[AMA] I'm a Senior Psychiatric Registered Nurse Who Works in a Secure Mental Health High Dependency Unit. Ask Me Anything

Hey fine folks, feel free to ask me anything regarding the NSW Mental Health Act (2007) and what to expect if you, a loved one, or a friend are *scheduled by police, ambulance officers, or mental health professional. Please keep in mind that I am unable to comment on your personal experiences, the suitability of the medications you have been prescribed, or your diagnosis.

*Scheduled - detained as an involuntary patient under the NSW Mental Health Act (2007)


        • -1

          Perhaps you shouldn't challenge them, but you can question it gently by asking questions to see how deep rooted their world is and to gauge their level of insight. For example: "Everybody is out to get me; strangers on the street knew that I had done xyz and are here to punish me." You can probe by asking, "hang on, how do the strangers know what you've done?" It's a perfectly legit question that doesn't challenge it per se but can reveal how delusional they are. The answer of "I don't know" is different to "That's because they can read my mind."

  • What are the current ratios of nurse to patient? Do you think this is acceptable?

    • +4

      The ratio in NSW high dependency mental health units is a maximum patient load of four patients to one nurse. In general acute mental health units it's five patients to one nurse. It's tough to say whether this is acceptable or not. It's more than enough some days and other days it's desperately inadequate. Something else to consider when discussing ratios in mental health units is the 'acuity' of the patient. Each patient is assigned an acuity level based on how unwell they are and these range from 1-5.

      Acuity 1: a nurse must be present at all times with the patient and must not lose sight of the patient.
      Acuity 2: a nurse must sight and document where the patient is on the unit and what they are doing every 15 minutes
      Acuity 3: every 30 minutes
      Acuity 4: every hour
      Acuity 5: every two hours

      High dependency units generally care for patients with an acuity level of 1-3. If they're changed to an acuity level 4 they are transferred to the general acute ward, bed availability permitting.

      • Thank you very much for sharing your story. When I first saw the title of your AMA, I thought you might have been a nurse at an aged care facility for dementia patients. I know someone who resides in such a facility which is also described as a secured high dependency unit. In regards to acuity levels, staff/patient ratios and the requirement for male and female nurses, do the same rules apply in a dementia facility such as the one I have described?

        • I'm not sure what the ratios are in dementia wards. They would not vary greatly from high dependency units is my guess.

          • @DisabledUser267651: Dementia wards would have a much lower nurse-patient ratio for sure, but then there would be a few support staff around as well. Any yes they would be secure, but that's just to prevent them wandering off…

            • @DisabledUser256231: I’m at a private psych facility in QLD. We have no ratios. But a normal day is 1 to 9. It’s so shit.

              • @digitalbath: Qld and Wa is the highest payed nurses in Australia

                • @edwardysh: Pays ok. Ratios are shit.

                  • @digitalbath: Public in Vic is 1 to 4 acute setting rehab can be 1-5 or 6 and more during the night. Ratio is terrible in private hospitals. Can be up to 1 to 12 in Rehab at night

  • Do you have straghtjackets, facemasks and padded rooms like on TV?

    • +4

      Thankfully the days of straight jackets, face masks, and padded rooms are a thing of the past. We still seclude patients for their own safety and the safety of staff if they become violent and need to be chemically restrained. Secluding a patient is a last resort. A seclusion room has nothing in it except a foam mattress and a weighted blanket - the walls of seclusion rooms are not padded.

  • +1

    What proportion of sectioned patients are due to personal external circumstances like divorces, bankruptcy etc compared with those where circumstance doesn't really play a factor?

    • +5

      Perhaps half of scheduled patients are in crisis because of the social stressors that you mentioned and others. These patients are often scheduled as Mentally Disordered rather than Mentally Ill. Being scheduled as mentally disordered generally means that a patient has presented with depression, suicidal ideation, or thoughts of self-harm linked to social stressors and it is expected that these feelings will dissipate in a few days.

  • +1

    Super interesting thread!

    Aside from drugs what is the next biggest cause of mental health issues? It seems more common in the younger generation than I remember … or are we getting better at diagnosing it?

    • +4

      Glad you're enjoying it. Many mental illnesses develop from social stressors such as relationship breakdowns. Trauma and abuse are also leading causes of mental illness. I'm not sure we are getting better at diagnosing mental illness but we do take a much more cautionary approach to mental illness which results in increased admission rates.

  • +1

    Here is my real* story (*or maybe this is just fiction). It is a long story but please bear with me,

    I was born into this world after mum and dad had a one night stand. Mum was 16 when I was born; she had an intellectual disability who had lived with her mum after dad had left her. Mum loved smoking weed, she loved drinking - she drunk more than me but it's 2019 and I have more interesting choices, you just wait for what I use later in this story.

    My real dad, I don't know him. In fact, I have never met him but mum says he was a year 7 high school drop out. Mum said Jack, that's supposedly the name of my dad who I have never met, quit school so he could work. Jack did have the occasional job but for the last 15 or so years he has been relying on unemployment benefits, assuming he goes to Centrelink and submit his paperwork. He too had a poor childhood - his dad was an alcoholic and when he was drunk, his dad beated him, and that's after he had beaten up his poor wife. Jack was twice the age of mum but when you are young and in lust, and had too much to drink and not enough planning - making babies is a possibility, and I am a proof of that.

