Bringing joy to a psychiatric ward

A mental health team from Wales talk about what earned them the Team of the Year title at this week’s Nursing Times awards

The work of a north Wales mental health unit, including members of UNISON, was recognised this week when they were awarded the prestigious Nursing Times Team of the Year Award.

The award came in recognition of  “incredible” changes they are making in in the eight-bed Tryweryn psychiatric intensive care ward, part of the Betsi Cadwaladr University Health Board in North Wales.

“By using a new human rights approach in our psychiatric unit, we’ve managed to halve the amount of restraints we’ve had to perform in the past five months,” says Caniad service manager Denise Charles.

“Restraints” happen because “When someone is in acute distress, they may become violent towards themselves or others,” she explains.

“This means taking them down to the floor and holding them down to protect them or to protect staff … or a chemical restraint, where they are injected to calm them down.

“When people are already being held here against their will, restraints are traumatic experiences,” adds Denise.

“If you’re acutely psychotic, you might think somebody is after you. And it feels so real to you, that when everybody else is telling you it’s not real, it makes you more paranoid.

“Then imagine that you’re trying to get away from what you’re experiencing, and people are running after you and pinning you to the floor.”

So Denise and her team, including past patients and parents of patients, began to talk to people on the ward about how things could be done differently, and exactly what they wanted.

The answer? A ‘rant and relax room’.

“Different people let off steam in different ways,” says Denise.

“If someone is feeling like they’re not able to express themselves, they may start screaming, shouting or become aggressive.

“Instead of pinning them down, we can guide people towards the safe room and encourage them to either let it all out, or just lay under the weighted blanket. We comfort them.”

The rant and relax room has a sofa, weighted blankets, calming essential oils, different lights and noise-cancelling headphones to listen to music through.

The patients designed all of it – down to where the lights go and where the sofa would be placed.

“We calculated that restraints use up an average of 22 staff hours a month,” explains Denise.

“So now we’ve reinvested that time back in prioritising joy at work for staff, which makes the experience better for patients too.

“We encourage staff to bring their hobbies to work. For example, staff who love baking and cooking have been baking on the ward with patients and supporting them to cook their own meals.

“We also have joint yoga sessions and hand massages. Before, this time would have been taken up by restraint.”

Tony Carr is an expert-by-experience and has been involved in the project from the start.

“I was three weeks out of alcohol detox and needed to find something positive to do at the time,”  he recalls. “So I was introduced to Caniad.”

Caniad is an organisation commissioned by the health board to support service users and their carers. Caniad is hosted by rehab and recovery charity CAIS and mental health charity Hafal.

“At first I went in with my eyes wide shut and thought ‘Oh, we’ll just make them smile’,” recalls Tony. “Then you see that you’re not just helping their happiness you’re also helping their treatment.

“The residents love it and they’re happy and you don’t have to worry about them being aggressive.”

“Instead of pinning them down, we can guide people towards the safe room and encourage them to either let it all out, or just lay under the weighted blanket”

Denise adds that there’s now much more laughter in the ward, “because it’s patient-led”. “Patients have said this is what they need,” she says. “We’re listening to patients. This is patient-led, patient-focused and that is leading on to being more staff-led.

“A lot of what makes people severely unwell is trauma. And patients are reporting to us that they feel safer – that’s all we can ask.”

By investing in joy at work and putting at the centre of what they do, staff have benefited from a reduction in paperwork as it has been replaced with human contact with residents.

Deputy ward manager Leanne Gill described the unexpected impact on the staff

“At first the time that staff were saving wasn’t that evident,” she says, and then when we tallied up, the staff quickly realised that with every incident the paperwork is immense.

“So by de-escalating situations before it got to a situation of restraint, they could spend those staff hours sitting talking to patients instead.”

Connection, community and joy have completely transformed the culture of the psychiatric unit.

Ward manager Matt Jarvis explains: “It’s all very simple really – just asking how we can support people’s individual needs, and actually listening to what they have to say.

“And we’re all connected that way. It’s become a small community where everyone has relationships and links.

Instead of patients just having to meet our criteria, we’ll also meet theirs. We’ll meet them when they’re in crisis and support them in the way that they want.”

UNISON sponsored the Team of the Year award and national nursing officer Stuart Tuckwood says: “We’re really impressed with what the team are doing at Tryweryn.

“It’s a really good example of what people can achieve when they work together. It’s a team working approach that’s benefited both service users and brought benefits to staff.

“We’re really happy to support this team and are glad they’ve won this award. We’d love to help them share their experiences and what they’ve done across the NHS.”