Before I took a job as a healthcare assistant on an acute ward I had assumed that mental health hospitals were dangerous places. It was my first time opting to work in a setting like this and in my mind adult-aged psychiatric hospitals were places for uncontrollable people, the type who are far beyond reason. In fact the day before my first shift I had butterflies, and not the good kind, like I was travelling abroad somewhere sunny. I was terrified that I would be assaulted. I imagined myself avoiding eye contact with patients as I looked for the door or somewhere safe to work from. This was a strange feeling as I had worked as a mental health researcher and was familiar with the diagnostic criteria of mental illness. Despite this prior knowledge, I still fell for one of the pervasive myths of mental illness: that psychiatric hospitals are for society’s least manageable.
It turns out I was wrong. What I found, and quickly, was that I was working with some of the poorest and most vulnerable citizens in London: individuals with tragic and painful life stories. Most, if not all, of the stories I hear are of individuals who have suffered emotional and physical abuse. But the stories don’t start with our service users; they go even further back: parents, grandparents, layers of trauma that have been passed down through the ages. The scale of what we – people trying to be compassionate; people trying to fix things – were up against was suddenly laid bare.
Of course, wards can be aggressive places. There are violent incidents but from experience the roots of this violence is plain to see: “I want to go home”, “I don’t want my medication”, and “Why are you talking to me like that?” Every aggressive situation I have witnessed has stemmed from a feeling of injustice, that they are disrespected and being denied perceived rights.
Of course, there are some service users whose mind is unknown to us and their behaviour is unpredictable but this is rare. The lesson I have learned is that, as an HCA, I must be hypersensitive to the needs of patients. From behind the nurses’ station it is easy to convey an emotional and physical distance. The positive impact of promptly attending to a patient’s needs – as unusual as that need may seem – should not be underestimated, nor should standing still as we listen carefully instead of having one foot out the door. We can’t afford to be too busy to care. We must never forget that we work mostly with patients who have been systematically neglected. To make them feel once more neglected in the very place they should find respite would be careless and reckless.
I went into my job as a HCA with a view to it being a stepping stone towards eventually learning more about psychological therapies. This is still my ambition, but what being a HCA has taught me is that the foundation for good mental health is relationships. It is in a way terribly simple. However, it’s not at all simple when you think about the lives our patients have outside hospital. The absent support networks, the pressure of an unforgiving city. There are no easy answers but I am forever thankful that I work as a healthcare assistant: I am working day in, day out with the people I strive to help. I don’t have to do the paperwork that distracts so many other professionals. Healthcare assistants are in some ways not just the frontline, they are the only line. It’s a cruel paradox that HCAs spend the most time out of all health professionals with patients, but have the least amount of training and supervision. We must, and can, do much more to value HCAs and to invest in them.
My job is stressful and challenging, but if you want to see what society can do to people, and you want to help people who have fallen through its widening cracks then becoming a healthcare assistant is the best place to start. I hope that as I journey through mental health care, I still get to spend as much time with patients as I do now.
