Friday, April 03, 2015

Blue Witch asked me about the incident where I was punched in the jaw by a patient in my last blog post. What was the aftermath of the incident and what happened to the patient.

Well, we did not resort to that pictured above!
I managed to bring him to the floor using control and restraint techniques and because there was only one other staff member around who went for help... I sat on him! We used the time to talk through why he attacked me and to reassure him because he was distressed and frightened. In his case, he attacked me because the hospital, his home for twenty years, was in the process of closing down. We were moving the last residents into the community which caused many of the patients huge distress, fear and anger. This particular chap was responding to delusional ideas about him being victimised and he just 'lost it' one afternoon and punched me. Once other staff arrived, we went somewhere quiet, talked with him and he requested medication. I was more annoyed with myself for not picking up on his anxiety and agitation that day although two staff with twenty patients meant we were kept busy. I also had a good relationship with this chap and he apologised the following day saying he was horrified he had attacked me.
Nowadays, as back then, we try to ensure a stress free environment on the wards recognising what the early signs of anxiety and distress  are for each person. We look to de-escalation of this before it does become aggression or deliberate self-harm. I have certainly been in very scary situations on the ward and in the community but recognising the potential risks and dangers, minimising these and managing the situation before it develops does help. The control and restraint techniques used these days are more gentle and only used to ensure the safety of the individual and others (us!). Sometimes people are surprised that an individual can be extremely noisy or appear threatening but staffs have backed off to allow them space and time to vent their feelings. It can be noisy and look chaotic but is in reality controlled and managed by the staff. The chap mentioned above was mentally ill but I have had confrontations with individuals who use mental illness as an excuse for their aggression and bad behaviour. I make no bones about it: if someone has capacity for their actions or uses alcohol / drugs knowing it is likely to fuel their bad behaviour, they should be culpable for their behaviour and be punished accordingly. It's one of the reasons I love reading court reports in the newspapers to find out what the defence lawyers cite as mitigating circumstances. It's also another reason why I have little love for lawyers defending thieving, lying, violent scrotes who lack empathy for their victims and usually have an extensive history of similar crimes.
As for the chap above, we moved him eventually into a small 24/7 supported accommodation with other patients who were unlikely to survive in their own accommodation. He was very happy with the move because he felt supported and safe there. One of his fellow residents had been in hospital for over 50 years having been admitted in 1938 and others had spent 30 years inside. Individuals who nowadays would possibly manage to live in the community although my views on community care may require another lengthy post! I hope that answers your question BW.


Anonymous Blue Witch said...

Thanks for such a detailed and informative answer delcatto.

I have a colleague/friend who moved from the world of educational into forensic psychology, and now mainly spends his time working with people on remand, in the highest security prisons, attempting to work out whether they are mad, bad, dim, or just plain evil.

The thing that most people don't know if that if someone can claim an IQ below 70, the legal system considers that they don't have capacity to stand trial.

Given the extremely questionnable nature/validity of IQ testing, and that lawyers tell their clients not to co-operate with testing, or to give deliberately incorrect answers (so that they score poorly), there are many criminals/mentally ill people around who play the system.

This puts us all (particulalry those front-line treating professionals) at huge risk.

10:50 am  

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