I hate restraining mental health patients but often it"s the only option

People imagine mental health nurses like me as kind and gentle, as mother figures in uniform. What they don’t see is the harm we do to our patients: we lock them away, we restrain them and we take away their freedom. We do this in line with the law and we firmly believe we are doing the right thing. We are not “nice”, but when I look at my colleagues, I see strong, selfless, determined heroes.

I wish I could offer service users something better: a peaceful outdoor space, their own room, something less clinical than easy wipe armchairs. Most of them do not even agree that they are unwell and this deeply felt sense of injustice permeates the ward.

I remember one woman, Sarah*, was so psychotic by the time she entered hospital that she was not eating and had not washed in weeks. She could not see that she was unwell and was convinced we were trying to harm her, so would not accept medication. You could see how much she was suffering from her disheveled emaciated body to the distant horrified look in her eyes. We couldn’t just leave her like that. Her psychiatrist decided we needed to give her a long acting antipsychotic injection. She would need this to treat her psychosis.

The time comes to give her the injection. Despite doing everything we can to persuade her, she refuses to accept it and we have to do it under restraint. She is terrified and struggling so much to try to get free that we need five people to restrain her so she is lying on the floor. Her injection is licensed for the top of the buttock only, so we need to lower her trousers and underwear to administer it. We constantly check our techniques and her posture. We make sure that she can breathe freely and that we are not damaging her joints. She needs to be very still so we can inject her in the right place and not near important nerves or arteries. We explain this and try to reassure her but she remains terrified of our intentions. She lets out a primal wail of fear and then starts to scream. The room smells of sweat and anxiety. But we still have to inject her. I stay with her afterwards and she cries uncontrollably.

What really cuts right through me is that restraint is not some awful mistake, it is a carefully planned intervention. Everything in your being wants to stop this, to let the poor women be, but you have to carry on because you know it’s the right thing to do. It takes more than “niceness” to be here, you have to have a heart as big as the earth and, at the same time, be made of stone. Of course it helps that I found out a few months later she was rebuilding her life again: she was eating normally and looking after herself.

In my experience, there are very few decisions in nursing that weigh on us more heavily than whether or not to restrain someone. By the time someone is in hospital, they are often in extreme states of crisis and all the kind words in the world will not persuade them to take medication.

Prevention, in mental health, is everything. If we catch people in the community, as they start to deteriorate, they are more capable of engaging with services, of expressing their wishes, of maintaining their dignity and autonomy.

In the case of Sarah, and so many others, services were so under pressure that there were not the resources to catch her at this tipping point. The answer is not just medical intervention, it’s about keeping Sarah well by supporting her to live a rich and purposeful life.

Now, with so many cuts to social care, she is increasingly isolated. Real terms spending in mental health services dropped by 8% between 2011 and 2015. The success of these savings is constantly being rated against efficiency criteria like length-of-stay and symptom reduction but, for me, the real human cost is harder to quantify.

*Not her real name

Some details have been changed

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I hate restraining mental health patients but often it"s the only option

I assess if you are fit for work. I hate having to score your life this way

I’m the person who assesses whether or not your medical condition is stopping you from being able to work – and I have never felt so dejected by a job.

It’s my job to carry out work capability assessments to see if people qualify for Employment Support Allowance (ESA). For 18 months, I’ve been working for a private company to which the the Department for Work and Pensions (DWP) outsources this task.

I’m a healthcare professional who joined after being disillusioned with working in the NHS. I will be honest: for me, as for many of my colleagues, the salary, which is far higher than NHS pay, was a big draw. But like all healthcare professionals, we want to do a good job. We go into caring professions because we care.

But in this job I just don’t always have the time to be as sympathetic as I’d like to be or give people the time they need. We are under constant pressure to assess at least six claimants a day, spending 65 minutes on average with each.

If the company I work for fails to meet its assessment targets it can get fined by the DWP. So I often get a knock on the door to ask how much longer I will be and when I can pick up another case.

ESA is a contentious type of benefit and the people who walk into my assessment room are often anxious, angry, scared, pessimistic or resigned. Many have lost faith in the system and feel the government is abandoning them. We are often the sounding board for the people who come in. They confide in us about the horrific things that have happened to them.

About 80% of the people we see have mental health problems. I have assessed clients who were actively psychotic, in a manic bipolar phase, or severely depressed to the point where they couldn’t speak and a family member had to do the talking for them.

There has been a general improvement in reports since the company I work for took over the contract, but there still isn’t always the time to give full consideration to the complexity of cases. Some people have as many as 15 medical conditions and we have to document and obtain a history for every single one. When this happens, staff know it will take longer. It can lead to us rushing and missing things because we are so concerned about not seeing enough people during the day. It is relentless.

Most people I assess understand we are just there to do a job. But some people are very volatile and some do resort to verbal abuse, intimidation, and occasionally, physical violence. They’re angry at the system – and I can understand why.

As the face of that system, I am the one who bears the brunt of their ire. We all try to placate and soothe the people who come in as best as we can. But sometimes we just can’t. I have had to abandon cases and there have been countless times where the emergency services have been called. Sometimes I feel genuinely scared.

