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Experiences of Mental Health In-Patient Care: Narratives From Service Users, Carers and Professionals
Am J Psychiatry 2008;165:779-779. doi:10.1176/appi.ajp.2008.08010151
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edited by Mark Hardcastle, David Kennard, Sheila Grandison, and Leonard Fagin. New York, Taylor & Francis, 2007, 248 pp., $100.00.

This book is one in a series conceptualized and put together by the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses (ISPS). As readers learn, ISPS is a global society dedicated to the education and support of mental health professionals, service users, and caregivers of the chronically mentally ill. Members come from a wide spectrum of interests, from psychodynamic, systemic, cognitive, and art therapy to therapeutic institutions. The editors, who are from the United Kingdom, represent a similar breadth of experience: Mark Hardcastle is a consultant nurse, David Kennard is a clinical psychologist and group analyst, Sheila Grandison is an art therapist, and Leonard Fagin is a retired consultant psychiatrist and senior lecturer. A brief history of inpatient care in the United Kingdom prefaces the book, explaining the transition in the 1980s from old Victorian asylums to modern hospitals, similar to de-institutionalization in the United States. This led to long-term patients being accommodated into residential nursing homes or hostels, with some ending up incarcerated and subject to rampant drug use, a major contributor to recurrent psychotic episodes.

The book is a collection of brief narratives from service users, their family members turned caregivers, and service providers of different specialties, including nurses, psychiatrists, psychologists, occupational therapists, art therapists, hospital administrators, a chaplain, and a hotel services assistant (cleaning personnel). Each narrative is paired with several complementary commentaries which present more angles of the same experience, woven into a rich chapter texture. The patients describe with courage and honesty their feelings about situations ranging from involuntarily admission to acting out while psychotic to getting better and spending daily quality time with a staff member. One teenage girl, who felt ostracized because she couldn’t be admitted into the children’s unit (“they didn’t do psychoses”) and didn’t feel safe in the adult unit and whose parents had to fight the system to get her the care she needed, presents a touching testimony in Chapter 8, entitled “Feeling Alone.” The narratives are heartfelt and moving, allowing the reader access to psychological layers that may otherwise remain hidden under a patient’s primitive defenses or bizarre behavior. It behooves professionals to attempt this kind of dialogue with their patients, although the main themes of the providers’ accounts are frustration, feeling overwhelmed by clinical pressures, and feeling unprepared or at times apprehensive. Even sadder is one nursing assistant’s perception that if he was to further his education and become a nurse, he might not have time to provide meaningful care such as taking patients for walks or simply listening to them (Chapter 17, “Mixed Feelings”). An occupational therapist discusses her feelings of powerlessness when, after spending time helping patients to relearn daily necessary skills and prepare themselves for an independent lifestyle outside of hospital walls, placement in the community is delayed, leading to relapse into illness (Chapter 21, “Feeling Frustrated”).

No less relevant is the account of family caregivers, who feel neglected and unimportant, having spent days in the hospital without being informed about the admission process or treatment plans, or allowed to participate in their loved ones’ healing, and are ignored until discharge (Chapter 10, “Why Us? Feeling Invisible”). At the same time, there are stories of caring physicians, nurses, therapists, and ancillary staff and the kindness and optimism they offered frightened patients and caregivers, helping them cope with difficult moments (Chapter 13, “Feeling Grateful”).

Dedicated mental health professionals continue to provide care to those suffering despite all the difficulties outlined here. This book is a collection of pearls honoring those who battle mental illness on all fronts, whether patient, caregiver, or care provider. It will resonate with many of us, as it raises poignant questions, as well as proposing discussion points for team meetings. The editors’ advice to mental health professionals on improving inpatient care is captured in the following: be human, be yourself, tell people what’s going on and why, involve patients and relatives in clinical care planning, look after yourself, take time to communicate, share, and reflect on your experiences with trusted colleagues, and carry out meaningful practice audits. This is a powerful book, and its lingering echoes are both humbling and inspiring.

+Book review accepted for publication February 2008 (doi:10.1176/appi.ajp.2008.08010151).




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