Abi Crossland-Otter is a Trainee Counsellor and Mental Health Support Worker with lived experience of Anxiety and Obsessive Compulsive Disorder. Here she describes her first month working in a psychiatric hospital.

After a month of training and another month of supernumerary shifts, I have begun my role as a Mental Health Support Worker (MHSW).

"Even when I think I’ve left the issues of the day at work, at night I dream I am still there and find myself sitting up in bed forcing myself to stay awake and continue my observations."

Despite the thorough training programme, never have I been filled with such anxiety at the thought of going into work every day. Nothing can prepare you for working in a psychiatric hospital, other than quenching your catastrophic imaginings by experiencing the not-so-terrifying reality of it all. That is not to say there have not been terrifying moments or that the anxiety that I experience is unwarranted. Spending twelve hours a day with patients who are depressed, suicidal, manic, and sometimes unpredictably violent is all-consuming and draining. 


Even when I think I’ve left the issues of the day at work, at night I dream I am still there and find myself sitting up in bed forcing myself to stay awake and continue my observations. On wards where the severity of the patients’ risk to themselves or others is deemed to be high, you will spend the majority, if not the entire day, on observations. Some patients will be on what we call Level 3 or 4 observations where they must be kept either in eye sight or at arm’s length by one or two members of staff on a 24-hour basis, until their risk has reduced.

I was surprised after my first week to experience the overriding emotion of boredom. Whilst it is part of an MHSW’s duty to encourage and facilitate activities, the combination of high dosages of medication and high levels of depression, observations are often spent watching the patients sleep. However, when they are awake, patients are able to do things such as baking, crafts, sports, have beauty treatments, or, depending on their sectioning, go on leave.

A myriad of different disorders

The wards support patients with a myriad of different disorders, with a large proportion of patients living with more than just one. In my first month I have worked with patients with schizophrenia, Borderline Personality Disorder, depression, Post-Traumatic Stress Disorder (PTSD), psychosis, eating disorders, Bipolar Disorder, substance/alcohol addiction, and anxiety disorder. One of the most surprising things I learnt during my training for this role was that females tend to self-harm more than males. Having spent time on both male and female wards, I am yet to understand the reasoning behind this gender disparity.

Patients can be triggered by anything to self-harm, make a suicide attempt, or become violent. Examples range from traumatic memories triggered by food, noisiness on the ward, certain times of the day or dates in the year, to the approach of their discharge date. Patients who are set to be discharged relapse quite often; the safety of the ward is far easier to process than all that the outside world entails.

De-escalation and restraint

When patients do become violent or attempt to harm themselves and verbal de-escalation fails, we may be required to conduct physical restraints. Using ‘reasonable force’ that is necessary and proportionate, we use our Prevention and Management of Violence and Aggression training to safely intervene. At least two people are needed to perform a restraint, so in these cases we pull our alarms and (hopefully) in a matter of seconds support comes.

In cases where a patient in restraint does not become settled and refuses medication, an intramuscular injection will be administered, without the patient’s consent. I was surprised to find that this method of rapid tranquillisation was actually used outside of movies, but I have witnessed how, when nothing else works to calm a patient in extreme distress and unable to make decisions for themselves, this method is necessary.

Despite the inevitable struggles that come with a job such as this, more than anything, being an MHSW is incredibly rewarding, and for a large part, enjoyable. I spend a solid 50% of my time on the wards laughing; many of the patients are charming and, although it should be the other way round, they look out for us. They appreciate our presence and I leave work every day feeling valued and grateful for the life I have to return to.