As we don’t make the ultimate decision, we never find out what happens in the end. When someone asks how they have done, it can be very difficult. I’m not allowed to tell them anything, but I know that if I have scored them little or no points, they will most likely lose their benefit and be expected to hunt for a job. It makes me feel so dishonest and I imagine their face when they’re hit with that letter or phone call, delivering the bad news.

It is most difficult with the ones who are trying their best to get by but just aren’t deemed bad enough to qualify for any support. Many claimants are older and underskilled, which makes it much harder for them to find work. I have cried on two occasions after an assessment because I felt so awful that I couldn’t help.

The job is incredibly demoralising and psychologically draining – by the end of the day I’m exhausted. I honestly don’t know how much longer I will last.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

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I assess if you are fit for work. I hate having to score your life this way

Why your brain makes you hate certain foods | Daniel Glaser

Mealtime is a common battleground in many families. Exasperated parents may be relieved to learn their children’s fussy eating might not be their fault. New research suggests picky eaters are just as likely to be influenced by their genes as environmental factors. But fussy children can grow into fussy adults – so if there’s one food you particularly despise, it’s worth thinking back to what might have caused this.

Young children have many more sweet tastebuds than adults to encourage them to drink milk and not eat bitter berries. Over time, tastebuds are ‘pruned’ to tolerate many new flavours. But a single bad experience can be enough to put someone off a food for life.

Violent vomiting after eating dodgy fish or a terrible tantrum before eating spinach can create an almost permanent connection in the brain between the food and a strong adverse reaction to it. The psychologist Martin Seligman, who tested this theory on rats, called it ‘sauce-béarnaise syndrome’ after his own bad experience with a gone-off French dish.

Time to stop nagging the kids to eat spinach or brussels sprouts, perhaps.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Why your brain makes you hate certain foods | Daniel Glaser

I"m a new junior doctor and I already hate my job

I’m scared, I’m exhausted, and I hate being a doctor.

This was not the plan. Sat on the kitchen floor of our flat, tears poured down my face as my partner looked on, stunned and worried. My third day on the wards was over, and I never wanted to go back.

I’d certified the death of my first patient – examining the cold body of a woman I had cared for, trying to forget that this was also my first time in a mortuary. I’d struggled to draw blood from patients who didn’t deserve my trembling, wide-eyed persona stuttering towards them with a needle. I’d welled up with tears as I sat in front of a computer trying desperately to remember how to prescribe a drug, paralysed with the knowledge of the harm that could befall my patients if I got it wrong.

Related: Hospital A&E wards ‘in crisis over shortage of emergency doctors’

Throughout medical school, I had been told that my foundation years – the first two years of a doctor’s career – would be totally different to my training. I expected to be thrown in at the deep end, but I expected to be supported. I expected a well-oiled team around me, keeping an eye on me, never leaving me feeling alone. Sat at that computer – the only doctor on the ward on my second day in the job, praying no one would ask me anything – I was clueless, exhausted, and had no idea what to do about it.

On our first day on the wards as new doctors, the more senior doctors were also new to the hospital. This was also the case on the second day. The well-oiled team was not there – it hadn’t even been created yet. After years of scribbling in notes, and learning to prescribe on neatly laid-out forms, I was faced with a system computer I’d never used, on which I was expected to request every test and order every drug.

I barely spoke to any patients as I followed my consultant on the ward round. I then sat at the computer, and wished, as I ham-fistedly hit the keyboard, that I had learned to type properly as a child. I tried not to think about how the patient who had reduced fluid intake was still taking in more water than me that day.

After finishing my jobs, which was only achieved two (unpaid) hours after I was supposed to end for the day, I did a quick walk round the ward, to make sure I hadn’t missed anything with my patients, to reassure myself that it was ok to leave them to the similarly overstretched night team. Patients and relatives seemed glad to see me, asking questions about their care, commenting on my having been there for 12 hours already (though none of them seemed surprised).

That walk-around was probably the only reason I made it back in the following day. Having the chance to speak to the people I was trying so hard to care for, I was able to glimpse the reasons why I’d started my training – that I would help people, that I would learn from my patients, that I would make a difference. That night, my partner arrived home to find me passed out on our bed, still wearing my coat, my microwavable supper still in the fridge.

I received my rota for this job three days before it started. Only then was I able to confirm whether I could attend my oldest friend’s wedding at the end of August. A week in, I still have no contract, and no one can tell me how much I can expect to be paid. My parents and partner are keeping me in food and rent until the end of August and my first payday, and I have no idea when I’ll be able to start paying them back.

Related: ‘I prick my finger while taking blood’: my first week as a junior doctor

I hope and pray it will get better. We already know that gaps in rotas caused by understaffing are bigger than ever. The whole NHS seems to be teetering on a precipice, with everyone ploughing on, but unable to ignore that this is unsustainable without proper funding and better staffing.

Many of my patients don’t need to be in hospital. They need to be in the community, where they are less likely to be stuck in bed for hours, less likely to contract the infections that, despite our best efforts, will always populate hospitals full of sick people. But social care is in even worse shape than the NHS, so we’re having to pick up the slack (and the cost).

