Chapter 13: Sociological understandings of mental health

Case Study: Sue

My name is Sue and I work on a fairly ordinary acute mental health ward. I say ordinary, but it seems these days that this place is not the same as it was 15 years ago when I first came to work here. We seem to have no time for the patients anymore and I feel overwhelmed with the various demands on my time, most of which seem to be about administering the process of being in hospital or being subject to mental health law, or risk management, rather than sitting down and talking to people. When I do get the chance to relate to patients or relatives I am reminded of how good this job can make you feel and also that I do possess good listening and communication skills. A lot of the time, however, I feel conflicted and guilty that I am not spending sufficient time with most of the patients on this ward. I know my colleagues feel the same. But some of them are agency or bank staff and won’t be here tomorrow. I get home after long shifts and I am tired and irritable; it doesn’t take much now for me to lose my temper with people I am close to.

I recall from my training we used to think a lot about different explanations for mental health and making sense of how our work was organised. I think sociologists might say I am alienated in my work, and that I can’t help adding to the alienation of service users. Just being able to name how I am feeling right now isn’t much succour. I would love to have the luxury to stop and think these days and involve my colleagues and patients in thinking through what goes on on this ward. Maybe we could try and desist from some of the more bureaucratic tasks that distract us from patient care and protect time for constructive dialogue that may help find solutions. More resources would help, but the answers must involve more than just that.

Put yourself in Sue’s shoes, what, if any, practical solutions might help you and your colleagues working in such a ward environment?

How might the sort of sociological ideas presented in this chapter inform relevant discussions?

› Possible answer

Sue is correct to say that resources are not the entirety of any solution. What the team are able to accomplish within their own capacity is important; and this could meaningfully involve efforts to make time with service users. Initiatives such as the Star Wards programme suggest ways for spending meaningful time with patients and various alternatives to simple bio-psychiatry emphasise relational care over and above bureaucratic case management and paperwork activities (see http://www.starwards.org.uk/). Interestingly, these approaches may prove to be more rewarding for staff in terms of job fulfilment.

Despite this, resources are clearly important. For instance, to provide sufficient staff to be able to create the space for critical dialogue and patient care. The team may consider how to negotiate with managers and employers for safe staffing levels. Being members of appropriate trade unions ought to assist.

Critical realist theories can help staff make sense of their own, and service users’ alienation under psychiatry.