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Conditions at our hospital: an open letter to the Director of Patient Safety and Relations

June 12, 2012

GBHS: a slab o’ health. Copyright 2007, Wikipedia

I’m interrupting my self-imposed hiatus from activism to bring you a little (or rather, a big) something fellow Survivor Melanie Knapp and I have been working on.  It’s part of our Project for Positive Change in Grey and Bruce.  Here is the text of a letter we have sent to the Director of Patient Safety and Relations at our local hospital.  It’s our little  Wittenberg moment.  I’d encourage you to plough through it, long though it be, because it reveals in no uncertain terms what we’re up against here.

Diana Ryman,
Director of Patient Safety and Patient Relations
Grey Bruce Health Services
1800 8th Street East
Owen Sound, Ontario
N4K 6M9

We are two concerned citizens of Owen Sound who also happen to be occasional users of GBHS’s inpatient psychiatric services. We have teamed up to help make you aware of the need for better care on the psych floor. To this end, we have compiled a list of the things that we consider most need to be addressed. It is in the hope that things can improve that we present to you this list. It is lengthy, but to us this speaks to the significance of the issues. We thank you in advance for your consideration of our suggestions.

  1. Reading Material. If reading material returned to the lock down unit, it would help pass the time and make people more comfortable. Reading material is available in the outpatient areas. On the same principle and for the same reasons, we believe it should be available in lock down. We are perplexed at its disappearance.
  2. Clothing. Both in lock down and on the regular unit there should be a concerted and genuine effort to get people back into their usual clothes. This in itself will surely effect a notable increase in the patients’ state of wellness. The importance of one’s own bathrobe and pajamas, at the very least, to someone on the unit cannot be overestimated. Access to personal effects ought not be considered a “privilege.”
  3. Rights. It is vital that patients be promptly informed of their rights by the Rights Advisor, and have full access to that person as necessary.
  4. Treatment Options. Patients should also be informed of all available treatment options, like social workers, ACT and After Care.
  5. Psychiatrists. This region should be in possession of no less than 11 psychiatrists. We would request that the hospital re-establish its priorities around this appalling deficit and aggressively pursue the issue.
  6. Air Quality. The vents should be quieter and possess better controls. Air displacement has affected people’s health and we strongly suggest that a high and low option be installed on air vents. Current temperature control is also unsatisfactory, and should be re-evaluated. At the very least, patients who have mobility or dexterity issues should be monitored in order that they remain at a comfortable temperature.
  7. Blankets. It should not be difficult to obtain and stock blankets again. These could easily be purchased or donated for the psych floor. Blankets would be important if only for the extra warmth and reassurance that they can provide. In the interim, patients could be assisted in obtaining a blanket from their home and invited to use their own blanket to stay warm and comforted.
  8. Customer Service Standards and Ward Culture. For many of us, our mental health issues are classifiable as disabilities. However, even in the most severe of circumstances, and with the gravest of diagnoses, we are always independent, free-thinking individuals who require and expect to be treated with the utmost respect and dignity. We do not feel as if the lock down ward has a particularly good track record in this regard, especially concerning interpersonal communication between nurses and patients, and in the granting of “privileges.” Remember that patients can’t always stand up for themselves when they are in need of the hospital. It is necessary that nurses be polite, respectful and kind. A nurse can make an immense difference with a good bed-side manner – i.e., with those patients who rarely leave their beds: with positive encouragement, a nurse can encourage communicativeness and help some people connect again, and even get out of bed despite being medicated. Nurses could also spend some time with patients making sure they have what they need for regular toilet breaks and for proper menstrual care. We would also ask that you to advocate for better and more comfortable care for patients without resorting to over-medication.
  9. Observation Period. Please guarantee that the 72-hour observation period not be extended summarily or without the patient’s consent. If the patient is to be kept in the lock down area after the mandated observation period because the outpatient section is full, ensure that the patient obtains civvies and access to the outpatient section immediately. Serious consideration should also be given to the early provision of day passes.
  10. Programming. For both the outpatient side and ICU, it is hardly likely that voluntary or low-cost programming is utterly unavailable. Can recreation sessions or WRAP not be conducted? WRAP is an increasingly popular programme, and one with a proven record. It is also fully available in Grey-Bruce. For those in hospital for an extended stay, is it not possible to get out by partnering up with Community Connections or Union Place for recreation? At the time of this writing, we know of individuals who have willingly volunteered to provide entertainment, yet were refused the opportunity. We would ask the hospital to re-examine its protocols in these matters.
  11. Volunteers. Volunteers are extremely encouraging and provide an inestimable connection to the outside world. Could you help get more volunteers into the psych floor, perhaps by steering new recruits in that direction?
  12. CSDP/Family Network Support Team. Jim Lonie used to do walkabouts from the Family Network Support Team. This was helpful and educational. Could this start up again?

