Placement on a secure ward during the COVID-19 pandemic – Welcome to The Student Social Work Hub

So where to begin? I won’t start by telling you that I know what it is like to stay on a secure ward as a ‘patient’, because I have absolutely no idea and hopefully never will, but what I can give you is aglimpse into this kind of a secure environment with added COVID19 restrictions, from my own student perspective. 

If you have never been in a secure hospital or on a secure ward/unit, it is difficult for me to describe the feeling that you get when you enter into that environment. It’s a different feeling you get than when you walk into a general ward. With a general ward you may feel relatively safe and comfortable (maybe not now because of COVID19), but the injuries or illnesses are usually quite visible -broken bones, post-surgery wounds, maybe hospital nighties, the beeping machines and faint smell of some kind of cleaning fluid. 

But, on this particular ward the illnesses and indeed most cases, the trauma is less visible. There are no crutches or beeping machines, no curtains round the beds or the big white pull down televisions that cost the earth to run, this place is nothing like that, but yet the impact these patients’ illnesses can have, can be just as serious as the people you see with wires and tubes attached to them and can often be longer lasting.

To enter my designated unit at this hospital I need to make a walk to reception to get a fob that is behind some locked cupboards. This key fob allows me into the different unit areas and also tracks my whereabouts. I also need to have a belt that can have a key strap attached. No belt means no shift. And no matter what… no mobile phones allowed. These added security measures can add a sense of dangerand fear to the back of your mind, even if you are an experienced worker.

Upon entering the unit of my placement area, on first glance it just looks like maybe a double storey community centre or office block. It does not look like what you would imagine it to. I probably know what you are thinking it looks like, perhaps something that resembles a prison? Well, no it doesn’t. Except…. the thing that gives it away is the tall green fence around a basic looking garden with some kind of smoking shelter. But it is not daunting in the slightest. 

Now, no matter how many secure environments I have worked on, whether that is high, medium or low- I still get that same feeling, a feeling of unknowing and a slightly heightened stress level. Why is this? I have no idea; Perhaps if I didn’t have this feeling I wouldn’t be in the right job. I have worked in the same kind of environment for over ten years and know that individuals diagnosed with a mental illness are no more likely to cause me harm than those without. But I suppose the thought of over fifteen men with criminal convictions detained under the Mental Health Act, all in one unit might be what is niggling away at the back of my mind. 

Maybe the media that surrounds us on TV, social media, newspapers and the language that gets used, constantly portraying people living with mental illnessas “crazy schizophrenics” or the ones with the “split personality” may subconsciously have been making its way into my mind… even though I know it is all a load of tosh.

What did I expect upon starting my placement? Well from experiences on other secure wards there was often a commotion going on somewhere or an “atmosphere” that could be sensed as soon as you open the door, perhaps someone at the nurse’s office upset their needs had not been met or loud voices to be heard arguing. But this place was different. There were no alarms going off with people running around like headless chickens trying to locate the source of the emergency, but there was a sense of calm and if I remember correctly, a faint odour of lynx Africa. 

I remember walking in and specifically started to recall the breakaway training from the day before, what to do if someone attacks you from behind… all these thoughts going through my head, still after all these years I felt like a novice- Why was I thinking this? I have never been attacked from behind nor do I know of anyone that has been. 

I also remember spotting a large fish tank in the corner of the living room area and thought blimey they’re brave having that, but then I noticed the big metal bracket bolting the tank to the wall, this made me feel slightly relieved. Oh, and the sight of the clinical blue heavy chairs with that squeaky plastic texture were dotted about the place, that brought back memories of previous jobs. If you have never tried to lift one of them, you ought to but I take no responsibility for injuries caused. 

After being introduced to the ward and settling in for the first week I quickly learned that there wasn’t going to be any plastic cups thrown at me, or the sound of doors being kicked, but there was an eerie sense of calm. However, this calm may not have always been present. You see, on my first shift the whole unit was put into “lockdown”. Yes, even more lockdown and restrictions than a secure unit usually has. No grounds leave, no visitors, no trips out, no family and friends… nothing. Just the staff and over fifteen men all in lockdown, all under restrictions together – how ironic. 

The staff were forced by infection control to wear scrubs, they’re like comfortable pyjamas, and have decent pockets that can fit literally everything in.These must be worn at all times apart from when it is time to go home, then you must change into your own clothes. This meant that most staff opted to remain on the ward even during breaks as the thought of wasting 10 minutes getting changed and back into own clothes again was almost too much to think of. One of the benefits for my placement though is that meals are provided on site and are brought to the ward, you can choose every morning what you want, for free. To me this is an absolute luxury.

So, my thoughts returned to the men. Where were they all? Were the men frightened of mixing like they usually may have done because of COVID19? Were they that annoyed that all leave had stopped that they would rather stop in their rooms with their own comforts? I soon came to realise on my fifth week in placement that the majority of these men were actually rather comfortable being in their rooms with their own televisions and belongings. The majority coming to and from the main living room and dining area during specific times when they needed to and using their garden leave for their e cigarettes at the allocated times. 