    I grew up with mum in a two bedroom Housing Commission flat, in a really rough suburb of Sydney. In this part of town, you had good odds of becoming a teenage parent - just look at my mum. Some of us ended up in gangs, some starting using or dealing drugs, but most of us, if not all of us, dropped out of school - Finishing high school was the equivalent of Serena Williams winning Wimbledon. Anyone who went on to get a job at the local factory working night shifts for award wages - that's a success story, just like how Mark Zuckerberg went from nothing to Facebook.

    Enough of my suburb but more about me.

    I think I was born with an intellectual disability. I noticed that I grew up slower than the other kids around me. I sometimes blamed mum because I am guessing she was using drugs and consuming lots of alcohol when I was still growing in her stomach. She will never admit it but I know it's the case - I have googled Fetal Alcohol Syndrome and know what it is. I was poisoned with alcohol when I was developing - but then again, I am the lucky one because I started young and that is why I am in love alcohol today. Hard liquor is my go-to. Whisky, Kava, Absinthe, Raki, Ouzo just to name a few. Sadly, I know more drink styless than I have friends.

    Thankfully, mum took me to the doctor one day and I was diagnosed with Attention Deficit Hyperactivity Disorder - I was only 7 years old goddammit!! Not only was I slow at learning, I was now terrible with attention. A few years later I somehow passed primary school and started growing up become a teenager.

    Starting high school was hard. I was picked on, teased at, had made no friends, and all the other kids were laughing at me. I kind of felt that the teachers were laughing at me too. I tried to remain positive and hopeful, and always thought to myself that I would try and live my best life - and that's when the voices started. Those pesky voices in my head telling me that "everyone is laughing at me" and I couldn't get that out of my head. The voices increased, people were laughing at me because I was fat. I looked at babies in prams and I wanted to hurt them because they were teasing me. Anyone who looked my way, I had the same thought - it just wouldn't stop. Someone was going to get hurt real bad.

    I saw the doctor and was given some pills. Mum wasn't the best mum in the world - but she tried her best - I knew she faced her own problems. I became more problematic because one day I thought mum was laughing at me for being fat and that's when I had hit her. I would never have had done that but I was chronically unwell, the voices would not stop despite the doctor giving me these expensive tax payer subsidised mental health drugs.

    I mean, if anyone thinks you can just give drugs to a mentally unwell person and the problem is solved - then why the f* have we not found a cure for cancer!! Unfortunately, sometimes, mental illness is treatment resistant. That's my case - just like certain cancers - just not treatable.

    Mum called the police. They were here in six minutes with lights and sirens blaring. The two police officers said I was under arrest, I can't recall hearing them say that because the voices in my head said that "they think I am fat and they want to hurt me". I lashed out when they were trying to handcuff me, so apart from assaulting mum, I was now charged with assault police. Welcome to my downhill spiral and my first of many interactions with the criminal justice system.

    That night it was my first night in the police cells. I kept on hearing voices but I felt safe - those strong metal rods protecting me from the world. I was never ever fat - at most I weighed 75kgs for my 182cm frame. When I was arrested, I was down to 54kgs!! I was medically and physically anorexic but the voices in my head said I was obese. Why don't those drugs work dammitt?!

    I was released the next day on bail but could not return to mum's. If I went back, I would be arrested for breaching an Apprehended Violence Order. I didn't know where to turn to or who to turn to, maybe my real dad would help me or maybe not. I didn't care either way, I had my own real problems and I needed to make these voices stop - stop fast.

    Mum loved a drink and I knew it legal and easy to get. The theory is drink lots of alcohol and the pain slowly fades as I become tipsy and eventually pass out. Solution solved I thought. This was a rinse and repeat process. I didn't have money so I spent time at the local pubs, stealing other peoples drinks. I drunk so much that I was taken to hospital several times; I almost died several times - at the bus stop of all places. I was becoming a nuisance to others but to me, it was the best feeling - escaping those voices using alcohol. I believed I damaged my brains severely too but that was OK too. It was a merry go around but don't blame me, blame the health system!

    The hospitals didn't like me because I was considered a drunk, and then the community mental health outreach teams hated me because they believed it was my intellectual or brain injury that caused my behaviour and not my schizophrenia. That's the first time in my life I have ever mentioned schizophrenia - it is such a strong word and something I am clearly ashamed of. I fell between the cracks, and there are many like me. We are the non-voting people in the community who have no voice - politicians don't care about us and don't want to fund our problems, mental health is a crazily expensive business to fund. But sending me to hospital, back onto the streets, taken to court, back into our jails and repeating itself - that is more expensive right. When I am drunk or really unwell, taking me to hospital requires a police escort and an ambulance. That's at least four very well paid workers doing mental health work - taking away resources from real crisis happening elsewhere like a sexual assault, a vicious robbery or even a person having a heart attack. I feel sorry that I took up so much time but if our politicians funded mental health properly and offered more support and services - then I wouldn't be here. Maybe a safe supported home where I receive 24/7 support, I don't know - I don't vote remember! Imagine me turning up at a polling booth - what is your name and address? Oh, it's Drunk and I live by that tree in that park across the road.

