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July 5, 2013 6:30 pm
Just like other doctors, although without the white coats, psychiatrists hold ward rounds. They don’t actually walk from bed to bed bearing stethoscopes. Rather, the patient joins the psychiatrist and team (nurses, psychologist, therapists, social workers) in the seminar room. Relatives and friends are invited and there may be students present. Private conversations with patients to clarify their wishes and mental state precede the main event.
The point is to sort out diagnosis and treatment, to explain the illnesses and to make discharge plans. This formal process is called the Care Programme Approach (CPA), which documents needs, monitoring and follow-up. Cynics call it Continuous Paper Accumulation.
Acute psychiatric wards can be stressful in themselves, with 15 or so relatively psychotic patients needing a lot of delicate care and support. Other patients may intrude, and families are often anxious, sceptical or at a loss.
But unlike the more elderly patients found on general medical wards with chronic relapsing conditions, psychiatric patients are younger and tend to get better. Students are astonished to see people who were incoherent and dishevelled on admission becoming perfectly sensible in a few weeks, able to articulate their thoughts and describe the strange things that have happened to them. One young man transformed himself from catatonic posturing, wearing his clothes around his head, to a sensible languages student who could explain the logic of his actions (wherever he looked, a nuclear bomb fell, so it was best to cover his face). People who may have been unwell for months, drifting away from family and friends, can be magically restored to life and social functioning.
Mrs X came to visit her husband having not seen him for two years. When she left him he was unkempt, muttering to himself, chain-smoking cannabis and convinced he was the King of Hackney. Unable to communicate, she simply went to live with her sister. When she saw him on the ward, his hair cut, properly dressed, smiling and talking sensibly, she broke down in tears, as did her two teenage children. They were too fraught to let him move back in, but since discharge they visit him regularly, and he has been living a quiet life, on regular medication (and with just the occasional joint).
A young man with schizophrenia, brought to us in a confused state from a Midlands railway station, took some time to get better. When eventually we got through to him we realised he was from Italy, had not been in touch with his family for months (because of thought disorder and hallucinations), and had socially disappeared. Contact via the embassy, who were very helpful, led to a visit from his brother and the weeping happiness of his mother down the phone. When she arrived on the ward the next day to see her long-lost (and presumed dead) son, we were all overwhelmed by her elegance.
Acute psychiatric wards are unique configurations, much maligned, and adept at managing people at the very end of their tethers. The recovery rates (not too bad at around 70 per cent), the patience of the nurses and the stories that emerge from the mists of unrecognised illness are constantly heartening events. Treatment means more than just health restored, it means changing the way people are seen, and the way they see themselves.
Trevor Turner is a consultant psychiatrist working in east London. Some details have been changed to protect identity
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