An Accidental Psychiatric Nurse

Part 11. The exercise of restraint.

I only spent three years at Tooting Bec, just enough time to get my exit visa known officially as an RMN certificate. Others weren’t so fortunate. Patients obviously, but also Andrew from our training group who failed his final exams after three attempts. It was a mystery to me how he managed this feat as he was intelligent, gentle and compassionate. At the same time, he had a naivete that left him ill-equipped for the harsh complexities of psychiatry. He had worked as a theatrical dresser and perhaps that environment was better suited to his personality than the rawness of disturbed mental states and the sometimes physical nursing response to them. I left the hospital with a Nightingale badge and a copy of the Nightingale prayer. The badge has gone but the prayer sits in a drawer with other documents like my Last Will and Testament and a certificate in ‘Control and Restraint (Shield Work)’ from Three Bridges Regional Secure Unit. The worst and most inappropriate course I have ever done. I suspect that the learning outcomes may have been set by Charles Bronson:

1. competently inflict therapeutic levels of pain and document appropriately;
2. survive strangulation using a range of clever manoeuvres that you won’t remember when being strangled;
3. manage siege situations involving hostage-taking as if you were a Strangeways prison officer.

The trainers were over-enthusiastic advocates of role play as an aid to learning. I’m reminded of this by the permanent scar on my shin from a metal bed thrown at me in the ‘Patient Barricaded in a Side Room’ scenario. I was dressed in inferior Robocop protective gear with a perspex shield that offered inadequate protection from flying bedroom furniture. The same trainer had pretended to bite my genitals in an earlier exercise called something like ‘Escorting Patient up Three Flights of Stairs in a Controlled Manner’. I was meant to be holding his head as the other members of my team held him in fancy wrist locks. ‘Nearly lost your family allowance there,’ quipped the Bronson protégé as I laughed nervously. The Nightingale Prayer didn’t cover these eventualities. One of the other trainees seemed better suited to this style of nursing, evidenced by his stoic refusal to submit to any pain from the wrist-bending locks. Even the trainers gave up and I pondered if he might have an Achilles heel, maybe his ears like the housewives’ nemesis Mick McManus, but that particular move wasn’t on Charles Bronson’s curriculum.

The Three Bridges course was absurdly disproportionate even for a Regional Secure Unit in 1988. Ten years later in 1998, David Bennett died in a Medium Secure Unit in Norfolk, at least partly due to improper restraint and partly, as an inquiry later revealed, due to institutional racism in the NHS. Thirty years later in 2018, legislation finally hit the statute books aimed at reducing the harm caused by restraint, known as Seni’s Law (Mental Health Units (Use of Force) Act 2018). Maybe Andrew had a lucky escape. He never got his exit visa, his certificate or his Nightingale badge, but I hope he held on to his gentle innocence.