    Being homeless isn't fun either. I try to be drunk during the day so then I can be awake at night which is what most of us do - homeless people get assaulted and robbed very frequently. It is very unsafe at night so I try to sleep near other homeless people too. There was one time and I remember that time very clearly. It was a Friday night, the moon was full, and a gentle breeze cooling the air, and helping my malodorous smell. A good looking group of men in their 20's were approaching, wearing work attire, long pants, long business shirts, unbuttoned at the top, their ties hanging over their necks loosely - no doubt having a fun night out with many rounds of expensive drinks at the pretentious Establishment Bar. One of the men said something to his mate, and before I knew it, I was kicked in the stomach and it hurt like hell. I swore at the guy and then that's when his other mate kicked me in my face - I lost two teeth that night. Luckily, the other three men pulled the two guys off me, and all five ran off in the direction of the station. A passerby saw what happened and called the police - they came - but they didn't really want to know my story. You know I was homeless, a loser, a sore thumb to a lovely city. More importantly to them, I had previously assaulted one of their own, and once you hurt one cop, you have hurt them all.

    That night, I felt terrible. I had bruised stomach, my liver hurt - was it because of the kick or due to liver disease, I had loss two teeth and the voices were blaring. Just a few steps away I saw another homeless brother inject himself with powdery white liquid. I don't know what that is but I knew at that point I wanted some. I could take a dose of that and make me feel good, maybe it might ease my pain or maybe I might just overdose and die. I didn't care. I just needed that, I didn't know if it was meth, cocaine or heroin. I had no money but my new homeless friend was kind enough and feeling rather generous - you see him and I faced the same homeless dilemma so we were in this together, we were street brothers. I didn't ask what it was but before I knew it, a belt was tightly placed over my arm and then I was injected with the same white powdery liquid I had seen minutes earlier. Nothing happened and I started thinking of bad thoughts about the used needle that I just put into my vein. Will I catch HIV, Hepatitis or both and more. And then bang! it hit - hitting so hard that I couldn't remember what happened next - but either my eyes popped out of its socket or my body just convulsed uncontrollably. All I know is that the paramedics was next to me, I was gasping for air and they wanted to take me to the nearest emergency department. I was angry and told them to go away - they had just reversed my first drug overdose!

    The next day, the voices came back - my homeless friend had moved on but did the council just move him on, I don't know. I had nothing to stop the voices. At this point in time, I was willing to drink, consume or inject anything - meth, alcohol, petrol, turps, marijuana, cigarettes, anything. I remember once I was so desperate that tried injecting liquid hand soap that I found in a public toilet! It wasn't the most pleasant experience but I tried it, I will try it again if I have to. I have tried injecting window cleaning fluid too - I was seriously messed up.

    My life sucked a lot and it sucked a lot more at this point. I was homeless, I was schizophrenic, I had a mild intellectual disability, I was an anything-goes-drug user, I had given myself permanent brain damage from all the drinking and drug taking that I really can't understand much now - please don't mention about my behavioural problems from my brain damage too. I have been arrested so many time it isn't cool anymore. My jail friends, more than 55% of them have a mental illness according to government statistics. Jails are basically oversized mental institutions. If and when I get out of prison, nobody wants to help me because I am so messed up and I am too time consuming.

    I don't know what to do other than you hearing me out.

    My legal aid solicitor is working hard to get me out of here but I don't know where else is suitable. Each time I am in court, the judge will ask where I will stay if I get out of jail - I don't know nor does my smart lawyers, so the only real place is to be thrown back into prison.

    At least in here, this 6 x 4 foot cell, I can call home.

    And I can type this up - without being assaulted.

    Live Your Best Life,


    • +1

      Damn that was a rollercoaster of a comment mate. I'm glad a nice bit of fiction is all it really was though - that would've been a tough life to have actually lead. But I somehow have my doubts an alcoholic, schizophrenic, homeless guy with police record would have Hilton Diamond Status, or even know to lie about it. =P

      • +1

        Remember I did tell you my other story - where my family were refugees.

        One of these stories is real, the other is fictional but behind every fictional story, there are a lot of real truth to it ;)

    • Thank you for sharing your story.

    • +1

      Where does your Santorini trip fit in?

    • +1


      • +2

        All good, everyone's busy ;)

        As long as you aren't the one neg'ing my posts because its TL :p

    • I cried after reading your story.

  • +9

    Good night all and thank you for participating. I'm pleased to share my knowledge with you. I'll attempt to answer any further questions tomorrow.

    • +1

      Thanks for doing this and please get plenty of rest. I know a few people in your line of work (though I don't think in nearly as stressful an area) and it's definitely not an easy job.

    • +1

      this was very interesting and insightful.. thank you

  • +1

    What's your stance on the war on drugs and should they be legalised? What do you think could be legalised, which should never? Could tax revenue be used to fund mental health or is that a self fulfilling vicious circle of harm treatment harm?

    • +10

      There is evidence that shows decriminalising illicit drugs does not result in increased drug use. Personally, I would like to see the decriminalisation of drugs because far too many of society's most vulnerable end up with criminal records and are incarcerated for possession. That merely puts them further behind the eight ball and solves nothing. That said, methamphetamine is so completely destructive to the lives of users that I'm inclined to advocate for it to never be decriminalised.