We appreciate your serious consideration of concerns which to us are paramount and deserve due acknowledgement. The bottom line is that as the Schedule 1 facility in an area without crisis diversion centres, GBHS is where people in crisis in Grey and Bruce must report to. Yet we speak with authority when we say that the atmosphere of the GBHS lock down unit often discourages people who are at serious risk of harming themselves or others from voluntarily seeking treatment. We therefore trust that any action taken in response to our concerns to assist the recovery of patients on the psych floor will be a positive step toward overall improvement.

After all, the difference between a “community member” and a “patient” is neither a diagnosis nor a condition, but the fact that the former merely becomes the latter upon admission to a hospital. We know, because we’ve been in both situations: hospital and community. We hope we may notice some improvements the next time we visit someone on the psych floor.

We have also worked with the H.E.R group and are helping improve things ourselves by offering paper, journals, pens, books and the like every few months. Christina, the social worker, has these supplies, and if you know people who may need something or if you could let more nurses know that she has them, then we can make sure those supplies get out to more people.

We hope you will respond to this letter when you are able. We hope this letter makes a difference.

Thank you,

Melanie Knapp
Richard-Yves Sitoski
 

ADDENDUM!!!

Mel and I forgot to mention that food portion sizes are significantly smaller in psych, and that there are no clocks on the ward!  This is frankly disrespectful, undignified, pointless, inexcusable and idiotic.

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10 Comments leave one →
  1. June 13, 2012 12:00 am

    You have poignantly and pointedly made some very good points. I am sure that you understand the political milieu in and within and under which staff are asked to function. I hope that everyone involved will hear with open minds and hearts and that some caring care can be devised. I’m with you … who knows I might be the next person who goes from community member to patient. Each of us is only a hair’s breadth away from being at the mercy of the medical model.

  2. Joan MacDonnell permalink
    June 13, 2012 6:04 pm

    Wow! Well written and very powerful. Thank you for doing this for everyone in Grey-Bruce. I truly hope this can effect change. If I can add my support in any way, please let me know. Joan MacDonnell

    • June 13, 2012 7:24 pm

      You bet, Joan! It looks like an uphill battle, especially because from my perspective it appears that the real problem is that we’re working against the innate conservatism of institutions. These tend to make a disappointingly large number of decisions not based on their explicit goals, or in accordance with their stated mandates, but merely as a function of keeping their homeostatic balances running and propagating/perpetuating themselves. It’s bureaucracy. And bureaucracy exists, in the end, to serve itself. Whither people?

  3. Kare Rosalie permalink
    June 13, 2012 8:25 pm

    What an excellently written and thoughtful letter. Only people who have been on inside, can provide the perspective required to speak to these issues accurately and compassionately, like you have. There are many “community” members that are already wrestling down some form of mental illness; easily becoming “patients”, should the appropriate crisis insert itself aggressively into already difficult lives.Thank you both.

    • June 14, 2012 6:35 am

      Thank you very much, Karen. I appreciate more than I can express all the help and support you’ve given — and give — me!

  4. June 14, 2012 12:15 pm

    Well written. The only other thing I would suggest adding, is allowing recovered patients to be allowed to volunteer to provide motivational and positive support to those who are in the hospital. Often hearing from someone else who has experienced a mental illness, and knows what it’s like, can say things that are a lot more comforting and healing than those who have never experienced or who has only had book learning, to go on.

    • June 15, 2012 2:56 am

      Absolutely correct! The hospital ACT team is still in the process of defining the position of “Consumer” (Patient) Representative, and they seem resistant to the idea of Survivors coming in — either as private citizens or as peer workers. We don’t really have a peer support worker culture here, and the few we do have work for bureaucratic non-profits and rarely make it to the hospital.

  5. June 16, 2012 9:08 am

    We didn’t include the need for good programs and classes. Also there could be a lengthier time for occupational therapy with more staff on the ball. There are also some old books there but there could be an effort to collect self-help books for people so people have a chance to use and learn tools for recovery. A walking group could be established as well each day to walk the hospital grounds with company and possibility for friendship.Looking into other psych recreation programs could give this hospital some ideas. Gathering the people together on the floor often has a surprising healing affect with people helping people.

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