Psychiatric hospitals: what are they really like?

Before Christmas, we spent quite a bit of time visiting a psychiatric hospital. One of our elderly relatives was ill--suffering from schizophrenia--and we travelled to see her when we could at the weekends.We learnt an awful lot over that period, not only about the illness itself, the therapies used to treat it and the legislation surrounding mental health, but also about the physical institutions in which people suffering from severe mental health problems reside.

People's perceptions of mental illness have, I think, softened over recent years. There probably still exists fear of mental illness, but not to the same extent. It's talked about more openly--is in the media even--and is no longer considered something to be ashamed of.

Our relative has been ill for a long time, so we're very used to the symptoms of mental illness, but this was the first time that we had set foot in a psychiatric hospital. And it was quite an eye-opener. The hospital is situated in an affluent town on the south coast and you reach it via a pleasant drive past what look to be very expensive executive homes. The hospital is indicated by an innocuous NHS Primary Care Trust signpost--no mention is made of 'psychiatric', just 'hospital'.

But once you are on site, things feel quite different. In order to gain admittance to the hospital you have to report to the (very friendly) receptionist, explain who you are visiting, sign in and put on a visitor badge. Much the same procedure as when visiting any workplace, you might think. But going onto the ward is quite different again. The doors are locked, because most of the people on the ward are being detained under the Mental Health Act, which means that they are only allowed out unaccompanied if they have been granted leave by their doctor. All entry to, and exit from, the ward must be noted by a member of staff. Thus, when you arrive at the ward, you must ring a bell for admittance and, because the staff are very busy, it can often take a long time before anyone answers the door. Children aren't allowed on the ward, which meant that when we weren't taking our relative out, we had to meet her in the hospital's designated 'family room', away from the other patients.

Walking around the wards is also quite an experience. The patients are suffering from all kinds of mental health issues. Some are very pleasant and friendly, but others can be unpredictable and verbally aggressive. In the 'acute assessment unit', the ward to which all patients are initially admitted, it is common to see police officers, since new patients are, often, brought in as an emergency by the police.

I wouldn't exactly describe the hospital as Dickensian, but despite friendly and helpful staff, it is undeniably a bleak place, and the locked doors and police presence lend it an air of detention rather than one of caring treatment. Our relative has now been discharged, thank goodness, but there's a high likelihood that she will need to return at some point in the future. And that is something that none of us will relish.

The worth of music

The other day our youngest daughter asked if she could give up learning the violin. Her reasoning was that she was finding it boring and also difficult because, at the moment, she learns the piano and the recorder as well. Learning so many instruments turns out to be confusing!

Of course, we agreed. We always thought that three instruments was quite a lot to handle! But this got me thinking about what we would do if our other child asked to give up the violin. She only plays the one instrument, but is quite keen, playing in the orchestra and also singing in the choir.

Realistically, I'm sure we would agree to her giving up. There really doesn't seem to be much point in forcing someone to do something that they don't enjoy. But in some ways it would be a hard decision -- not only has she learnt to play the violin, but she's also learnt to read music, gained an appreciation of of a wide range of music, and been given the opportunity to perform. All these fringe benefits are valuable and the longer she plays, the greater the benefits become.

Yet another parental dilemma!

Sadly, NHS not so different from (some) other workplaces

I, like many others, was shocked by the reminder in the news this week of the dreadful failings at the Mid Staffordshire NHS Trust between 2005 and 2009 which led to terrible neglect of patients and many unnecessary deaths.

This kind of dereliction of duty in the hospital sector is particularly shocking since it really is (or can quickly become) a matter of life and death, and also because when someone is ill in hospital we expect that people around them, and most particularly nursing staff, will be caring and compassionate.

Yet this kind of breakdown in work ethic and respect for persons is not restricted to the healthcare environment. It can occur anywhere and is something that I've experienced in my past, working in an office environment for a large organisation.

Sarah Montague on Radio 4’s Today programme interviewed a number of individuals who work, or used to work, in the NHS in order to try and find out why a situation such as that in Mid Staffordshire might occur. The people she interviewed talked overwhelmingly about employees who didn’t care and senior management who failed to listen; a culture in which complaints were ignored and in which whistle blowing by staff was met by bullying, coercion and the threat of dismissal; a culture in which underperformance was not challenged and in which underperformers were moved sideways rather than disciplined. The net result: an environment in which the best performers leave and the worst performers stay, and in which people behave exactly how they please without check. A veritable recipe for disaster.

All of this I recognise from my past. The environment that I experienced was one where the senior managers (who had had been in place for years) were interested only in keeping complaints to a minimum and making sure that their own positions were safe. They ignored internal complaints about underperformance and unacceptable workplace behaviour. This meant that people simply suited themselves—turning up late for work, failing to do their jobs properly, and being (sometimes shockingly) rude to their managers and those with whom they worked. When the head of department retired, a new head was hired who recognised all of these problems and set out to change them. She really rocked the boat and (surprise, surprise) was fired (or ‘asked to leave’) in less than a year.

