I came across something today that really made me stand back and think about the history of nursing and how badly in the past we treated those with learning disabilities as well as mental health problems. Even until15 years ago there was in the UK the presence of  long stay hospitals and asylums for people with mental health problems and people with learning disabilities.This has led some ex patients to have extremely institutionalised behaviour and even after all these abuses from the past are still labelled as being clients with challenging behaviour.

Today when taking a client out we bought a drink from a local shop, after taking a few sips I offered to put the lid back on for the client. This caused a massive agitated reaction where the client started self harming and shouting in the middle of the street. I caught on pretty quickly that the client was  scared that I was going to take the drink off them. So I calmly explained to the client that I wasn't going to take their drink, and was only offering as I thought they might like to keep some for later. The client drank their whole drink, and this made me wonder why there was a fear surrounding drinks, and I wondered about institutionalised behaviours.

When returning to the home I consulted with other staff who have worked in this area for far longer than  I have and they explained that a few of the clients had spent many years in a  local  long stay hospital. Where under staffing, under training and abuse were often the order of the day. The client I worked with today is largely non verbal in communication although the client does make some sounds and two very definable words. In these institutions food and drink were often stolen and that might explain why when receiving food and drink these clients will gulp them down often without taking time to breathe. What a legacy to be left with, clients so afraid of not being allowed to finish their food/drinks that they will gulp them down risking choking.

It suddenly started to make sense to me the differences between some of the clients I work with those who stayed at home and had access to freedom of choice and those who were raised or lived in long stay hospitals. Some of the service users are so compliant with everything that it is difficult to gauge whether they want to do something or not. Asking  particular clients if they want a walk or a bath they will immediately get up and go towards the bath/or to their coat. I always assumed maybe wrongly that this was because they would like to undertake a particular activity, however maybe this is institutionalised behaviour. Other clients when asked if they would like to do a particular activity will make it clear in whatever form that they do not wish to do something. Effectively in being able to communicate no the client can express their individuality.

Other staff today confirmed that there has been an improvement in the institutionalised behaviours since the clients from long stay hospitals have been within the trust. Some are now communicating in their own ways how and when they would like a drink, refusing to eat food they don't actually like and refusing to engage in some activities. In the past they would have waited to be given a drink, eat everything they were given and generally comply with anything that was asked of them. I think this shows how far we have come from the days of the institution however there is still a way to go. How do we go about supporting these clients develop their individuality and self esteem to the point they can live their lives as they would wish rather than the ways imposed on them by the institution. That is the million dollar question!

Im a Mental health nurse through and through however I also love the work I do in learning disability services.
This is a new website for LD Nurses :) http://learningdisabilitynurse.com/learning-disability-nursing

Something that Seaneen from The secret life of a manic depressive wrote. I think its worthy of reading as it is so true and what is happening in the mental health world right now!
http://thesecretlifeofamanicdepressive.wordpress.com/2012/02/19/the-mental-health-system-divide-and-rule/#comment-44331

Free Clinical Skills e book for Students Nurses

http://www.jazannurses.com/books/nursing/Compendium-of-Clinical-Skills-for-Student-Nurses.pdf

Mental Health and Physical Health equality enshrined in law : Finally

New legislation that could see the end of mental health stigma in the NHS

post taken from Rethinks Blog.

http://www.rethink.org/about_mental_illness/personal_stories_blogs_forum/blogs/paul_jenkins/the_lords_have_taken.html

The Lords have taken a stand on mental health, now it’s up to all of us to make it a reality

09 February 2012 | 10:44 AM

Paul Jenkins

Topics: Campaigns, Stigma and discrimination

Important things don’t always happen when you are looking for them.  Last night’s vote by the House of Lords to enshrine in law the principle that mental and physical health must be treated equally within the NHS, may be one of them.

The amendment is mostly a symbolic change, but one which is highly significant.
For all its revered status as national treasure or religion, the NHS has not always had a good record in responding to the needs of people with mental rather than physical health problems.  When the NHS started, most people with mental illness were ‘out of sight, out of mind’ in institutions which were often a byword for abuse and poor care.
In the 1980s and 90s, Community Care, a good policy, was undermined by the leakage of resources to prop up acute services.  Even today, after some significant improvements in mental health care, outcomes for people with mental health problems are significantly worse than those with a physical illness.
This is borne out in a number of ways.  Mental health care is often characterised by a lack of choice and control for people using services.
People with mental health problems struggle to get access to evidence based interventions. A poll by Rethink Mental Illness in 2010, found just 16% of people who have schizophrenia and bipolar disorder are getting access to all the treatment recommended by Nice for their diagnosis.
People with mental illnesses also experience much worse outcomes in terms of physical health.  Can it be acceptable that someone with schizophrenia dies on average 20 years earlier than the rest of the population?
Most concerning is the fact that the NHS continues to be one of the places where people with mental health problems most regularly experience stigma and discrimination, whether in mental health services themselves or in primary care and A&E.
I accept that such things will not be changed overnight by a few words in primary legislation.  The inequalities I have described above are symptomatic of a deep seated ‘Cinderella’ status which is represented as much in the culture of health services as it is policy agendas or formal systems of governance.
However, symbols are important. As Dr Johnson said, having a legal duty “helps concentrate the mind”. Furthermore, there are many situations in which this duty to promote an equality of esteem could be of practical benefit to people who use mental health services and their families. It will be relevant to how Ministers set the proposed mandate for the new NHS Commissioning Boards.  It will be relevant in reviewing the balance of objectives in the various outcome frameworks set for the NHS, social care and public health. It should be considered in setting priorities for investment in research. 
It will give an important message to Clinical Commissioning Groups and Health and Wellbeing Boards about their priorities and about the need to engage mental health service users and their carers in local decision making.  Finally, it sends a clear message of ambition that whatever the NHS can achieve for people with physical illness, it must achieve for people affected by mental illness.
In response to the defeat, the Government has said that this is not a matter of principle and that there may be other ways of establishing parity of esteem.  That may be so.  I do not doubt the Government’s good intentions in relation to mental health, which have been demonstrated in its mental health strategy and its investment in the expansion of talking therapies and the continuation of work to challenge stigma.  However, if they share a fundamental passion to see parity of esteem then there can be no clearer symbol than to place it as a duty on the face of this legislation.
In the next couple of weeks there is a duty on all of us in the field of mental health; people affected by mental illness, professionals, voluntary organisations and NHS bodies, to demonstrate the strength of feeling on this issue.
It would be a travesty for this amendment to be overturned in the Commons for the sake of political expediency and for MPs to vote against a change which directly affects at least one in four of us.