“It’s always a baptism of fire”, people tell me. “That’s how you learn”. But I don’t want to risk people’s health for the sake of my own education.

I’m scared. I’m already exhausted. I’m not sure I want to be a doctor anymore, and I’ve only just begun.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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I"m a new junior doctor and I already hate my job

I hate Web page three but applaud the Sun"s breast cancer campaign | Gaby Hinsliff

The Sun: battling breast cancer with cleavage shots. Photograph: David Levene for the Guardian

Phwoar, what a timely health care reminder. Which is the rather confused message we are presumably meant to take from Monday’s Sun, which as a special deal with for female readers promoted the Web page 3 pretty to web page a single for a day – the twist currently being that for when all her clothing have unaccountably fallen off in help of avoiding breast cancer (geddit?). It is boobs, yes, but not as we know them. Which is strangely disorientating.

Most grown ladies know quite properly what they think about the Sun stunners by now: dated, seedy, juvenile at ideal and demeaning at worst. Personally I never favour a ban, a lot as I like the No Much more Webpage Three campaign’s cheerful activism, because I would far rather the paper’s editor simply woke up tomorrow and determined that in 2014 it seems frankly weird to have Ukraine at war on a single webpage and – oh look! boobs! – the next.

But cleavage for a function? Damnit, that’s a trickier contact, due to the fact it raises the query of when a breast is just a breast, and when it turns into something else entirely.

Any person who has ever breastfed a infant for a couple of months will bear in mind the strange shift from seeing one’s breasts as erotic invitation to seeing them as dreary previous public property. You start off with furtive manoeuvres in dark corners, feeding the infant below an elaborate overlapping method of shawls gradually, you realise that it really is not a disaster if the shawl slips a bit, because everyone’s fervently not looking anyway and ahead of lengthy, you’re whipping them out wherever with rest-deprived abandon. What was once an object of lust comes to appear about as desirable as the stained T-shirt covering it, so much so that eventually it feels really typical to open the door to a startled postman mid-feed. The flesh is the same, but the context utterly changed.

The Sun, 4 March 2014 Photograph: Information Global

It is accurate that numerous males – or postmen – never very attain the same stage of blase indifference to a nipple, maternally or otherwise exposed. But most intelligent adults are nonetheless capable of grasping that the identical breasts have diverse meanings in distinct contexts. Kate Moss painted topless by Lucian Freud is artwork Kate Moss topless underneath a sheer designer dress is fashion Kate Moss topless in an advert helps make you question regardless of whether she wouldn’t possibly like to put some clothes on just for once Kate Moss photographed topless on a personal beach is a breach of the press complaints code. How exciting, then, that when Moss supports the yearly Vogue Targets Breast Cancer charitable initiative she does it by pulling on 1 of their nice higher-necked T-shirts.

Soon after all, it really is precisely the panting schoolboy obsession with breasts in well-liked culture that makes mastectomy so distressing for several ladies. It really is challenging to come to feel reassured that dropping them will not indicate losing all your allure when even cancer-awareness campaigns look for to grab interest by flaunting a excellent pair (oddly, you seldom see a perky pancreas or saucy little liver exploited in the exact same way). Some cancer survivors will doubtless see this campaign as a crass and offensive stunt, a cynical try to regain the moral substantial ground for soft porn. Other folks may possibly think it would have been a great deal more empowering had the Sun selected to increase awareness by handing the Page three slot to a superbly photographed model with a mastectomy scar.

But that mentioned, there’s no ducking the truth that by asking millions of readers to examine routinely for the warning signs of breast cancer, this campaign will possibly save lives. Granted, deploying glamour versions barely out of their teens signifies that the paper almost certainly is not speaking to individuals older women who are statistically at highest threat. But provided it is doing work in conjunction with the youthful women’s charity CoppaFeel, launched by a 28-year-outdated whose cancerous lump wasn’t diagnosed until finally as well late to halt its spread, this campaign is obviously targeting a a lot more niche audience. It is rare for ladies in their 20s to get breast cancer but it happens and since it is unusual, there is a danger of misdiagnosis by GPs who will not count on to see it in women so youthful. The cheeky, perky CoppaFeel tone (not to mention name) might grate on any individual who has seasoned breast cancer close up, but it really is probably a good match for the mood of young women who nevertheless truly feel as well immortal to heed standard public well being campaigns. And if the sight of Rosie, 22, from Middlesex undoubtedly grabbed more male focus than female, effectively even which is not always a bad factor: a considerable quantity of lumps are actually found by a woman’s partner.

So I get No More Webpage Three’s point that there’s some thing quite odd about fighting illness using titillating images of ladies in their pants. These photos are profoundly divisive. But all I can say is that to my surprise and faint embarrassment, my gut feeling is rather considerably what it was on initial doing a double-consider in the newsagents’ this morning: first, why the hell couldn’t the model be allowed to preserve her jeans on? And 2nd, an awful good deal of girls will be checking themselves in the shower tonight.

This is the best Page 3 the Sun will ever run. What a shame they didn’t go out on a large, and make it the last.

I hate Web page three but applaud the Sun"s breast cancer campaign | Gaby Hinsliff