Advocacy for Recovery: Voicing concerns about the system

By Jessica B

jessica b.jpgABOVE: Moving out of home at 16 can often lead to greater difficulty but Jessica found it was ‘the best decision I ever made’ especially as she had support and remained in contact with her family. PHOTO BY WARREN HEGGARTY 

This is the third in our series on Advocacy for Recovery. Here, Jessica tells how her experiences spurred her on to advocate for people with mental health issues. After many hospital admissions from the age of 16, Jessica found that there was a lot of room for improvement. Panorama also spoke to Flourish Australia Professional Practice Manager Janet Ford about better ways of handling the situations about which Jessica speaks.

WARNING: This article deals with the issue of physical restraint 

When someone is agitated and emotionally unwell, there’s a lot you can do to ‘de-escalate’ the situation. It involves talking to the person. 

Unfortunately, in my experience of many hospital admissions from the age of 16 there have been times when nurses and even police have acted in ways that have made the situation worse! Thinking about my experiences has made me interested in the field of advocacy for people with mental health issues. 

I was 16 years old and in a hospital emergency department. I was a bit agitated and kept walking off, so they decided to tie my leg to the bed to stop me, saving Security the trouble of keeping an eye on me. I couldn’t reach the nurse’s buzzer and I couldn’t go to the toilet. 

Another guy who was visiting someone else saw them tie me to the bed and went off at the nurse. ‘How could you tie a child to the bed?!’ he said. I couldn’t understand it either. I hadn’t been doing anything violent. 

On another occasion in hospital, there were police in the room and they went really over the top. They had me down with a knee in my chest and handcuffed me to the bed. I was restrained by all four limbs. It was over the top because all I had done was I had confessed to having self-harming thoughts. 

I have also been placed in seclusion. One time I was placed in a seclusion room in my underwear and felt extremely embarrassed and vulnerable. The nurses suggested they would take my underwear off me as well if I didn’t behave. 

There was one nurse I met who used restraint as a ‘go-to’ for any problem. If I was boisterous she would say ‘If you don’t calm down I’ll sedate you.’ [This is called ‘chemical restraint’- Ed] When you hear that every day for weeks at a time it is a real problem. 

Some nurses are lovely of course, but some others aren’t! It seems that there are a lot of people in the profession who just don’t have the personal qualities to be able to work with people who are mentally unwell. You get nurses who scream at you ‘WHAT ARE YOU DOING?!’ They say unhelpful things which make things worse. 

Of course, the better approach –talking to people- takes time. I find that time is something that staff have very little of in a hospital setting. In my experience of community settings such as Flourish Australia, people DO have the time to talk. 

Before coming to Flourish Australia’s YCLSS [Youth Community Liaison Support Service], I had reached a point in my life where I was resigned to the belief that the way things were, was the way they would always be and that nothing would ever improve for me.

In clinical settings, like hospital, even the environment, the white walled rooms, can put you on edge. It is a very intimidating setting. Another negative aspect of the clinical setting is boredom. I remember this from my very first hospital admission to the short stay unit at a hospital which only has six or so beds. I thought it was going to be wild and terrifying but over the two days I was there it wasn’t too bad on that occasion. Except for the boredom! 

Later, when I was admitted to actual mental health units, there were more severe problems. With about thirty beds and being the youngest it was quite scary. I’m nice to people so that helped me avoid worse trouble, but it is a very intimidating setting. And it is so boring. 

They don’t seem to do anything for you except give you medication. There are no activities, sometimes there seems to be no treatment. In a hospital situation, you don’t learn to deal with the issues that brought to you hospital in the first place! It then becomes a ‘revolving door’ where you return to hospital again and again. 

That was quite unlike my experience at Flourish Australia. When I began accessing Flourish Australia’s service at Penrith, I found that they would come out to my place to see me. The way staff treated me was more friendly and there was more general chatter. That made me feel more relaxed and less under pressure. I felt I could be more open and honest about things. 

Last year, Flourish Australia asked me if they could write about my recovery journey in the Annual Report. I agreed. As my article in the 2017-2018 Annual Report on pages 32-33 says, I graduated from YCLSS feeling empowered by the experience. I started living in a unit of my own and set out to achieve some significant life goals. 

One thing I have done volunteer work with the local State Emergency Service (SES) at Claremont Meadows. 

Another of those goals involves working to ‘influence political decision makers in mental health matters.’ You may have read about how I met the then Prime Minister Malcolm Turnbull at a ‘politics in the pub’ event in Penrith and was able to speak to my concerns about the mental health system. 

The local MP for Mulgoa and Minister Marise Payne was there too and we were planning to have a private meeting to discuss it further. That was interrupted by a change of Prime Minister and a change of Ministerial portfolio for Marise Payne but I still hope to go ahead with it. 

One of the biggest but most beneficial steps I have ever taken was to move out of home at 16. It was a very poor home environment at the time and my parents had actually become burnt out. I decided to move into a youth refuge. That gave my parents a break and meant that I had support. I have remained in contact with my family and have stayed at home on a few occasions since. So moving out actually helped a lot. 

My mental health issues have fluctuated over the years but are now mostly under control. One ongoing problem I have is Chronic Fatigue Syndrome. I am a lot better now than I was ten years ago when it first appeared. 

I am currently on my Ps for motorbike riding and I am learning to drive a car too! 

Flourish Australia’s practice is based on restoring dignity

Flourish Australia’s professional practice manager, Janet Ford, says that restraint and seclusion such as that which Jessica experienced are actually prohibited in our services. “People who access our services do so from their homes in the community and there is no place for something like seclusion in people’s homes, or in our centres,” says Janet.

As for ‘restrictive practices’, they are not very common. ‘Most often where we employ restrictive practices it will involve something like cigarettes. An example would be where we hold on to a person’s cigarettes and hand them out at set times so that the person does not run out and go through withdrawals before pay day.’

‘Initially, we would want to come to an agreement with the person. “Let us help you not to run out of smokes before pay day.” If they say “OK”, fine, but if it doesn’t work out and the person becomes agitated due to withdrawals all the time, we might consider an application to the Restrictive Practices Authorisation Panel. We would have to demonstrate why it is unsafe to continue as we are and how a restrictive practice will help people. It’s a very lengthy process which is time-limited.’

How do we deal with situations where a person who accesses our services might be highly distressed?

“De-escalation is a way of allowing the person the opportunity to regain control over themselves, to help them to become more calm. We focus on restoring or maintaining dignity. To do this we will use open body language. We won’t get too close to them, but we will aim to stay with the person and aim to sit down rather than stand up. We’ll concentrate on the here and now. “I can see you’re very angry.” We won’t try to solve problems because that would not be a good time for problem solving. Flourish Australia offers a training module on de-escalation.’

“We also apply boundaries. When we visit a person in their home who becomes abusive for some reason, we will say to them “I like visiting you but it doesn’t work well if you use abusive language, we need to work something out if you want me to visit.” We expect people to behave responsibly.’

Flourish Australia’s approach to restricted practices is covered in several policy documents including ‘Duty of Care and Dignity of Risk,’ ‘Restrictive practices’ and ‘Medication support.’

Flourish Australia YCLSS

232 Derby Street PENRITH, NSW, 2750

(02) 9393 9779

penrith.jpgABOVE: Penrith PHOTO BY WARREN HEGGARTY

 

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