Dealing with mental patients

Being constrained by circumstance to have to regularly accompany a relative to the mental outpatients department at St Luke's Hospital, I would like to draw the attention of the authorities to a number of factors that are rendering life very difficult and unpleasant for both the patients and the staff of this department.

The appointments system is on a first-come-first-served basis. Patients get there as early as 7 a.m. but have to wait interminably to be seen to. This unpleasant wait is further compounded by the fact that the doctors never arrive before nine. In order to alleviate the endless waiting, patients who arrive early register their name and then go to have a cup of coffee. This, of course, arouses the ire of patients who, arriving later, see a number of patients (those that would have already registered) apparently jumping the queue. The confusion and chaos that this causes has to be seen to be believed.

The atmosphere where the patients wait and are seen to is ugly and depressing; hardly the kind of place where to treat patients who are suffering from disorders such as depression. The chairs are very old and uncomfortable, the walls are flaking and the waiting room is small and crowded, with chairs placed along its perimeter and in row upon row in the middle.

Nurses coarsely shout out patients' names in much the same way as hawkers do at an open-air market. Smoking is rampant and this adds an intolerable strain to the already close atmosphere (in summer breathing becomes difficult in the heat that builds up in this room). To make matters worse, the unit itself is located outside the hospital grounds and this makes many of the patients feel as if they are being ostracised.

The shape of things to come is glimpsed at the reception desk, as one is invariably greeted, and I use the word "greeted" in the loosest of possible interpretations, by surly, unsmiling nurses, who judging by their attitude, need to get some distance and refresh their perspective on the requirements of this job.

Not surprisingly, the strain on patients who have to wait to be seen to under these appalling conditions and who are already suffering from a number of mental or personality afflictions, is telling; everybody becomes very nervous and some patients' behaviour starts to verge on the violent. Everyone looks tired and strained; indeed sometimes patients actually faint. Others start to rant and rave, or to weep quietly.

Although I am not a doctor, after a prolonged, unwelcome familiarity of 15 years, one thing that I cannot help noticing is that nobody seems to improve, as week after week, month after month and year after year, one keeps meeting the same people. Indeed, some of the patients who use this facility will actually confide that when it is time to pay a visit, their condition seems to get worse with the anticipation of what they have to go through.

Allow me to make a number of suggestions, which, if implemented, would go a long way towards making the situation more acceptable to both patients and the staff, who are as much victims of the situation as the patients themselves.

First of all, larger premises are needed. These should be decorated in a quiet, tasteful colour scheme. Pictures and posters with positive messages should be hung on the walls. The reception area should be made more welcoming. If smoking is to be allowed, there should be a separate smoking area, adequately ventilated and provided with ashtrays. The seating should be comfortable, possibly with a few low tables and magazines scattered usefully about. A television set could be placed strategically in a separate area for those who might want to follow a programme, rather than read or talk.

The whole facility should be properly served with dispensing machines for such necessities as hot drinks, minerals and maybe even some snacks. There is a dire need for vastly improved toilet facilities, equipped with the necessary supplies - soap, hand-drying material, mirrors, and toilet paper. Nurses should have a decent PA system through which to call the patients' names. The effects of an occasional, transient cleaner's broom would be better enjoyed if the broom were to be more frequent and less transient.

Talking of nurses and staff, these should be specifically trained to deal with their special charges. They should be smiling and upbeat in their attitude. If necessary, a roster allowing them to be in other wards, away from the mental patients, might help them be more positive and fresh when it is their turn to be with them. Under no circumstances should the nurses or helpers be allowed to scream at these patients, which is something that happens distressingly often. It has to be kept in mind that in the case of mental patients, beside the medication, healing can be helped by the attitude of those around them. That is why it is so vital that the nurses, doctors and staff should be sensitive.

Appointments should be set at intervals of 15 minutes and if the first-come-first-served system is to be retained, numbered tickets should be dispensed. This simple expedient would avoid so many needless confrontations. For those who are committed to long-term therapy or monitoring, subsidised transport should be provided, should it be needed. There could be rooms set aside for patients to attend group counselling sessions while they are waiting to be called.

These are just a few suggestions out of the many more that could be made to turn the mental outpatients at St Luke's into a pleasant, welcoming place, thus enabling it to carry out its proper function of bringing medical staff and patients together in an environment which truly fosters healing and re-growth.