A mental health activity facilitator at an acute psychiatric ward is worried that cuts are causing patient care to be diluted
I am an activity facilitator in an acute psychiatric ward of a mental hospital run by a foundation NHS trust. We aim to help people with severe mental health issues to re-enter the community, while ensuring that they won’t be a danger to themselves or others. Obviously, the quicker we achieve this aim the better, both in terms of costs and to limit ‘bed-blocking’ – when patients stay in hospital for longer than necessary. Most of our patients are quite poor, working class people; upper or middle class people normally seek this kind of treatment in private care.
My main duty is to facilitate therapeutic group activities, such as cooking, meditating, relaxation etc. The first step when a patient is admitted into the ward is to follow a specific procedure that involves talking about the different therapeutic activities that may facilitate their return into the community. Although I mainly organise group activities, a patient can request solo sessions if they wish.
I have worked for the same employer for about three years; I started as a volunteer, then worked through an agency and I am now employed directly by the foundation trust. Through the years I have witnessed more and more funding cuts and, consequently, a steady decrease in the number of employees. The result is that we all have to do more work with less staff, within the same lengths of shift and for the same wages.
As a result, there is definitely an increased level of camaraderie among the staff; we all help and support one another when patients are violent or abusive - I am also a restrain team member, which means I am trained to prevent and manage violence and aggression if a patient becomes irritated for any reason. Unfortunately the cuts do aggravate the level of violent or aggressive behaviour, because it can be triggered by patients receiving care that has been diluted due to declining levels of staff, money and time.
Both my job and those of the occupational therapists – who also assist patients to reintegrate back into their community, by organising supervised days out and ensuring that they have everything they need to be mobile and self-sufficient – are currently at risk, because the trust’s budget is getting tighter and tighter. However, if patients do not get this kind of rehabilitation before being released, they will struggle when going back into the big wild world out there. More of them will relapse, because they are unable to cope or are not taking their medications, and come back into hospital for another period of time. This can cost more than the preventive therapeutic care which could have made their return to the community successful the first time around.
We work in association with other agencies, such as housing associations and drug abuse rehabilitation centres, as they are vital for success in the mental health sector. Once patients have been treated and are ready to be released from the ward, they need a home to go to. However, unfortunately the system does sometimes fail patients. In fact, it can happen that patients who do not have any family or money, or who have caused problems in their previous accommodation, are released onto the street as homeless. They then have to be assisted by an associated care co-ordinator whose role, among others, is to ensure that they register as homeless to get shelter and some benefits and that they take their prescribed medications.
Because associated care co-ordinators are very stretched, a few years ago the role of the support time recovery (STR) worker was introduced. They help with the bureaucratic side of following up released patients; but because of the increasing NHS cuts, STR jobs have been decimated. The result is that patients may not be assisted after being released. For the system to work well and effectively, we need more staff.
Volunteers could certainly help, if those volunteers are prepared to put in the effort and commitment that it takes to deal with such difficult clients. Working with people with acute psychiatric disorders is not easy, and if a volunteer mental health support worker is not professionally trained, seriously committed and totally aware of what the job entails, then they could easily create problems rather than help.
The idea of a Big Society is good, because it promotes a fairer and much-needed community spirit. However, if volunteers were to arrive without highly specialised training and profound commitment, it would be detrimental all around: for the volunteer, for the paid staff, and for the service user."