  • -1

    Wow. It's refreshing to hear someone in the health industry acknowledge the dangers of Seroquel. Turns out now that it messes with hormone production and causes male gynecomastia. Far to many doctors lean on it as cure for every illness, and this leaves many patients with no where to turn and prisoners in their own bodies. Even if they manage to get the treatment overruled by a Mental Health Tribunal, many people are left with hormonal problems that never get diagnosed and a greater risk of diabetes.

    Anyways how do you feel about shock therapy for mental health conditions, have you ever noticed an improvement in the health of a patient after treatment ?.

    • +3

      We mostly use electroconvulsive therapy (ECT) for conditions such as chronic depressive disorders. I have witnessed excellent results overall from ECT. There is still stigma associated with the procedure but most in the community are unaware of how the procedure is delivered today. We don't put a piece of wood between your teeth and turn on the volts. A convulsion is induced under general anaesthetic and generally lasts about 30 seconds. Patient's are treated with 12 sessions of ECT [two sessions a week].

    • +2

      Every therapy in medicine has its own risks and benefits, and quetiapine is no different.

      While quetiapine does have significant side effects, most importantly extrapyramidal and metabolic in nature, they are comparable, if not better, than the majority of other alternative medications in cases where it is used.

    • ECT is beautiful and can work miracles. Everyone knows the side effects of seroquel, which is an antipsychotic. All antipsychotics that block dopamine can cause gynaecomastia. it's well known.

  • Do you tired of reading comments on articles about violent offenders, where the commenters will say things like Oh the offender is just going to pull the mental health card and get off scott free!!?

    • +1

      Personally I don't get tired at all.

      The media and people who don't know about mental health or don't care - believe the mental health card is played all the time. Yes there are some dodgy apples who play that card - but then there are dodgy apples in any sector of the community:-

      The statistics speak for themselves;

      "Of the 385,100 individuals who reported having ever been incarcerated, 41 percent reported having had a mental-health disorder" :-


      1 in 4 prisoners take medication whilst in prison for mental health issues, 2 in 3 prisoners have not studied past year 10:-


      1 in 4 people were reported to be "homeless" in the four weeks leading up to prison:-


      I could bang on about it, but the point is proven … have a look at my story a few posts above. It's the longest post you will see on OzBargains in a long while, and whilst it is fiction, there is a lot of truth and substance in it…..

      • +1

        lol, is there a TL;DR? I can't read that whopper, especially as you've ousted yourself as a fictional story.

        My comment was in, I think, agreeance to your feelings - that the media and most people (who have no idea what they're talking about) think that the Mental Health card is pulled on majority of court cases. And they're delusional enough to think it's an easy, get-out-of-jail free card.

      • It's not a secret that lower educational attainment, predisposition to mental illness, homelessness and criminality all intersect and correlate. I think the point most people make is that below a certain level, these factors are not sufficient to justify the attendant criminality - for example, someone who is depressed is mentally ill, but that wouldn't explain, and shouldn't excuse, mugging someone for their wallet. And this applies to an even greater extent for homelessness - being homeless doesn't mean you can't understand that what you're doing is wrong.

        • +2

          I think my story example suggests that there are often 'multiple' factors that will cause serious issues.

          If I am a lawyer with a loving family, great group of close friends, and then one day, my two cats escapes and never returns, and I might get some serious depression. My family and close friends will support me, and if they can't, try and get me professional help. I am not going to go rob someone or steal food because I need to - I'll just hide in my study and order Uber Eats 6 times a day until I get fat. My active support network will continue and eventually I will recover and get better. And go back to a normal life.

          Now, if I am a lawyer, same group of family and friends, same cat disappearance. And I resort to drinking a bottle of whiskey each day, then goes to two bottles per day. Then I get a permanent brain injury, and as a result of that brain injury - my thinking / behaviour might change. With those changes, I am no longer suitable to live on my own but my family/friends can't support me with the care I need. There is no other places either. There is no going back to my original life.

          Ok, let replace alcohol with illicit drugs say ice because food and alcohol didn't solve my depression. I might become unwell, I might become addicted, desperate and what not. During my 'crazy' period, I do things - illegal things - and get into trouble. I stole food from Coles because I was hungry, or I stole someone's phone to support my drug habit, because the drugs was to "self medicate" from the pain/depression I was feeling, then I got addicted.
          My ongoing drug use meant my behaviour changed and becoming too erratic, and too much for my family and friends. They decided to limit their contact with me due to risks to themselves, and my friends desserted me - said they couldn't be my friends if I am drugs. But I can't stop this snowballing issue.

          So yes, there is lots of grey areas here and definitely no clear lines between right and wrong, especially when someone is unwell.

    • I think OP might agree with some of those commenters:


      The worst part is dealing with drug and alcohol patients who game the mental health system to avoid criminal charges or pending court cases.

    • Gaming the mental health system to avoid criminal charges or court dates is fairly common. I would highly recommend to anyone thinking of gaming the mental health system to reconsider because it could result in them being prescribed powerful and unnecessary medications.

