“Let us never consider ourselves finished nurses… we must be learning all of our lives” – Florence Nightingale
This quote is so true. The beauty of being a mental health nurse is having the opportunity to constantly learn and grow from everyone I meet. My textbook learning ended when I qualified in January 2014, but that’s exactly the same time when my real learning started. There are many reasons I started nursing, most of which are truly personal and some of which I have completely forgotten now. None of them, however, are the reason I still do it.
I feel lucky to be in a position where I can say I have fought personal battles with my own mental health and also worked as a professional who can use that (subtly and secretly) to help others. As a mental health nurse on a peer support site I was asked if I would mind answering some questions people may have. I of course said yes, because if there’s a stigma I want to crush it’s the negative stigma that professionals don’t care… and I love the chance to chat to people and share stories.
As the quote above states, I am in no way a finished nurse, I am still learning and shaping and developing my understanding of people and how mental health affects them. I don’t pretend to be an expert or get it right all of the time. All of my answers are coming purely from my personal experience of working. So, please feel free to disagree with any of my answers and let me know what you feel about things!
What is the hardest part of your job?
This was a tough one to answer because there is the stock answer of not being able to help because of resources and staff limitations etc etc… but the real answer is having to tell people that I can’t help because of staff limitations or lack of resources. My main role is assessments, seeing people for the first time into specialist mental health services. People who have struggled for years with just GP support or no support at all or people who have come to a crisis point, been seen for the acute stage of their mental health and referred for long term support. Meeting with them and spending 90 minutes asking the most intimate details of their personal struggles and trying to build their trust to open up to me in a short amount of time to then tell them that there will be a wait before anything can be offered never fails to be crushing. The look on their face will never stop hitting me and I know my apologies are meaningless and I then become the face of their rejection and disappointment in services, which is the opposite of what I set out or intend to do.
The other and truly the hardest part of the job is when I lose a patient to suicide. I have received the call only a few times to say that someone I’ve been caring for has died and I will remember each one forever. It’s a tricky line to toe as there is the personal sadness that a human I have bonded with has gone and that connection is lost but there is also the professional guilt and questions of could I have done more? What if’s and when’s. This is all very much so a natural and expected reaction to any death in any professional setting but when this internal guilt and questioning is then echoed by family, friends and investigators it becomes more and more difficult to rationalise. The ultimate feeling of failing someone who has been in your care is absolutely the hardest part.
What is the most rewarding part of your job?
In contrast to the first question, this one is easy to answer. Without a doubt the most rewarding part of my job is helping someone to get to where they want to be with their health. Recovery is a heavy term that is laden with expectation of “symptom free” and “medication free” and “100% well”. In fact, recovery is a much more personal thing than that. Recovery for someone could be feeling able to go within their local area to run errands or back to working or being able to tolerate small talk in the playground on the school run or dog walk. Setting a goal with someone and watching him or her work toward it and achieve it is the best bit about what I do. Signing my name against a discharge letter of someone who no longer needs services is a great feeling and one that I will always look forward to. I received a letter and a photo in my work inbox just last week from a woman who used to be a glider pilot and had never thought she would fly again. The photo was of her in the cockpit, ready for a solo flight and I don’t know if it was the cold air, the chili in my lunch or the searing pride, but I choked a little.
Is there anything that really surprised you after you’d started working?
Yes, the strength people have to face the worst things imaginable. Sometimes I hear someone’s story and I lose just a little bit of faith in humanity, however, here they are, seeking help and willing desperately to move forward. I forever find myself being surprised and inspired by those people. That sounds very cliché but it really is true. When I read a referral and brief myself before I meet someone I’m often expecting anger and mistrust and pessimism, which would be 9 times out of 10 understandable. This typically isn’t the case though which shocks me, but maybe that says more about me than anyone else! I perhaps need to learn to love and let go more!
What is the most important thing for growth in the mental health industry?
Depending on the type of growth you desire would dictate what would be important to achieve it. For me, I only strive for personal growth and have no intention of descending into the lofty management heights. That being said, for clinical growth, the most important thing is to learn from the patients around me who know more about life with mental illness than any book will ever teach. People offer an insight into real life experience of living with certain symptoms and quite often offer the best analogies of how things feel or look for them. I shamelessly bank these and often offer them to other patients who are struggling to make sense or verbalise how they are feeling. The other thing that helps me grow in my position is peer supervision with other professionals who can make suggestions and share anecdotes of similar situations and how they managed.
For me, setting out an honest stall with people is the best way to build up a therapeutic relationship and have a fair expectation of what can be done and what is needed from both parties. It’s also essential to maintain integrity and stay true to your morals and values to be taken seriously as a professional. In my experience, people can spot someone who’s intentions aren’t legitimate from a mile off and there is no worse trait than someone who is not willing to admit that they don’t know something or that they got something wrong. Being thick skinned also helps!
How important is diagnosis?
So, here is where my personal opinion may differ from other professionals. I personally don’t work much to the medical model that is based around diagnostic criteria. Depending on the diagnosis, I feel like it’s only as valuable as it is to the person receiving it. However, diagnosis quite often dictates treatment plan so in this manner it can be considered very important. If, however, someone would like to try a different type of treatment to what is recommended for that particular diagnosis then this can be a hindrance. For example someone seeking medication for symptoms of a personality disorder may find this difficult to access due to there being no licensed medication for this diagnosis. I personally prefer to discuss symptoms with people, or, work toward a formulation model which looks at why someone may feel as they do based on their past experiences rather than attaching a label. Again, however, having a name for how someone is feeling can be reassuring and comforting and provide a base platform for personal research and seeking support.
How important is a support network outside of professional services?
Personally I find this a difficult one to answer, as I am very aware that a lot of people don’t have a support network outside of professional services. Having said that, Professional services should not be considered an alternative to personal relationships, as they shouldn’t be banked as being long term. I feel like one of the most important things that professional services can do is to help people find social connections with either like-minded people or in their wider community depending on what their preference is. This is why peer support is so vital and where social media can be a huge comfort to people. Finding comfort and a sense of belonging can go a long way to improving someone’s mental health. Whether this is with a face to face connection in a social circle, family unit or with colleagues at work or online social media groups…or peer support mental health websites… feeling needed, valued and important or powerful will indefinitely add to our sense of wellness.
I hope these answers offered some insight into my way of thinking and working! If you, dear reader, have any more questions or topics or comments then please feel free to ask them here and I will respond as and when I can!