Is it me?

During a discussion with a non-clinical colleague about a member of staff that had been involved in several ‘incidents’ on the ward, and was subsequently signed off with PTSD (along with some physical injuries), the comment came up around why this member of staff was involved in so many incidents. 

It was something that I was expecting to be mentioned at some point, and I already had an answer ready – the job role meant that they were most often in communal areas such as the lounge/dining area, where incidents are most likely to happen. My non-clinical colleague briefly acknowledged this, and then went on to say maybe the member of staff needs more training to prevent incidents. 

I acknowledge that for those who do not work on an acute mental health ward, predominantly caring for those experiencing an acute episode of psychosis, the nature of the work is not always understood. However, as I’m only human, I felt a rush of frustration, and that I needed to jump to the defence of an incredibly competent and caring member of staff. I assured her that this is not the case with this staff member, and I had worked with her for two years and knew her well. I had observed her interaction with patients and she was good at de-escalating a situation. Before a tense situation becomes an ‘incident’, it is often a certain type of person that enters in to that situation in an attempt to de-escalate. This takes a special skill and judgement, but it is also part of our role to keep patients safe. If it’s possible to de-escalate a situation then that is the best approach, rather than waiting for a frightened or angry patient to reach a crisis point and react in a verbally or physically aggressive way. 

There are many skills here – being observant to the environment; asking the right questions during handover; personal knowledge of the patient; and excellent communication skills to name a few. However even with all those things in play, de-escalation does not always work, and that is the nature of the delusional beliefs and hallucinations that many of our patients are experiencing; often you can’t rationalise your way out of them. 

Therefore, the first person to be targeted, or at least feel the brunt of the incident, is usually the person who was attempting de-escalation.

I am a strong advocate of asking questions and making challenges when we have concerns, and I admit that in this instance, I feel emotionally involved with the situation. However I also feel it’s important to note, again, that you can’t always tell what’s happening in practice by the paper records that we keep. It is impossible to judge competence by numerical means, for example counting the number of incident reports that mention a certain person. Yes, it’s right to ask questions, and I would probably do the same. But maybe we need to reframe the question – seeing one person involved in a number of incidents doesn’t necessarily mean there’s a problem with that person, so it shouldn’t be the first thing we jump to. 

On the whole, it comes down to an entire team, from senior management to cleaners. In this instance, my feeling is that staffing levels are not safe, to which I was of course told that the trust follows the safe staffing levels set nationally. I was already feeling defensive by this point so opted against launching into the problems with ‘safe staffing levels’, but you can always read my blog post on it.