Reflection: 2008 Acute Mental Health

This reflection was written on an Acute Mental Health Placement.
2008
Today I rounded up every one I could to join a positively me group (psycho-education) on ward 35. From 34 I brought up 3 clients and while waiting for the clients from 35 one of the 34 clients became agitated, he is 21, and has only been admitted to the ward in the last few days for psychosis. He appeared to begin to hallucinate and was getting angry that the group had to wait for more clients before it could start. He began to yell at the senior therapist telling her that she was useless. She very calmly tried to verbally calm the man but he remained tense and angry, the therapist and I eventually managed to convince the man that it was a good idea for him to return to 34 so he could relax. As the wards are separated by lock doors with a stairway in between I had to walk the man down, I was comfortable with this and reported the incident to his nurse. On my return to the group one of the clients, a women in her 30’s with anxiety issues and paranoia was in tears she stated that she though it was her fault that he had become upset, the second women in the group who had some cognitive difficulties also thought the outburst was her fault, it took some time to explain to the women that in fact he was just very unwell and it had nothing to do with them. Later on the therapist apologised to me for asking me to walk the man to his ward as this could have put me in a dangerous situation, this was something she stated she would later reflect upon as she felt she had put me in an un-safe situation. To me this demonstrated a lack of awareness in my self as I had not thought it was an unsafe situation, I had an alarm on and the man had appeared to react well to my suggesting he return to his ward. By this stage in my training I have acknowledged the effects of mental illness and there for while I was surprised by the outburst I understood that it was not provoked by any one person’s actions but a general un-wellness and uncomfortable situation. This experience has taught me that one persons actions can really upset another person in a setting such as a mental health group where people are often in a vulnerable state of mind, also I need to think more objectively when it comes to my own physical safety in a situation such as this, having never spent a lot of time in unsafe areas I have noticed a tendency in myself to put a lot of trust in people, and while in many situations I see this as a virtue, in situations such as this it has potential to be very dangerous.
GOAL: When gathering people for groups, think objectively about what sort of group it is (psycho-education, art, etc) and who is suitable for that group as well as where the group is being held and what staff are available to help when needed.
Julia Coleman

Reflection: 2006 IDS

This reflection was written while on a field work placement in an Intellectual Disability Services (IDS) facility.
2006
Today we took a group of clients to the physiotherapy pool, it’s great how you can see them relax both physically and mentally, they obviously really enjoy it. When it came to dressing the clients afterward I was helping one client in particular, he is 42 and has developmental delay but appears physically fine. For my first time ever dressing an other person I was surprisingly at ease, however obviously not known the client well, I was unaware of his level of tolerance and in an attempt to use backward chaining I put is shoe half on and was asking him to push the other half on. He quickly became visibly agitated but was still trying so I continued to encourage him. He then grabbed me by the arm and began to hit him self in the head with my hand. I was mortified and had no idea what to do. I tried my best to pull away. My supervising therapist quickly stepped in and swung me out of the way and managed to verbally calm the man. Later during an informal supervision she explained that having been in an institution most of his life he was use to having every thing done for him and having just been for a swim was probably exhausted, this was most likely what lead to the out break. I learnt 3 major lessons from this ordeal; to always be watching and reading a client for cues as to any changes in mood or irritation, not to take these incidents personally. Initially after the incident I felt horribly guilty for upsetting the client and thought I must have done some thing to upset him, and in turn was unable to build rapport with clients and would make a horrible therapist. In fact I had simply asked too much of him. And thirdly always find out as much relevant information about a client and their condition before working with them. Next time I would read his cues when they appeared and helped him more in achieving the activity.
GOAL: In week 3 I will work with this client during the dressing portion of the swimming group, and by reading his cues he will remain relaxed through out the task, this will result in no violent or aggressive behaviour.
Julia Coleman