I found it incredible that this kind of situation could exist and be allowed to continue, and I left the organisation as quickly as I could. My experience was of course far less shocking than the situation at Mid Staffordshire. For starters, people didn’t die as a result. But nonetheless, the situation that I experienced was harmful to those it touched and unacceptable. I also find it interesting, from a purely intellectual point of view, how people—some people—will behave in the absence of a strong, engaged and moral leadership, no matter what the sector.

In search of that elusive summer holiday...

We are in the midst of our annual Big Project--finding and booking a summer holiday for the family. But this seems to be proving even more difficult than usual, perhaps because we usually book before Christmas, but for a variety of reasons have had to do it later than usual this year.

It all started off rather well. We found we had sufficient Tesco Clubcard points to cover the cost of return flights for all four of us to some relatively close destinations. Hooray! However, when we looked closer we found that the flights that we could actually take with our points were fairly limited and, what's more, were selling fast.

We settled on Milan as our destination of first choice--enough flights at decent times to a good location (we planned on renting an apartment on one of the Italian lakes). But when we started to look at apartments, we ran into all sorts of problems--high prices, booked up, non-flexible changeover days which didn't fit with our flights, etc., etc.

So, back to the drawing board. Plan B was Nice--good weather, millionaires to laugh at, beautiful scenery and things to see and do near at hand. What could be better? The apartments still proved a bit of a problem, though--more flexible changeover days, but still expensive when what we wanted was enough space for four people, plus pool, plus washing machine...

But, finally, it looks like we're sorted. The lovely Pierre is willing to rent us an apartment for 10 days with swimming pool (and even tennis court!) at a price that we can afford. At last, we can breathe a sigh of relief.

But I never quite understand why booking a holiday is so difficult.

Thumbs down for the National

Last weekend we were looking forward to an exciting family treat involving both kids and grandparents -- dinner out in London, followed by the evening performance of 'Hansel and Gretel' at the Cotteslowe Theatre at the National. But things didn't go quite as planned...

Snow had fallen on the Friday, so we checked that our route was clear beforehand and set out early, arriving at the National with time to have a coffee and look round the shop before meeting the grandparents. So far, so good.

We were just settling down with our menus in the Mezzanine restaurant, when an announcement came across the tannoy: 'We regret to announce that we have had to cancel this evening's performance of "Hansel and Gretel"'. No explanation as to why. We were somewhat surprised and somewhat disappointed, to put it mildly. But there was nothing we could do except make the best of it and enjoy our meal.

When we went down to the box office to ask what was going on, we were told that one of the principal actors had fallen ill after the matinee and, as the Cotteslowe runs at a loss, they don't employ understudies. So the show couldn't go on.

We got our money back, but the explanation for cancellation seemed lame, to say the least. Surely it shouldn't be that difficult to cover for such an eventuality? It is the National after all. Plenty of understudies around for the other theatres in the complex. Why not have them double up and understudy for the Cottesloe too? Or, for that matter, many of the waiters in the Mezzanine restaurant are young actors trying to make it. I'm sure they'd jump at the chance to understudy as well as wait -- even if the understudying wasn't paid. What an opportunity for an aspiring actor to fill in at the National, after all!

So, we'd travelled 65 miles in snowy conditions with excited children for what turned out to be a non-event. Actually, the kids were fantastic, accepting the situation with equanimity and simply being pleased to see their grandparents. But the whole fiasco may well make us think twice about booking tickets for the Cottesloe in the future. I'm sure others are thinking the same. Not a good thing for a theatre that already runs at a loss, is it?

The end of Creation?

We went to see a fantastic production of Aladdin over the Christmas holidays put on by local company, Creation Theatre. It was very entertaining—imaginative props, strong acting and a truly talented circus performer. But then all of their productions are very good and imaginative.

They started out (in 1997, I think—the year that we moved to the area) as an open-air theatre company, performing during the summer only, in the gardens and quads of Oxford colleges. They gained themselves some deservedly good reviews and grew gradually over the next few years, moving into indoor as well as outdoor venues and putting on productions at other times of the year. Eventually, they opened their own theatre—the North Wall.

But the poor summer weather, flooding and a reduction in tourism over the past couple of years have really taken their toll on Creation. Summer bookings were down and outdoor performances were rained off. Things reached crisis point this Christmas when Creation regretfully announced that if they were not able to raise £50,000 by the end of the financial year, they would be forced to close down.

All of this makes you realise just how wide-reaching the effects of unusual weather patterns can be. It’s not only about ruined houses and impassable roads. It can even affect entertainment and the arts. Let’s hope Creation survives.

Back to school—and exams

My kids went back to school on Monday, but it was a busier start than usual as they were going in opposite directions. My youngest was going back to primary school and my oldest was off to a different school to sit a secondary entrance exam. Both of them had to be at their respective locations by 8.45 am, so I had to play that common parental trick of managing to be in two places at once. (Well, not quite. It was more a case of dashing from one location to the other at high speed.)

This also meant two lots of kits to get ready for Monday. School bag, PE kit, school meal order form and water bottle for my youngest. Pens, pencils and geometry kit; packed lunch; and sangfroid for my oldest.

Both came home by 3.10. Both were relatively happy. Now we just have to wait for the results of the exam!