      • very true - they can destroy you as a person within days…..so why are they being routinely dispensed?

  • Interesting thread

  • +2

    Thanks for sharing! You're doing an amazing work.

  • +1

    The next chapter of my life :-

    Last night was another tough night. I hit my 30th night in prison for 2019, that is a record start for me. If I am not locked up here I would likely be in a psychiatric ward of hospital. I know the names of all the psych wards off by heart. I have probably met the Original Poster to this thread several times previously. Apart from prison I have spent 22 days this year in a hospital. I abscond from hospital all the time because I despise the place - even though I know the doctors, nurses and social workers want to help me get better. I successfully escape 2 times out of 3 attempts - pretty good right? I tell them I need a smoke and because hospitals are now smoke free zones, they give me 30 minutes 'smoke break' on the front lawns of the hospital. I light a cigarette and then disappear. In such a big city, it is easily done. In such a busy hospital, it is even easier.

    Last night was tough because I was worried about my court appearance later this morning. My bed in prison is much more comfortable than the cardboard I rely on when I am on the streets - sadly, the streets is what I call my third home. So far in 2019, I have counted 14 nights sleeping rough on the streets.

    Prison isn't a nice place either - they were designed for murderers, rapists, paedohiles. Those very bad people that do the crime - do the time. Prisons weren't designed for people like me who have an active mental illness. Some of us here get medication but some don't. They give it to us but it's up to us if we comply or not - many do not. The screaming here is awful and it goes on all night, then the tapping - finger nails against the metal prison doors. I couldn't sleep because of this and now I am all weary eyes.

    Breakfast has just been served - the same old stuff e.g toast and beans. It sounds terrible to regular people where the norm is going to hipster cafes that serve smashed avocado with 62 degree boiled eggs, and don't mention truffle shavings on top! Actually I appreciate the food here - you taxpayers are paying for it after all - and I bet it costs $20.00 per meal and this isn't an exxaggeration. I have eaten much more food here than the last six months combined that I have actually put on some weight and turned a nice shade of floral pink on my cheeks.

    In about 20 minutes, the prison welfare officer will bring me a spare set of clothing so I can wear them to court. It is a terrible idea to wear the standard prison green to court. I read that research has shown that wearing prison gear especially those bright orange stuff that give you in America, people are likely to judge you as guilty? If you were a judge and you saw the same person wear bright orange prison gear versus the same person wearing a cheap suit with a tie, who would you think is guilty?

    Anyway, I need to go and get ready now - brush my teeth, a quick shave and style my hair before I head off to court.

    The problem is, the judge will ask me where I will stay once I get released from here, and I still don't know and that doesn't help me one bit.

    I might be back for my third install.

    Wish me luck!

    Till then, Live Your Best Life,


  • Have you encountered patients possessed with supernatural spirits?

    • -1

      You mean "patients who claim to be possessed with supernatural spirits"…. right?

      • yes, that would do too

    • +3

      The large proportion of paranoid delusions have religious themes underpinning them.

  • Hey OP, sorry to hijack your thread with my story.

    I think I will have to quit my job and become a writer - luxury travel blogger on the one hand, and then the life of homeless man on the other.

    You must admit though that my story is pretty legitimate right? Given that you work in a HDU, you would encounter people like me.



    • Axis-II?

      • +1

        Ha Ha Ha ;)

        Maybe I happen to be good / or both things interest me (despite the contrast) IRL :p

  • What are some signs one can look out for (self/friends/family), to know one needs mental assessment and help ?

    • -1

      There are Mental Health First Aid Courses you can attend and learn the signs, they are really really beneficial.

      • +1

        $300 bucks to even know what signs to look for ? https://mhfa.com.au/courses/public/47542 !!!
        I think there needs to be more education disseminated to general public. No wonder so many mental health issues go undetected for years and the quality of the individuals life is pissed down the drain.

        • There definitely there needs to be more education given that 1 in 5 of us will get a mental illness at one point in our life.

          For better value, St Johns Ambulance offers the course for $155. Whilst it may seem expensive, being aware of what took out for and even being able to help your family or friends - will outweigh any upfront costs.

          Better yet, get your workplace to pay for it.

    • +3

      If someone who is normally outgoing becomes isolative and guarded and this persists for a week or two, it's usually a sign that something is going on. Cutting behaviours are also an obvious red flag. If someone's mood and affect are incongruent that is a sign that something is amiss. A persistent elevation in mood can be an indication of a possible manic disorder. Hypervigilance is also a red flag. There are many warning signs and they are fairly obvious if you know the person well. It is important that you approach them non-judgmentally and make them aware that you are aware that their behaviour has changed and offer them unconditional help. AND FOLLOW UP with another offer of help in a day or two if they refuse your initial offer.

      • -3

        'One in five Australians aged 16–85 years had a mental disorder in 2007, according to figures released today by the Australian Bureau of Statistics (ABS).'
        'Approximately 1 in 5 adults in the U.S.—43.8 million' google.

        how many pollies in parliament? one in 5 is probably mentally ill - so give em ect, and watch the protective legislation roll out within months.

        how many staff in your unit ? one in 5 is probably mentally ill but they keep working with diminished capacity don't they? Maybe that's why you're here even?

