Post-War Reform in Mental Nursing
- Author:
Staff Nurse TOM CATHERALL (late of Chester County Mental Hospital)
Winner of the “Lord” Memorial Essay Prize, 1942
anv Hfe are-menta^ hospitals in which it is hard to find of .e Patients. In other hospitals there are hundreds .Patients obviously suffering from continued inactivity. Ho own hospital, I have seen such patients with eo- hope of improvement ; but from the changes HevCtCC* t’lere by Occupational Therapy alone, I would hu h ^esPair even the worst case. I have seen idreds of patients made into human beings. This is Th reason f?r taking up the subject of Occupational of JraPy as a post-war necessity. Without this method ho atment’ numhers of patients would be left without As the possibilities of Occupational Therapy for?me more widely known, I believe it will be imperative every Authority to remedy a very grave defect, any reforms might be suggested in the sphere of an npa^ nursin8? hut, judging by the results of this widely ppiicabie form of treatment, it seems that the universal f0 ePtance of the principles of Occupational Therapy Urgen1611^ Pat*ents *s t t^1e Sreatest value and change in atmosphere and conditions in hospitals reve[e .Occupational Therapy has been adopted is a hav6 Where it has been applied, its possibilities e become apparent; this work of Occupational re e^aPi’> along with the accepted application of the lif - S medical research, has completely changed the the f1 ?.ental hospitals. Here is a means of preventing ‘Utility and pitiable waste of lives. It is always a eventive against chronic dementia when all admissions fr e the benefit of Occupational Therapy in some form the date of their admission.
. when admitted to hospital a mental patient is out of . gnment with normal life; his outlook is distorted; he ma^ without initiative and have no interest, or hv may the capacity to attend to his personal ygiene. Patients suffering from melancholia may have 0rbid delusions which produce a feeling of unworthiness with the consequent loss of confidence. Schizophrenics escape from reality and live in a world of fantasy. Occupational Therapy alleviates the suffering of many types of mental patients by helping to readjust or alter the above characteristic outlooks and to re-educate those with faulty habits; it arouses the desire to achieve, restores confidence and balance and brings back patients to reality. Before this treatment was introduced a patient’s life was monotonous?day after day was passed in inactivity, broken only by the routine of meals and walks in the airing courts?a changeless round in which there was no hope of arousing the apathetic patient, and no outlet for the energies of the excited, other than that afforded by perpetual quarrels or their well-known destructive habits. True, a small number of suitable patients worked on farms or in the gardens, but of those remaining the irritable were aggravated by being closely confined, and there was no stimulus for the indifferent. Where Occupational Therapy has been introduced and organized, conditions are different. The patient is employed and is given a specific occupation which is within his capacity?something which will interest him, divert his attention from himself and become absorbing. The results are encouraging.
At present Occupational Therapy in mental nursing is only in its infancy; it has not been developed as it might be. It must be fully practised and its principles accepted. How can this be achieved ?
One of the most important factors is the environment. To obtain the greatest benefit the patient must be housed in congenial surroundings. There should be ample space with large, airy wards, good lighting, pleasing decorations and furniture; and no overcrowding. The building should be well situated, with a pleasant outlook from the windows, the gardens adjoining well planned with rockeries and lawns, and the patients there should be encouraged to take an interest in their cultivation and to participate in games. Above all, the retaining fence should be inconspicuous so as to avoid the feeling of frustration. Such surroundings would do much to dispel the ” shut-in ” feeling, lessen resentment, create an atmosphere of responsibility and restore the confidence of the patient.
Occupational Therapy must begin at the first possible moment; idleness is devastating to mind and body. In the wards there should be facilities for patients to per- form the normal routine of hygiene, and each should have his own towel, toothbrush, etc., and be encouraged to take an interest in his personal appearance. Toilet utensils should be labelled and kept where all patients, whether confined to bed or otherwise, have access to them, and a daily routine should be carried out under supervision. This is the nurse’s duty and should be conscientiously and daily performed until the patient learns the habit. One of the aims of Occupational Therapy is to bring the patient suffering from mental disorder back to the normal way of life, and it is impor- tant to create the desire for, and sometimes to re-educate in, these small but important duties.
