State of Mind by Robert J. Craig

Author:Robert J. Craig
Language: eng
Format: epub
ISBN: 9781633931237
Publisher: Koehler Books
Published: 2015-11-23T16:00:00+00:00

STAFF PARANOIA

It is well known that, among seriously disturbed mentally ill patients, staff behavior can benefit or harm patient behavior. For example, clinical staff are taught to portray and present a calming demeanor when interacting with patients, because such an approach has a calming influence on them. A more cogent example is below.

I attended a three-day training conference on suicide assessment, intervention, and prevention. As part of the training, we watched the movie One Flew Over the Cuckoo’s Nest, which illustrated Nurse Ratched’s over-controlling demeanor and behavior harming patient (and staff’s) coping behavior amidst a psychopathic resident, who managed to get the mentally ill patients to act out his own nefarious motivations. The following story illustrates this all too well.

There was a time during upcoming state elections that the opposition party held hearings about how “terribly” the mentally ill were being treated in the State institutions. The real motivation was not to improve the treatment of the mentally ill, but rather to embarrass the governing party and help sway the elections to the other side. Such was the environment when I began a new assignment at the hospital, as director of an acute admission psychiatric unit. This was a particularly sensitive issue for me, as I was designated as the first non-physician to head a psychiatric unit in the state psychiatric system. (Actually, as I have already told you, one of my colleagues preceded me as the director of the alcoholic treatment unit in the hospital, which caused the physicians to demand a meeting with the superintendent—a physician.) As a result of the meeting, the physicians rationalized that the alcoholic treatment unit was on the grounds separated from the main psychiatric units and hence “was not really a psychiatric unit.” This rationalization appeased them. However, when I was made a director, there was no rationalization possible and I felt a keen need to do well and get them on my side.

At my first staff meeting with the Superintendent and the other physician ward heads, the following conversation occurred in the meeting. I had been there only a few weeks, when the Superintendent said, “Dr. Craig, how come there is a higher incidence of fevers on your unit?”

Now I always believed that the best defense is a good offense, so I replied, “Maybe these things go unnoticed on the other wards!” Everybody laughed.

“I don’t know. I suggest you send the nurse epidemiologist to our unit and explore the matter.” This was done. Now back to the main story.

For the first week, I was careful not to offend the unit physician, who had been there for a few years and was used to doing things his way. He had a good clinical staff working with him but there was little organization and the main goals of the unit—to discharge a patient within 30 days or transfer the patient to one of our intermediate care wards—was not being done to the satisfaction of the hospital. As far as the organization was concerned, this

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