Thursday, April 06, 2006

Springtime... and Autumn

Well, I've been in my new job for nearly two weeks now, and our new flat for, ooo, 4 days. So it's time for an update from one of the Hospital Library's strictlyonlyforacademicorworkuse computer. So I'll talk about work first, shall I?

[Beware that some quite technical stuff follows, that may be a little boring for those without a mental health interest!]

So... how's it going? Good, actually. Bloody busy for much of the time, as the ward is, as we sometimes say in the industry, erm... mad. Not a terribly PC term, I know, and not one advocated by most mental health professionals nor used when addressing clients or their carers, but sometimes it's the only adjective that fits. It's the place that's mad, and the patients are ill, OK?

It now takes me just 15 to 30 minutes to get to and from work, once I've negotiated the two exceptionally busy 6-8 lane roads that separate home from the bus stop. Yes, in the city of trams I catch a bus to work. But we don't want the extra expense of a car if we can possibly help it, and my bike doesn't arrive till next week [yes, our stuff will finally be here!]. Plus the fact that it's quite nice to veg on a bus rather than have to think, especially at 6.30 in the morning or 10.30 at night before/after shifts.

For Claud, it's even closer and quicker to work via tram, even at peak hour, and we could probably walk into the CBD [or its fringes, anyway] in 20 minutes or so. This has yet to be tested, but my reknowned penny-pinching [I prefer the terms frugality and cost-effectiveness] means that this estimate will be tested sooner rather than later.

We were talking about my job, weren't we? The staff have been very friendly and supportive, or as much as they can be in the midst of the seat-of-the-pants stuff that has characterised my first few days. The living on the edge of chaos feeling is a familiar one to most nurses, particularly in mental health [the more apposite term psychiatry is used more commonly here, so I'll use this from now on], but it's been extremely busy by any standards.

I've been welcomed, given lots of orientation and a little training, though also thrown in the deep end on occasion too. It's all a bit bewildering, to be honest, as I try to get my head around new systems and practices as well as the new environment and people who speak funny. Yes, there are a few Kiwis here, as well as Aussies, another Brit or 2, a few Irish nurses, and a few strong regional or mixed Australian-European accents.

Moving back into adult work [old people are no longer adults, apparently - as I've previously ranted] has been pretty seamless, although the huge doses of antipsychotic and anxiolytic [sedative or relaxant] meds that are given has been a bit of a wake-up call for me compared with the tiny older age measures. And still the young manic and/or aggressive patients keep on their feet despite what appears to be enough drugs to zonk a small elephant.

The level of verbal abuse that you take in these units [and the erudtion that often accompanies it] is also bit of a surprise, and the language can be more than a little spicy. There's a pretty much zero tolerance approach taken to threats, and whereas in the UK you were pretty much left to your own devices if a patient becomes aggressive [in this hospital at least], security are called to assist.

As a consequence, the incidence of restraint appears much lower, albeit at the expense of reinforcing the oppositional perception of the cruel psych nurse maintaining a institutional and punitive detention service. Not a good thing if you already have a paranoid psychotic patient on your hands. Having said that, many of the primarily young people in the system who have a history of violence are quite used to the way things are done here, and I've seen little in the way of negative impact on clients' mental state thus far.

There's also a much more cautionary, proactive and interventionist approach to any [perceived or actual] threat, with generally higher doses given at an earlier stage than in the UK, although I'm told that the State of Victoria is actually pretty conservative in this respect compared with, say, Western Australia. Nurses seem to have more leeway in using prophylaxis [preventative medication] here, rather than allowing patients to escalate to a more dangerous and distressed state.

It's a thorny issue, of patient choice and their Rights, benefit of the doubt, safety etc., and the care, rights and safety of others. It does seem a little incongruous when you consider that the Right to be cared for least restrictive environment is enshrined in the latest revision of the Mental Health Act here, and not made so explicit in the UK equivalent. I guess there are semantic issues in that "environment" is seen as simply the physical environment rather than the extended interpretation encompassing manner and means of treatment, but I think it could be argued that the broader sense view is equally valid. Not sure if it's been tested by case law here, nor the effect of local or international Human Rights legislation.

It's all so new and unfamiliar that I'm not sure yet what I really think about all this, and I obviously can't go beyond a deliberately vague description of events on a public forum such as this, so I won't be commenting at any point on any specific things I've seen. But I have to say that I've felt safer here generally than on the adult wards I've worked on in the UK, though the severity of illness is pretty similar.

Patients are also allowed leave much earlier and with less restrictions than in the UK, although the use of Community Treatment Orders on discharge means that the terms of ongoing care is potentially more restrictive here. And it's something that has held up the UK's new Mental Health Act, as both MH professionals and service users have united against the proposals, arguing that they are both too restrictive and unworkable in practice. It can be argued than a psych nurse could abuse his/her powers in these circumstances, in effect saying "Do what I say or it's back to hospital for you...". Not exactly the basis for a sound therapeutic relationship...

I now have the unexpected, terrible and onerous task of saying a positive thing about John Howard, anodyne and personality-free Prime Minister of this fair country. He may be politically conservative and pro-free market, but he's announced that he's going to chuck a load of money and resources at the mental health system here. Well done, John! Now I have to go wash my hands.

So, it's looking good overall... I'm happy, and even my closest in-laws have commented that I seem like a different person now that I'm working: more relaxed, chilled and... dare I say it, more Aussie [The horror! The horror!]? The whole thing about contributing to society, of being valued and of value is something that I guess I'm subconsciously in dire need of. Maybe it's my protestant work ethic made flesh*?
[*though I've long since stopped protesting]

The only dark cloud on the horizon is the fact that we really do seem to have hit Autumn now. The trees are turning golden in tiny incremental steps and the wind has a little more bite; and even the perma-tan is fading fast. Yep, it's been less than 20 degrees for about 4 days now, and this looks set to go on till the weekend at least, only high teens. Read and weep, England, read and weep for us.

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