The following page contains transcripts and text descriptions of the graphic-novel style images contained in the Themed Review "Experience of children and young people cared for in mental health, learning disability and autism inpatient settings."
Panel 1 - Without
A boy sits on a bed staring sadly at his empty hands. In his mind we see different and incomplete thoughts: “Too many thoughts,” “Scared,” “Don’t know what to do,” “Confused,” “Feel trapped,” “Don’t understand.” Out of the window behind him, it is summertime and a calendar on the wall shows it is August.
Panel 2 - With
A boy sits on his bed with a digital tablet in his hand, laughing at a video of a sneezing cat. He thinks “This cat is hilarious”. Out of the window behind him, it is snowing and a calendar on the wall shows it is December.
Lengthy admissions can dislocate a young person from the things they value most in their day-to-day lives. Inpatient settings may lack the most important aspects of ‘homeliness’, especially if there are rules or ‘blanket restrictions’ that do not take into account individual needs. Promoting a sense of normality wherever possible, through flexibility and personalised care, can significantly improve a young person’s experience and wellbeing.
A blue felt noticeboard with a metal trim displays a staff rota. The staff rota reads:
- Monday - The nurse Ali’s never met
- Tuesday - The nurse Ali vaguely remembers
- Wednesday - The nurse Ali chat about music with (Deb)
- Thursday - The nurse Ali likes but is only here once a week
- Friday - The nurse Ali always beats at PlayStation (Mike)
- Saturday - The nurse Ali chatted to once
- Sunday - A completely different nurse
An inpatient admission creates a new set of relationships between a young person, their family, and the staff on the ward. Staff need to have enough time to develop meaningful relationships with the young people they are looking after. Trusting and empathetic acts of care, outside of therapeutic sessions, can improve the quality of a young person's experience and wellbeing.
A male staff member looks anxiously at a female young person, who seems frustrated and angry. The young person is surrounded by an overturned table and chair and the remains of a meal on the floor. The staff member thinks “Shall I restrain her? She could hurt herself”
The young person looks angrily at the staff member, she thinks “Is he going to hold me down now?”
The staff member says “I’ll have to restrain you”, the young person says “then I’ll struggle.”
The staff member says “Then I’ll restrain you more”, the young person says “then I’ll struggle more.”
Later that week we see the young person in a doctor's office sitting in an armchair looking upset and reserved. Across the room in a second armchair, a doctor looks puzzled. He says “You don’t seem to want to connect with me this week.”
Physical restraint can have negative consequences for all involved and should only be used as a last resort, to prevent harm to a young person or member of staff. It can leave the young person feeling scared and may trigger memories of past trauma. This can damage therapeutic relationships and mean a young person is less likely to engage in treatment. Staff may feel guilt and regret, even when they believe restraint was necessary. High-quality staff training (adopting Restraint Reduction Network standards) and good, needs-based, care planning can avoid unnecessary use of restraint.
It isn’t easy for anyone
Panel 1 - Sam
A boy, Sam, looks sadly out of a window at the moon while carrying a tray with his dinner on it. We see he is in a bare room with a single bed. On the wall is a fire exit sign, a photo of him and his Mum and a calendar signaling it is December.
Panel 2 - Sam’s nurse
A man, Sam’s nurse, is taking a break in a staff room. He looks tired and is holding a cup of tea in his hand. It is nighttime and we see the moon out the window. On the wall is a staff rota, a poster about ‘Restraint Reduction Network’ training and a wanted poster for a teaspoon. The worksurface has mugs, a kettle and coffee on it.
Panel 3 - Sam’s mum
A woman, Sam’s Mum, is in her home about to eat her dinner at the dining table. She looks sadly out the window at the moon and at an empty space set on the table. Behind her, we see a fireplace with a photo of her and Sam, and a ‘Home Sweet Home’ picture framed on the wall.
An inpatient admission is not easy for anyone involved: the young person, their family, carers, and hospital staff. Meeting everyone’s needs can be challenging. Understanding and respecting everyone’s perspective is essential to improve experience and outcomes.