Mad in the UK talks to Laura Moran about her experiences at work as a psychiatric nurse.
What is your background and experience as a mental health nurse?
I have worked as a mental health nurse for nearly 20 years in various settings such as inpatient, community and crisis team. I now work in a more community-based setting supporting people in finding suitable placements once discharged from hospital. I work with various people from older adults with dementia to younger people in acute and psychiatric intensive care settings. I often support people who have been detained in hospital for months.
Can you say more about what you understand to be the risks v the benefits of admission to psychiatric hospital?
There is clearly a place and role for psychiatric hospital admissions however I believe they should be used as a last resort when all other community support has failed and the risk to self or others is significant. The benefits may include keeping a person safe when they feel at risk of harming themselves or protecting others from harm – for instance if a person who is voicing paranoid thoughts, expresses the intent to act on them as a result.
However, I also recognise that there are also many risks and negative effects especially when people are admitted for long periods which might lead to institutionalization. There is always rick of harm from the prescribed psychiatric drugs, including polypharmacy, adverse side effects, and withdrawal reactions. I also want to draw attention to the negative effect caused by the medicalisation of normal human emotions and the unnecessary labelling of a person’s distress as a diagnosis, which may increase the potential for stigmatisation and intensify their suffering.
I have heard you talk about the ‘harmed community’, what do you mean by that?
I mean those people who have suffered adverse side effects or reactions to psychiatric drugs including antidepressant withdrawal, as well as those who may have been misdiagnosed with a ‘mental illness’.
I have had my own experience of going through antidepressant withdrawal and then having an adverse reaction from Citalopram. Both of which were extremely challenging and have left me with a degree of trauma. But it has left me with a passion to speak out about the potential risks and benefits involved.
How are your opinions received by your colleagues?
I am open about my lived experience with my colleagues when asked and I also take the opportunity to bring my insights into my work whenever I can. I certainly take a more critical approach to psychiatry. The recognition of psychiatric drug withdrawal in the medical field is growing and this is recognised in updated guidance.
What are your thoughts around informed consent when people are prescribed psychiatric drugs?
To obtain fully informed consent, it is important that the prescriber gives the patient all the information they need when they are offered a prescription for a psychiatric drug for the first time, rather than just relying on the leaflet contained in the drug’s packaging. This should include a verbal discussion of the potential risks involved such as suicidal thoughts and the risk of withdrawal which can be severe in some cases. The prescriber should ensure that patients are monitored throughout their treatment and there should be a clear discussion of proposed length of treatment and an exit plan with advice on how to safely cut the drug doses using a tapering regime. I think all to often people can be left on these drugs for years with perhaps no discussion or thought to how they might come off them safely should they wish to do so.
How has the transition from working on inpatient units to the community been?
Working in the community has given me more autonomy, and I much prefer being able to plan my workload and daily activity. In all honestly, I think I was becoming burnout from working on psychiatric wards, where people were suffering immensely, and their ‘treatment’ involved the prescription of various cocktails of psychiatric drugs. In hindsight I wonder if some of the behavioural challenges including self-harm and suicide attempts may have been due to the drugs they had been prescribed. Of course, I cannot say this for certain but it would be good if those working in inpatient settings would be open to this and question it as a possibility.
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Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own.