Having established the routine of personal hygiene and pride in personal appearance, specific occupations can be prescribed for the patient. A knowledge of the past history, physical capacity and the usual intelligence of the patient is a help in the choice of a suitable occupation. The medical officer in charge of the case, the occupational therapist and the nurse can assist here.
There are two groups of patients to be considered: those who are expected to recover quickly, and those whose illness will be long. Acute cases can be given a definite course of treatment by graded occupations, and others can be drafted into the utility services of the hospital and thus become useful members and, most important, be prevented from deteriorating.
For regressed patients there must be a time-table of habit-training and a daily routine. This habit-training would be a saving for many of the hospital services? e.g. in clothing, laundry, furniture and, above all, in staff”. In this matter the best will never be forthcoming while wards are very large. A ward of fifty patients is suitable. From an economic point of view it would be impossible to do away with the existing mental hospitals, which have too large wards and are prison-like in appearance. But it is possible in the future to build hospitals on the villa system, with thought for appearance, practicability and the type of patient to be treated. Let there be no suggestion of the prison ! Means of restraint must be inconspicuous and the aspect of the buildings should give a feeling of freedom. Space must be provided for the convenient administration of Occupational Therapy. Hospitals must be suitably equipped, and the training of mental nurses should include a course in Occupational Therapy.
Great care ought to be exercised in the selection of staff; it is very important that they should be of suitable character. The ideal nurse is well educated, of absolute integrity and has enthusiasm for the vocation, a sym- pathetic personality, and with ability to instruct. On entering the hospital service the nurse should receive at least three months’ instruction in an annexe apart from the hospital before having any responsibility f?r patients. The course should include lectures ?n anatomy, physiology, psychology, an outline of mental disease and a knowledge of the various treatments f?r mental disorders. An introduction to the treatment by occupation should he given and the nurses encourage” to study crafts, country dancing, exercises, etc. Nurses should be acquainted with the various departments, the different types of patient and the treatments being given- All should be obliged to take the qualifying examination in mental nursing, and those in charge of wards should obtain the General Nursing Certificate in addition to the Certificate in Mental Nursing and a qualification ‘n Occupational Therapy. Nurses who fail to take the examinations, or who are not up to the standard, should become auxiliaries and do the domestic work of the wards, but should never have charge of patients. This scheme should result in a very high standard of treatment, and a corresponding benefit to the patients and the profession as a whole.
Occupational Therapy, in conjunction with other treatment for mental illness, is a means by which the patient, if not cured, may be trained to make the best oj his limited capabilities and enabled to live his highest life. Regressed patients must be re-educated and have habit training; apathetic and depressed patients must be stimulated and made to regain confidence; excited patients must be stabilized. By the proper application of Occupational Therapy, all these classes can be enabled to contribute in some measure to the community and to themselves.
Occupational Therapy has been developed abroad- America led the way after the last war and recognized the value of prescribed occupation; Germany and Holland also developed the treatment. It is only in the last twenty years that Occupational Therapy has been practised to any great extent in Great Britain. This form of treatment is now recognized by Govern- ment Departments and is included in rehabilitation schemes.
Therefore, in the post-war reconstruction it would be well to include a reform which needs so little expenditure and where so many natural facilities are available- ” Work is nature’s physician.” Scientifically applied work and play can heal and alleviate the suffering of the mentally sick. It is our duty as a Christian country to include any reform that will make for a happier community.
My reason for emphasizing Occupational Therapy f?r the treatment of patients in mental hospitals in any reconstructional methods to be adopted after the war, Is that it is the only method I have seen that embraces all classes of patients, and also that hinders dementia in a great number of patients. I believe it will becorne imperative for every Authority to use to the limit of its capacity methods that have proved their worth. The alternative, I believe, is mental death for very many patients and the loss by Authorities of an economical approach to the treatment of their patients.
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