Reflections of a Mental Health Support Worker

Trigger warning: discussion of eating disorders, suicide, self-harm, and physical restraint.

From lecture hall to hospital ward

In 2019, the day after graduating with a Health Psychology MSc, I began working in a mental health hospital. The ward I worked on specialised in the treatment of women with both a personality disorder and an eating disorder. This patient profile, I was told during my induction, is very difficult to treat. I knew from studying eating disorders that the outcomes were poor and that personality disorders presented difficulties in engaging with treatment, but I was excited to move into a real-world context.

We were told that self-harm and the use of physical restraint was common on the ward. Within an eating disorder context like this, many of the patients would be fed via nasogastric (NG) tube. On a ward that cares for up to 15 patients, not every patient is at the same point in their recovery, so their meal plans looked very different. Some patients were eating physical food (either independently, or with staff support) and some were fed via NG tube voluntarily, whereby they would go into the clinic and have their feed administered via syringe.

However, some patients would need to be physically restrained for their feeds. This meant that the ward was particularly intense around mealtimes. This is where incidents of self-harm tended to occur, before or after mealtimes, and physical restraint was sometimes necessary to either keep a patient safe from engaging in self-harm, or to ensure that we adhered to our duty of care in administering the feeds in accordance with their meal plan.

The support worker responsibilities

Some of the 'rarer' responsibilities included going on escorted leave with patients – I once went bowling with another staff member and two patients, a strange thing to be paid for! I also attended the funeral of a patient's family member with them, which was a surreal experience but one that was a privilege as it ensured that the patient was able to attend and pay their respects whilst knowing they would be looked after.

Finally, patients sometimes needed to go to the general hospital if they were physically unwell. In those cases, we would remain in the hospital room with the patient for their stay, ensuring that their environment was risk-free and that they were supported. 

Observations, observations, observations

If you had taken a photo of me on the ward, chances are I would've been carrying a clipboard! This is because observations are done constantly in a mental health setting. These were usually in the form of 'general' observations, 'physical' observations, or more specific one-to-one (or two-to-one or three-to-one) observations.

General observations would be completed by a staff member for 90 minutes at a time and involved checking on patients in accordance with their level of risk. For example, many of the patients were on '15 minute' observations, meaning that they had to be checked on every 15 minutes. We didn't check on patients every 15 minutes on the dot, as patients might then recognise the pattern and (for example) engage in self-harm as soon as we had checked on them – instead, we ensured that within each 15-minute window, we were checking on them at least once.

I remember doing general observations for the first time without a senior member of staff helping me. A patient was napping in a chair in the lounge under a blanket, and I had to check that they were safe and breathing – I felt awful having to wake them up to check that they were alright, but I could not see their neck or hands.

Every hour, you also needed to check every door, window, and cupboard was locked, and that that the scissors and ligature cutters were in their correct place. This might seem excessive, but there have been (too) many instances of patients dying or hurting themselves due to poorly controlled environments, or observations not being conducted properly. There is no space for complacency in a setting like this, so the observations formed a key part of keeping people safe.

Patients that were higher risk would often be on one-to-one (and more rarely two or three-to-one). This could be due to their previous levels of self-harm, for example. These patients would be observed by specific staff in 90-minute blocks. A patient on one-to-one might be 'arms' length', meaning that you had to be always within arms' length of the patient, or 'eyesight', meaning you had to always keep the patient in your eyeline.

As you can perhaps imagine, being the person responsible for keeping a high-risk patient safe can be quite intense, and I have many vivid memories of those situations. I became familiar with 'cues' that preceded self-harm and used the de-escalation techniques that we had been taught in training, because physical restraint was a last resort.

Finally, physical observations included monitoring (several times per day) patients' physical health such as via heart rate, blood pressure, and temperature and so on. This was important as eating disorders are as much a physical condition as a mental health one. 

The joy in supporting others

Though I have hopefully provided a brief glimpse into some of the key aspects of being a Mental Health Support Worker in this kind of setting, I would like to emphasise what the role actually looked like for me.

Once you have learned the skills you need, the policies that relate to your work, and the processes you need to follow; you can keep yourself, your colleagues, and your patients safe. This is fantastic but might result in a very boring atmosphere. My fondest memories of the role are of joking with patients, keeping their minds busy such as by playing Mario Kart, answering Harry Potter trivia, or strutting our stuff on the karaoke machine.

I remember surprising a patient in the general hospital with get-well cards from their friends and seeing their face light up. The ward was intense, absolutely, but it was a group of individuals working hard to get better each day, and it was a genuine privilege to be there to help in a small way.

I remember, in my first couple of days, making a coffee for a patient that was very uncomfortable around men due to past trauma. We chatted about coffee (I do love a black coffee!) for a bit, and I thought nothing of it. Later, the manager came over and said the patient had told them I was kind and put them at ease despite their anxiety about me.

There are many 'highs' to enjoy in the role, and the 'lows' are offset by the knowledge that you are supporting someone in their journey to recovery. For those hoping to pursue a career in clinical practice, you will be working in contexts where even making a cup of coffee might make a difference to someone.

As a Mental Health Support Worker, you get to help someone when they cannot help themselves. Then, you get to help them as they learn to help themselves. Finally, you get to cheer them on as they become independent. What a lovely thing to have a front-row seat to.

Kieron Oakland is a psychology lecturer from Arden University and a PhD researcher at Birmingham City University. His PhD area is toxic behaviour within esports (competitive videogames), though he maintains a keen interest in eating disorders and is working with a former dissertation student to write up a paper for publication on 'the eating disorder voice' as experienced by individuals with eating disorders.

Email: [email protected]
Twitter: @K_Oakland