  • Can you suggest any methods to break into poor communication? What is the best way to get someone who doesn't communicate well to start communicating again? Is there any clinical methods to bring about positivity in a patient?

    • I find that coke does wonders…

      (apologies for flippancy)

      • +1

        Too expensive and they double down the down when the cokes gone…

        • -1

          True. Not a sustainable solution.

          • @HighAndDry: Good for 15 minutes.

            There's a way of talking and being open to people in this condition that can create a relationship and the possibility of them being more open and responsive.
            Clinically, how do the professionals create this response from closed people?

    • depends if the reason for their lack of communication is psychiatric or not. eg. if they are not communicating because they're drunk then stop the drinking. an eg of a psychiatric condition causing lack of communication may be depression or even schizophrenia.

      If your question is about how to elevate someone's mood so that they become more positive and ?happier to communicate/ less restricted then you have anti depressants and CBT if the reason for this is depression.

      Generally, if a patient is closed off that's not great for me because I need to do my interview. It's hard to make them happier; mainly just have to work on not making them sadder imo. I like to start by asking general questions like "how was your sleep last night" or "how are you finding the food" small talk stuff. You can build some rapport and let them open up to you a bit more before you dive into the deep stuff. So that is how you can facilitate communication to get the history but to make them happy is not something you can really achieve in the span of an hour.

      • Thanks Don, I appreciate the feedback. It's a common approach. There are many reasons people shut down. To the people who work with people like this every day, they build that skill, as you said, in building that rapport over a short time to let them open up a bit. I've also learned that after opening conversation, and getting the first response, to allow silence, for the person to start speaking to stop the silence. The more experience you've had doing this, the more ways you make it easier to open them up.
        The responses and stories in this thread reminded me of the situations I've had where getting someone to speak out is the goal, but they stay uncommunicative.

      • Anyone whose been in the system learns never to tell the truth within 48 hours. you have a self interest in attributing value to anything that's said to you. and that's without the effects of the medication on the patient, usually overprescribed….

  • Have you ever had, witnessed, or heard of, illegal or unethical sexual relations at your occupation, either between staff and patient, staff and staff, patient and patient, staff/patient and visitor or any other variant listed or not listed above?

    • +3

      Yes. Like most people, mental health patients have a desire for intimacy and sometimes they will have sexual relations on the ward. This is usually dealt with by educating patients on hospital policies and reminding them that they are putting themselves at risk, legally, physically, and emotionally. If a patient is found to be having sexual relations with another patient, one of them will be transferred to another facility and both patients will be offered a chance to speak with hospital management and the police if they feel they were coerced into the sexual relationship. It's important to remember that if a patient is scheduled under the Mental Health Act, it has been determined that they are somewhat incapable of making choices that are in their best interests. I have never witness a nurse or doctor having sexual relations with a patient but I do now it happens (very rarely).

      • -1

        so you don't read the papers - plenty of case's about staff in there….

  • My neighbour had locked herself in her car and locked the garage to intend to commit suicide. Fortunately, a guy upstairs realise something wrong in the basement after smoke coming out of her garage. People running around and I called police to break the garage door. She was unconscious but the fire fighter were able to save her. They took her to hospital.

    But my surprise is after 1-2 weeks, she was returned home. So I am not sure about the process of curing mental illness. My question is: is this common process? Just take a patient with mental issue for treatment in hospital in some weeks and they can go back home.

    I thought the process can take months or years.

    • +1

      Why were they suicidal? Most common is something stressful happened very recently in her life and she could not contain the stress and just saw no way out except suicide. It is very likely it is a spur of the moment thing and if she had thought about it and waited for a bit the urge to end it would have gone away. This is a situational crisis and we would diagnose it as an #Adjustment Disorder. If someone like this presented to ED they'd be given oxygen for carbon monoxide poisoning and possibly admitted to the medical team before being transferred to the psychiatric team. The psychiatric team would then evaluate suicidal risk/ identify the presenting problem and create plans in place for her. This would only take 1-2 days.

      So I'm surprised the stay was 1-2 weeks long, which is very long for a situational crisis type presentation. Hospitals don't like patients staying for too long. Slows down business. So what could have complicated this presentation? Perhaps there is some underlying depression/dysthymia, complex PTSD AND borderline personality traits. Those 1-2 weeks might have been because the psychiatric team was administering ECT to treat depression. Maybe she was psychotic and needed more time to work up.

      Thing about psychiatry is that a lot of the actual "getting better" is not in hospital but with the community health team. As long as you don't want to kill yourself too much, there is no space for you at the hospital. You can still be depressed and psychotic by the time you are discharged.

      • patients being formed can spend many days chained on a trolley in ed in a corridor waiting for a bed. this is crap.

  • Does a 4 hour AMA. :)

  • Is Fight Club real?

  • -1

    In your experience, do you think addiction to alcohol and domestic violence under the guise of hiding inter-generational trauma holds any water ?

  • Do you feel there are any patients in there against their will that perhaps shouldn't be there? (i.e. not really crazy / misdiagnosed)?

    • Yes, but it does not occur often. The process of scheduling a patient is two pronged. The initial schedule (called a Form 1) is valid for 24 hours. To uphold the first Form 1 the patient must be reviewed by a consultant psychiatrist [a senior psychiatrist]. If the consultant agrees with the initial Form 1 they issue a second Form 1.

