Working in psychiatry is fun and games


Drunk Member
Until it's not.
I work in closed reception psychosis ward as a nurse. Our ward treat the "worst of them" in district, as in, chronics, difficult-to-treats etc, most patients are in involuntary treatment because they're dangerous to either themselves or others. If we can't deal with it, next step is one of the two state mental hospitals with the forensic psychiatric patients.

I have no clue how it's in other countries, but in Finland it's one step away from hell for three reasons: salary, understaffing and our pathetic excuses for mental health laws.
We are being paid well under median wage in Finland despite being literally responsible for peoples lives (no, it's not just the doctor), being chronicly understaffed (I just did almost 17h shift, our normal shifts are 8-12h) and in my case working in constant risk of severe violence. To make matters worse, our district pays less for us in psychiatry compared to somatic side.
And then there's the laws. Sadly, every single change they make is for the worse from our point of view. They over exaggarate the rights of the patients to the very extremes. According to the laws we can't even search their bags without doctors specific order if the patient doesn't want to. This we have been able to work around luckily, but the bigger problem is that we're not allowed to search the patient him/herself without specific order from the doctor, and you need to have very strong reasons to believe the patient has something illegal/dangerous on/in him/herself. So practically this never happens (not a single time in my bit over 2 years in the ward). This is despite the fact that our patients in our ward are for the most part in involuntary treatment. Oh, and they don't need to take their prescribed drugs either, not even when involuntary treatments. The doctor can specificly make orders to use coercive measures to make the patient take the mediciny, but the ministry and our own upper floors are driving us to reduce the coercive measures to minimum (to the point that no, hitting a nurse doesn't necessarily mean you'd be isolated for aggressive behaviour)

Risk of violence is constant and pretty sure there's not a single employee that has been with us over 6 months and hasn't been the receiving end of some sort of physical attack, verbal attacks are obviously daily crap we have to deal with.
Luckily in my time there hasn't been any serious cases though - until last week that is. We had had to put a patient in isolation due her earlier actions. Later when the doctor came in to do isolation evaluation with three nurses, the patient attacked with a blade (can't be more specific at this time) smuggled in inside the patient. All three nurses received injuries requiring hospital level treatment, one of them had 2 tendons cut from her hand which required 3 hour surgery, 8+ weeks out of work and still unknown if it'll work like it used to, + 4cm deep wound in stomach, the other weren't as severe but still bad.
And the patient? Well, of course the patient was still left to be treated by our very same ward until we got a place from state mental hospital for the patient.

First thing our hospital head says to the press is that the wounds were "minor", later he 'apologized' for the expression used but it felt pretty much like "thank you"-cards you had to print yourself (yes, those really happened in Finland, they really thought it would count as some sort of compensation). We were also told to shut up about the incident if press asked anything. Luckily the nurse who got hit worst didn't like that idea and got big story out on newspapers so now I'm free to talk about it too.
We got even a minister of family affairs & social services visiting us, telling how this shouldn't happen etc and the usual crap which. Had to literally bite my tongue not to let her know few chosen words. or not so chosen. or worse.
According to investigation, our staff did everything correctly and by the book.

And what changes will this bring? Zero, zilch, zip, nada, nothing.

Really inspiring and motivating work. Cherry on top is our regulars, who literally come back in after couple weeks to couple months from being released out. Why? Because they didn't want to eat their drugs, and in Finland, you don't have to.

Sorry for the messy post, the locomotive driver of train of thought is not sober.
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Username checkouts.

But seriously tho. That was very unexpected. All this time I though European countries that are rich enough, always have humane law and humane pays.

You and your teams are heroes.
Username checkouts.

But seriously tho. That was very unexpected. All this time I though European countries that are rich enough, always have humane law and humane pays.

You and your teams are heroes.
Oh the laws are humane alright - and that's the problem. They're so humane that even dangerous patients in involuntary treatment have practically the same rights as any healthy person living normal life - except for the fact they can't leave the ward they're in (until the doctor gives them permission for limited time outings) while in treatment.
Just saw a column in todays paper - the writer had asked the ministry some questions they couldn't give answers to, like "why is it that I can be searched when I got to hockey match, concert, court etc, but a person who's dangerous to others or him/herself and in involuntary treatment can't be searched?"
The mental illness subject I believe is something that is by default not taken seriously enough or treated appropriately everywhere. Everyone taboos it to keep their own minds free.
It is something that everyone wants to avoid dealing with because it is a very complex condition that is hard to diagnose, deal or treat properly and involves overwhelming interaction, leaving those who work in the field to take all the weight.
Since these patients are in some form or another outcasted by society, they are just thrown into a place so nobody can think about it. Except you.
Because the condition is experienced mentally by them, telling them to take a substance to fix it, for the patient it feels like they are locked and drugged instead of allowing them to be free and heard. So you appear as a villain to them.
You need more support and probably a whole revision of how to treat these conditions.
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You need more support and probably a whole revision of how to treat these conditions.
The thing is, there's really no other way than neuroleptics in case of scizophrenia group that have gone into psychosis. For the bad cases, clozapine is as close to miracle drug there is, but it has severe side effects, has to be brought up gradually (and restart from scratch if the patient misses 2 days in a row) and when you've dropped it several times it can take forever before it "kicks in" even when the concentration is fine in lab tests.
Other mental illnesses are another story, of course.
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