. It lasted about 3 days and then he went back to his usual friendly self.
After 4 months of group sessions and medication, his behaviour improved and his mood stabilised. He was discharged from the ward and monitored in the community by the Home Treatment Team. They reported that he was doing well.
The dying man
This patient set fire to his flat in an attempt to commit suicide, because he believed that he was dying a slow and painful death. Thankfully he was rescued and brought to hospital. After an extensive examination he was found to be physically healthy. However, despite reassurance from staff, he continued to believe that he was dying. He would come to staff each day to complain that he had chest pain, his skin was rotting, his stomach was twisted or he had a tumour in his brain. It was heart breaking to know that he believed that he was dying, especially when nothing we could say would comfort him.
The dying man was put onto anti-psychotic medication to help manage his hypochondriacal delusions and sedatives to help him manage his anxiety. Staff also supported him with attending to his personal hygiene as, if he was not prompted, he would spend all day in bed without food, water or washing.
His distress seemed to gradually improve but he was still experiencing delusions by the time I left, about 3 months later.
There was a 6 foot tall muscular man on the ward who used to be an ex-boxer. He was fairly intimidating to be around and rarely spoke. We had been warned that he had anger management problems and had punched a patient on the previous ward.
I was often put on close observation with him, which meant that I had to be within about arms-reach of him to ensure that he didn’t harm himself. I tried to make conversation with him and treat him with respect. Thankfully he never showed any signs of aggression towards me and even seemed protective at times.
On one occasion I was approached by a patient who was very agitated and paranoid. He believed that staff had poisoned his food and had become aggressive as a result. Before I knew it the ex-boxer had appeared and was standing between us, facing the other patient. He stared intently at the patient but didn’t say a word. The patient gradually backed away and when to his room. The ex-boxer then turned to me and simply said with a smile, ‘Good morning Miss Stone’.
I found out that he’d been admitted to the ward after trying to kill himself by hanging. Apparently his girlfriend had left him and he was struggling to cope. While he was on the ward he attempted to kill himself again using his phone charger. Thankfully staff managed to stopped him. His mood gradually improved and he was released after about a month.
During one of my first days on the ward, a young man with brilliant blue eyes and a shaved head ran up to me and grabbed the personal alarm hanging from my belt, pulling it off the pin in the process. The alarm went off instantly throughout the ward. He threw it across the corridor, so it landed at another nurses feet, and then dived behind the reception desk. The other nurse didn’t share my surprised expression and simply smiled as she gave me back my alarm. By now 7 staff members had run towards us in response to the alarm. They reset it and explained that the man thought he was at war and alarms were grenades. He believed all the staff were enemy soldiers and he was trying to protect his comrades, the other service users.
The soldier had been diagnosed with Post Traumatic Stress Disorder after coming back from duty. Over time we managed to convince him that we were on his side and the anti-psychotic medication helped him gain insight. He gradually became aware that he was not at war and that it was safe on the ward. However, he still experienced some flashbacks and nightmares.
The matrix man
I once arrived on the ward to find a man wearing a long leather coat and sunglasses. He looked just like someone out of the matrix. As I walked past him he stopped me and said ‘dude…you’re stepping on all the little blue people’. I politely apologised and took a different route to get to the office. I found him fascinating, but sadly he was transferred to the ward next door before I had a chance to learn anything more about him.
The mute patient
The second patient I met was a young woman from the Philippians. The nurses needed help giving her medication so I went with them to her room. She was sat on the bed, clapping repeatedly. Whenever someone spoke to her she looked at them intently and changed the pattern of her clapping, as though she was trying to communicate something.
The staff repeatedly tried to communicate with her but there was no verbal response. Eventually they went to get the medication and asked me to stay with her in the room. I did my best to be polite and friendly and commented on the book next to her bed. To my amazement she stopped clapping, turned to me and said ‘yes, it really is an excellent book’.