    • in addition to OP's comment, i might add that the mental state of the patient changes all the time. What was deserving of detainment today might not be tomorrow.

      • sometimes they just ring up and form em without seeing them, more crap.

  • +1

    Is substance abuse and specifically abuse of/addiction to stimulants/alcohol/depressants as widespread with psychiatric nurses as it is with general nurses?

    Do you honestly ever gravitate towards misanthropic/eugenic views towards the mentally ill? More specifically, do you feel that there is some percentage of the population who are untreatably mentally ill and cannot be helped with any modern methods of treatment or rehabilitation?

    I ask this because I have spoken to both psychiatric and general nurses, young and old, who held quite negative or even hostile views of difficult, mentally ill patients and/or those perceived to be a disproportionate drain or burden on health system resources. I don't say this is representative of nurses in general but I am curious as to how common these perceptions are in the nursing profession.

    • +4

      I've never worked as a general nurse so I can't comment on whether the usage stats are similar. Illicit drug use is higher among young mental health nursing staff. Their drugs of choice are primarily cocaine and MDMA.

      No, I don't gravitate to misanthropic/eugenic views towards the mentally ill. We approach the treatment of every patient with the belief that their recovery is possible and sustainable. That said, some patients are treatment resistant and do not respond to medications and other psychiatric interventions.

      Mental health nurses are very susceptible to empathy fatigue and vicarious trauma. This can manifest into the hostile views that you referred to. It is fairly common. We have excellent training and are skilled in self-reflective techniques and it is incumbent on all nurses to seek clinical supervision to address such issues.

      • +1

        First off, thanks for the prompt reply.

        Mental health nurses are very susceptible to empathy fatigue and vicarious trauma.

        I can only imagine and hence why I wonder how their own mental health is affected by their repeated exposure to the full spectrum of mental health disorders.

        In your opinion, is working in psychiatry as a primary-carer or in patient-facing roles a sustainable, long-term career choice? Have you ever felt the impact to your own mental health and well-being was ever severe enough to warrant changing careers?

        We have excellent training and are skilled in self-reflective techniques and it is incumbent on all nurses to seek clinical supervision to address such issues.

        Is there any form of work-based compensation for work-related adverse health affects in the industry and do employers mandate regular psychiatric supervision/screening of nurses and/or free clinical consultations and assistance for nurses who require care?

        Is there any stigma or pressure on nurses and psychiatric workers to not manifest symptoms or disclose their own mental health issues due to the rigours of the job and the perceived impact to employability?

        • +4

          The attrition rate among mental health nurses who work in mental health units is higher than general nurses. Personally, I don't think it's a sustainable work environment in the long term. Mental health nurses will often seek community mental health position after some years on a ward or move into general nursing positions. And yes, I have personally felt an impact on my mental health and I often consider a career change.

          No, there is no work-based compensation for work-related adverse health affects in the industry and NSW Health does not mandate regular psychiatric supervision/screening of nurses. Workers compensation is available to nurses who have been assaulted on the job and need time off to recover. Clinical supervision is free for all nurse and encouraged but few actually utilise the service regularly.

          Yes, there is stigma around mental health nurses who are not coping emotionally with the job. Working in a high dependency unit is a high pressure and dangerous environment and every nurse is expected to be on their game. Nurses who are not coping will be counselled and moved to a less intense environment such as the Psychiatric Emergency Care Unit or general acute ward until they feel they are able to return.

  • First of all, thanks for doing an AMA. I was wondering if you had received any special training or had some tips for dealing with someone who has BPD. A childhood friend of mine was diagnosed when she was 21 and is putting a strain on a friends group with some concerning actions (slashed tires, broken countertop) nothing violent towards people but will lie about being on medication. They only seem to listen to me out of anyone in the group so I am isolated in my responses and cop flak from the group.

    I know it's a very specific problem, any advice would help a ton.

    • +3

      Yes, I have extensive experience dealing with borderline personality disorder patients. Unfortunately, I can't comment on you friend's diagnosis and their current behaviour. If your concern persists, call the Mental Health Telephone Access Line on 1800 011 511 and they will be able to offer you advice on how to proceed.

  • How do you deal with non compliant patients and medication? I know someone with schizophrenia and he boasted about the number of ways it's possible to hide a tablet in your mouth, open the mouth for inspection by a nurse, and then spit the tablet out later on. Hiding it above the gum line near the front teeth was his favourite. I know you've partly answered this question saying non compliant patients get injections, but what happens when the patients put on an act to make you think the medication was taken?

    How many people claiming to be Jesus Christ have you met in the ward? I knew a mental health care worker who told me the story of two people claiming to be Jesus talking to each other, but neither one could apparently hear what the other was saying. They were preaching to each other. Weirdest thing.

    • +1

      Medication noncompliance is something we deal with almost every day. Some patients are able to fool inexperienced nurses and divert their medications but it's something we a very vigilant about and they rarely succeed. We conduct regular blood test on patients who we suspect are diverting their medications. Many psychotropic drugs are available as a suspension [oral liquid] and these will be prescribed if the patient is suspected of diverting their oral tablet/capsule meds. If a medication being diverted is not available in a suspension we will administer the drug via IM injection.

