Golly, UK psych units sound quite different to NZ ones. Mental health nurses don't barge into people's rooms. Units are run much the same as medical wards but the patients are ambulatory. They do wake clients up to eat meals etc. otherwise they wouldn't get fed. But they can refuse a meal and go back to sleep if they want. Clients are encouraged to join some of the cultural and social activities but they are allowed to refuse and stay in the rooms or walk around the ward, socialising with the other clients, if they want, or sitting in the adjourning open space/garden. The many nurses I worked with were friendly but not over the top with it. The assigned nurse will probably have one conversation with a client during the day to do a mental state examination or offer support to the client whenever it is requested. Nurses are also obliged to keep observations on people with moderate to high risk of self harm etc. this does involve sighting the client depending on the level of obs indicated by the inpatient psychiatrist/registrar. Many clients are allowed leave to see to personal business or visit family.
Mental Health Units can be busy places with lots of different professional groups coming in to assess clients to prepare them for community care and family/friends can visit whenever they like during the day and at weekends. Therapy is not usually given on an inpatient unit as people are not well enough to have it. Wards are primarily for safety and containment, the administration of medication until levels of risks lower and they can be safely discharged into community care. Often nursing staff are busy trying to de-escalate patients who are have mania and acute psychosis.
There is usually a ward round throughout the day with the registrar and consultant doing mental status examinations, monitoring progress and adjusting medication, meeting with family and cultural advisors. It probably sounds strange but on the whole they can be quite friendly and quiet places.
However, sometimes they are unpredictable, where any raised voices usually sends staff swiftly walking (or running) to assess the situation and getting prepared to intervene with a variety of measures. Usually the most acutely unwell are nursed away from the main psychiatric ward in PICU (psychiatric intensive care unit) which has one to one nursing, a private high fenced courtyard, a lounge, a de-escalation area, three to four bedrooms and a couple of seclusion rooms with staff in a central pod doing continuous observations and control access into the area which is locked.
Medical Care is on tap. The admitting psychiatrist/psychiatric registrar takes a medical history and usually also has the medical history from the GP referral letter or the Electronic Health Record. The house surgeon is responsible for doing admitting physical examinations, full blood screening, ECG's and any additional tests needed. They deal with any medical concern that comes up for clients as they are under our care not their GP's. They inform the registrar/consultant of any concerning medical problems and discussions take place around the impact of the medical condition and any medication on the psychiatric presentation and the psychiatric medication on the medical condition. If the team are concerned with their limitation of knowledge on a particular illness they seek advice from the on-call medical consultant and often arrange for medical reviews on the ward. Out of hours, the psych registrar does this usually by triaging medical concerns with the nurses and prescribing treatment over the phone if appropriate. Often the psych reg is unable to attend as they are in an assessment in the community or in the police cells, and in this case an ambulance is called and the client is taken to A&E to be seen by the medical registrar.
However regardless of this, clients with ME are rarely admitted to a Mental Health Unit, most of our psychiatric care is done in the community, if the person is not a high risk of harm to self or others. We have small community mental health units that are unlocked, that are basically a house like any other house on a street, with peer and community mental health support workers looking after clients in a home like environment with a shared lounge and the clients often cook their meals with the staff. The community mental health nurse visits them daily and communicates with their community psychiatrist their progress, who advises on changes in medication and they see them every 3-5 days depending on their presentation.
Or clients are treated in their homes with one to one psychiatric nursing care and daily visits by the psychiatrist and the GP if required.