There was a momentary pause and then she started clapping again. I tried to continue the conversation but she seemed to be responding to some hallucination or delusion. I’m not sure that she was even still aware that I was there.
About a month later I met with her again. She seemed like a completely different person and I could hardly believe how much better she was. When I asked her about that first day I had met her she explained that she had no recollection of it, or any of the other things she had done when she’d first been admitted.
The abused man
There was a young man on the ward who had been diagnosed with schizophrenia when he was a teenager. He reported hearing constant derogatory voices, which had tormented him for years by called him a paedophile. He also regularly had visual hallucinations of being raped at night.
Staff could always tell when the voices were bad because he would appear to be arguing with himself and become fairly agitated. It would have been easy to misinterpret his outbursts as aggression towards others, when really they were directed at himself and the voices. Thankfully a few of the staff had developed a good relationship with him and were able to intervene quickly before his behaviour escalated. He was also generally fairly good about coming to staff to ask for PRN anti-psychotics (medication to be taken as and when needed).
Towards the end of my placement he was transferred to supported accommodation. His hallucinations hadn’t improved but he had learnt how to manage them without becoming aggressive.
The depressed nurse
I found this patient very challenging to work with. Not because she was difficult but because I identified with her. She was the same age, same characteristics, also working in healthcare, had been abused when she was younger and kept it a secret, was experiencing severe depression, had suicidal thoughts and had been self harming for years.
I could relate to everything she talked about and desperately wanted her to know that she wasn’t alone, but it would have been inappropriate to tell her anything about myself. Instead I tried to support her when she was having difficult days and always listen when she wanted to talk.
Over time she reported feeling less suicidal, although the depression didn’t seem to improve. She was given leave from the hospital, which gradually increased until she was back to living in the community, with support from community mental health teams. She was so thankful towards the staff when she left and each time I noticed her working in the hospital she was give me a small smile.
The government advisor
There was one patient who had been on the ward for a couple of years. He had severe psychosis and suffered from elaborate delusions of grandeur and paranoia. He believed that he was one of the most knowledgeable people in the world and that it was his responsibility to advise the government and solve problems like poverty. He discussed his theories at great length with other patients and staff and frequently wrote letters to MPs.
He spent most of his time pacing back and forth along the corridor, talking loudly to himself about his latest theory. He claimed that he had to take illicit drugs to counteract his anti-psychotic medication, so that he could think clearly about his theories; this meant that it was a constant battle to try and keep him stable.
At times he became paranoid that the people around him were out to get him or were going through his files. He often got worked up about this, to the point where he would shout threats but never actually act on them. Staff would always intervene and try to calm him down.
He didn’t seem to improve much during the six months that I was working on the ward and I often wonder if he’s still there now.
The woman with visions
I met a young woman on the ward who was experiencing severe psychosis. She reported having visions of people dying and angels telling her that she could save them by drinking salt water. She honestly believed that if she didn’t follow what the angels were saying, she would responsible for the deaths of hundreds of people. It was an unbearable burden for her to be carrying.
She’d been admitted to Accident and Emergency because drinking excessive amounts of salt water had made her ill. They then referred her to our ward after realising she was experiencing hallucinations and delusions.
Whilst on the ward she also expressed delusions which centered around me. She believed that I was marrying her ex-boyfriend, who was royal, and that I would be taking the throne. She repeatedly asked me about the wedding and why he’d left her. Each time she became more and more tearful. I tried so hard to reassure her that it wasn’t true but nothing I said could convince her.
She asked me again and again. Every 3 minutes for hours on end. The obsessive questions were exhausting but I knew it wasn’t her fault. Even whilst experiencing severe mental illness, she was one of the most compassionate people I have ever met. She spent most of her time caring for the other patients and making them tea.
I finished my placement a month after she arrived so I didn’t get to witness her recovery as it progressed but I visited the ward later on and she seemed to be doing much better. She was finally aware of her delusions and hallucinations and laughed at the strange things she had previously believed.