Remembering over fifteen men’s names and their room numbers took me two weeks. Some men spoke to me more than others, some smiled at me more than others and that’s fine. I did not expect the men to want to speak to me, but being me, I tend to try extra hard with the ones I know aren’t too sure about me. Each of the men have different hobbies, different personalities, different experiences, different diagnoses, different criminal convictions- but are all detained under the Mental Health Act 1983 on a section and ALL have had previous traumas in their lives. The most common sections at my placement are 37/41 and 47/49- I highly recommend @TheMaskedAMHP for discussion around the mental health act and sections or you can Google it. 

Now as a student I am here to learn. I am a nursing student on this placement but as you may know if you follow me on Twitter, I am a social work student too. My main focus and learning need for this placement is psychopharmacology and looking at all the different anti-psychotic medications. It is an area of interest and something I wish to learn more about. As a student reading this you may have some experience with medications but let me tell you, the number of different medications in this environment and the dosages are mind blowing. 

Some men are on 40 plus tablets a day. This is where I start to think with my social work cap on and wonder if any of these medications could be replaced with an intervention of some form? I know it is not as easy as that, but I hope you know where I’m coming from? It also amazes me how many medications are taken to counter the effects of other medications. 

One of the biggest responsibilities I feel a nurse holds is the medication. The pressure as a student as you are staring at an old-fashioned medications chart trying to go through the 9 rights of medication administration just simply frazzles your brain. There are over 15 men all prescribed with an array of different medications, pain killers, controlled drugs, injections, depots, inhalers, sprays, Nicorette sticks… the list goes on. What makes it worse is when they stand at the clinic with their eyes burning in the side of your head because you’re taking absolutely ages to pot their meds which normally take a few minutes by regular staff. I always thank them for being patient with me. But the pressure is sometimes unbearable.

What has made this placement a little more interesting is the lack of hustle and bustle on the ward. All the usual visitors such as the occupational therapist or the psychologist are all told to stay away and these have turned into virtual meetings. COVID19 has literally stripped not only the most basic of services for these men, but reduced the face-to-face contact to an absolute minimum. The impact of this must be devastating. However, I try to think positive and I workalongside a great team of nurses and health care workers so I try to do what I possibly can to help.

I have now formed some type of professional relationship with all of these men. They all know my name; all know I wear shiny Dr Martens shoes and all know I am a student. So now I’ve laid the foundations,I chose to be creative with my time. I have sat on the floor playing connect 4 in total silence, I have spent time listening to classical music, I have done more physical observations than I care to think of but each interaction has allowed me to try and build a relationship. I don’t brag that I am easy to get along with but I feel that I am able to start conversations with most people or indeed just be present with someone if they don’t wish to speak. I am also not afraid to be told to P*** off if someone doesn’t want my company. I would rather try.

As a student, I am there to learn. But I am beginning to realise more as each week goes on that text books can only teach me so much. When everything is stripped bare to the bones and there is only the staff and the patients all living through this lockdown together, sometimes sitting down for a brew and biscuit or running in the garden in the snow has taught me the most important thing about working with people. Whether I am a student nurse or student social worker- the importance of just being human can never be more important irrespective of my career path.

Mental illness isn’t there for us all to see plain and simple like a broken bone, it is deeper rooted than that and can be very well hidden. A mix of medications,psychology input, Occupational therapy work and all the rest of it may drastically improve an individual’s life, but sometimes by creating a bit of unplanned fun, laughter, hope and motivation can do something a pill and other interventions cannot.

Working in these types of environments can be challenging but so can every other job. A lot of the pre conceptions people have about this type of environment is through past experience, other people’s stories or through the media. My advice to any student lucky enough to get a placement like this is to go in with an open mind, don’t expect to face conflict, to feel scared or witness shouting and arguing, because the chances are, even if these did happen, they are more likely to be the because of the impact of the environment, not because of something you’ve done.

I am not naive enough to think that board games or jogging can change the pasts of these men, some which have been involved in extremely serious offences, but I’m not there to punish them nor am I there to judge them. I am there to help support them during their time on the unit with a hope of contributing to their recovery in some way shape or form. At this unique time on placement, I don’t expect to have all the same opportunities that normal circumstances would allow, but I am learning more on this placement that I ever could have anywhere else about building relationships. Whether its 6 months or 10 years down the line before the men finally live back in the community, I don’t really expect them to remember my name, but what would make me happy is knowing they remember what I did for them and how I made them feel. 

Everyone deserves to be treated with dignity and respect irrespective of their past, diagnosis, experiences, outlook or beliefs. It isn’t always easy but if we aim for that then we can’t go far wrong. 

I hope this blog gives you some small insight into what its been like for me over the past few weeks. Itsdifficult to put into words all the experiences and knowledge I have gained from my placement so far in such a short space of time.

I would be happy to help or discuss the placement further with any students especially those that are interested in this type of work.

My twitter account @3mm4G

Thanks for reading 

Note. My name is Emma Grady and I am a student at Edge Hill University. This blog represents my own views , and not those of my placement, university or employer and is personal to my own experiences.