      I have not encountered any patients who believe they are Jesus but it's very common for delusions to have religious themes. These patients often feel that they can talk directly to God and/or vice versa, and they believe they are receiving instructions from a higher power. We call this a command hallucination. These can be quite dangerous. Command hallucinations are not exclusive to religious themed delusions, though. Many unwell patients receive command hallucinations from electronic devices such as television or radio.

  • +2

    Having spent some time in correctional facilities around the state, it certainly seems that mental illness and circumstance plays a huge role. Such an important role.

  • +2

    amazing thread, and i really congratulate you on sharing your experiences and being in this field. considering the increasing rates of declining mental health i think this thread can be quite eye opening.

  • -2

    What do you do if your clothes catch fire 🔥?

  • +13

    Thank you all for your interest in this thread and for participating. I hope it has gone some way to lifting the veil on high dependency mental health units. My apologies if I did not get to your question, I've simply run out of time. Good night.

    MHTAL: 1800 011 511
    Lifeline: 131 114
    Beyondblue: 1300 224 636
    MensLine Australia: 1300 789 978
    Suicide Call Back Service: 1300 659 467
    Kids Helpline: 1800 551 800


    • -6

      My apologies if I did not get to your question, I've simply run out of time.

      Yep…. typical M H service response lol

    • +4

      Thank you for your time. Those of us who know people who struggle with mental illness appreciate your insights. This for me has been one of the better AMAs on OzBargain.

  • Does anyone recover? How and how long?

    • +2

      Not OP. Work in the same field.

      Most people take from a week from a episode of Mania, couple of weeks to months for schizophrenia, drug induce Psychosis only a few days. Suicide ideation/attempts few days to a weeks (depending if it's a crisis admission, secondary gains (mostly running from drug debts), B/NPD, Depression or schizoeffective disorder.)

  • +1

    Have you come across anyone claiming to be a time traveller? Can you search his belongings for a peculiar device, I need to get home.

  • Why do psychologists, psychiatrists, and authorities, not psychoanalise the 'insane' mindset of police, politicians, business people, religious leaders (hatter-mad), military, medical professionals etc. Instead they make their living picking on the weak and innocent. And locking them up, even mutilating them.

    Putin, George Bush, police, god-people, doctors, politicians, most business people, soldiers, bankers etc are obviously evil and INSANE for real, why are you complicit in a violent, insane society (church and royalty forced state, ie. slavery) that validates the violent arrest of people who are either deeply upset/disturbed OR in one way or another, 'mentally possessed' by church or state empowered members around them, playing insane mindgames while denying such esp/telepathy games are the norm, and often abused but never punished by the self-assumed authorities you are happy to serve everyday with little thought.

    To date, telepathy as witchcraft by church and state (search Google for validity) has been near 100% officially denied (particularly in the western world), yet natural telepathy in the past 50 years has been replaced worldwide by synthetic telepathy, and psychiatry treats victims as faulty, instead of actively policing the culprits, church and state, to cure the ongoing culprits, the ancient disease.

    This battle will end one day, I expect the bastards (like youself serving it) will get it and the earth will be destroyed to stop the effective slavery your job supports. Call me names/labels as you no doubt will simple minded servant, but you bullies are wasting your lives as you're wasting ours, with your self assumed, righteous authority, which I believe can only end in destruction and probably life end. Weapons against lying slavers that you support, will become available to defeat the bullying hierarchy. If not, your mindless group will destroy each other, so not much hope either way.

    The solution has always been to tell the truth. Particularly to yourself.

    I do not want a reply. Serving slavery isn't cool. There is no righteous authority, only violence based slavery authorised by, for example, a self-serving omnipotent god such as the rapist god of Mary, the mother of the Jesus character, being the plagerised version of Icarus, being again the plagerised version of other story characters dating back 7000+ years. This is true sickness that stops healthy life and evolution. Yet you get paid to violently enforce the viscious Christian creed. YOU AND YOUR MINDLESS BARBARIAN PRACTICE are mad.

  • Simply put; what’s the easiest way to get out once in?

    I had a friend who had her father admitted over basically a weird fight that was probably associated with new psychiatric medications. They swapped out the medication and his mood returned to normal overnight.

    Of course, not only could you not comment on a specific experience but on top of that, as a third party I SURELY don’t know the full story. But supposedly they kept observing for 2 weeks despite the whole family being extremely depressed/upset by the circumstance. They were under a belief that the EMT would just give him a sedative and the issue wouldn’t progress from there… they were shocked that he got admitted and kept for 2 weeks.

    They were begging for him to be let out but the observation just kept being extended “a few more days” repeatedly, and asking for advice on how to get him released. How long is it reasonable to keep people locked up when they’re not showing signs of aggression and they have a safe home/routine to go back to?

    My belief is that he’s been put at risk by the experience because the family has agreed they will never call for help again for fear of experiencing the situation again.

    • mental health tribunal application - it is by law that they must use the least restrictive treatment possible.
      things like assessment orders, treatment orders, to being in the containment unit.

      usually for about 3-5 days maximum, if they even want you for so long. These units are often maximally full..

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