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Reaching past the anger and fear

Working as a psychiatric nurse at a secure adolescent hospital has its dangers but can also be very rewarding professionally. By Flynn Murphy.

Speaking on the phone at the Forensic Hospital, a maximum security psychiatric hospital at Malabar, Jo McLaughlin says: “I guess this is the last frontier of nursing.”

McLaughlin is a psychiatric nurse and this night is working the late shift. She has worked at the 135-bed facility since October 2009, in its dedicated Adolescent Forensic Mental Health Unit, which is quarantined from the adult wards.

The hospital treats several classes of people – those who have been found not guilty of a crime due to mental illness, those considered unfit to plead in court, and those who may not have offended, but are considered to be a high risk. The patients and inmates include sex offenders and violent criminals, but McLaughlin doesn’t want to talk about any of that. At any rate, the fact doesn’t seem to faze her.

“We deal with their mental health, not whatever they might have done. That’s for the lawyers – and the courts.”

McLaughlin, who speaks softly but deliberately, says she is there to help the younger inmates. “The important thing with young people is to give them hope for the future. Our kids are often very sick, and have developed things like schizophrenia quite early in their lives, which is tragic. But they’re a lot better off with us than they are in jail, and they’re a danger to society. The community doesn’t expect that kind of danger out there.”

McLaughlin runs two programs at the centre: a drug and alcohol prevention program; and a mental health program. She has been a psychiatric nurse for 18 years. Before that she worked for 10 years in general nursing, including as an accident emergency nurse at the Royal Newcastle Hospital.

“I used to work in the community before this, which is very different. There is more autonomy as a nurse in the community, and I worked in a crisis team so I’d be going to shopping centres, schools and a whole lot of places being called to assess people who others thought were at risk. Going to bridges, and talking people down.”

But McLaughlin wouldn’t trade her job for anything, and she would recommend it to any general nurse looking for a change of scene. “It’s the best job I’ve ever had since moving from general nursing.”

“You’ve got to be a caring person who is fascinated by people, and loves to really talk to people. That’s what therapeutic intervention is all about – it’s about talking with people. But you also need to be a really together person, with a good backbone and sense of self. It’s no good if you’ve got problems yourself.”

For someone who works in such a difficult environment, McLaughlin is remarkably stoic about the dangers. “It can be a dangerous place to work, and you’ve got to have your wits about you. I’ve never been hurt, but I’ve got friends and colleagues who have been, badly. But you can’t come here with that burden on your shoulders.”

“Besides, the danger money is good,” she adds.

“There are lots of strategic plans around safety, and we’re constantly assessing everyone for the potential for violence. It’s about early intervention – preventing rather than having to deal with that kind of stuff. We’re constantly trained up, and we’re all very confident.”

McLaughlin says avoiding danger comes down to communicating and engaging with the inmates, winning their trust, and developing healthy relationships with them. “The [patients] are desperate to get better, they don’t want to hurt us.”

“The most dangerous thing about psychosis is that you can have command hallucinations which tell you to harm people. When someone’s psychotic, they don’t necessarily recognise that, and will be quite paranoid of being harmed themselves.”

“For the schizophrenics, they lose a lot of their identity once schizophrenia takes over, and can become quite isolated.”

McLaughlin helps the patients to build their identity back up over time, and to come to terms with their illness, and their need for treatment. “You’re always looking at the bigger picture with these kids – the sociological overlay to their lives. Most of them haven’t come from great places where they have been loved and taken care of, but had horrible lives. There’s been no real love or nurturing, and that’s what you see. They are the product of their shaping.”

“It doesn’t make sense to judge them on what they have done. You have just got to try to appreciate why they are the way they are – often their families are so fractured and dysfunctional. I’m a real believer in nurture over nature, even though obviously some mental illnesses are inherited.”

McLaughlin’s interest in mental health comes from her own experiences in early life. “Everyone has a closet story about someone in their world. I had an aunt who suicided when I was about 15, and I was very close to her, and I think that experience moved me more towards trying to find answers for her death, which I now understand. My family cut off from the whole idea of it, without wanting to understand it. They didn’t speak about her again in their lives.”

She says the issues commonly associated with mental health – shame, denial, and ostracism – are exacerbated when paired with crime, and heightened in adolescents. “No young person wants to feel abnormal. It’s very hard for them to cope with the idea they’ve got a psychiatric diagnosis, and nobody embraces coming into a psychiatric hospital.”

“The kids with family support do much better, but for a lot of the kids, their families abandon them. A lot of them don’t have anyone. They don’t do as well as the ones with supportive families who come and see them every weekend.”

“Most people in here have never been taught any kind of coping mechanisms when they’ve been kids, or any of the things it takes to become an independent adult.”

McLaughlin herself has a number of coping mechanisms to deal with the stress of working in a maximum security mental institution. Rather than getting angry and frustrated with the kids, you just need to remember that you’re a role model for them.”

“The people I work with have all got great characters, and there is a lot of camaraderie to get you through the day when you are having a bad day. Suicide is one of the saddest things that I have been exposed to, but you can’t take it home, and you need to have a whole lot of professional boundaries around your patient relationships, which come from experience too.”

There is also clinical supervision for each nurse. “You go and talk to someone on a regular basis, and that’s very important so that you’re not projecting onto your patients. You need to be together to help other people who are not, or you’re not really any help to anyone.”

“But there’s a lot of humour at work. There’s always a story.”

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