Working with individuals with schizophrenia: A reflection

Firstly, it has been the most important aspect of my life, following my first degree in philosophy and theology from Heythrop College, University of London, then to have encountered severe mental health difficulties when helping set up The Big Issue in London. I worked at street level with young and older people, signposting to services, such as drug and alcohol, sexual hygiene, HIV clinics, soup kitchens, and housing advice. I encountered psychosis for the first time in such exposing circumstances where hundreds of people were living open to the elements on the streets.

No wonder there was a preponderance of street homeless people taking uppers and downers, alongside alcohol and a range of prescribed and non-prescribed drugs passed around the fraternity of the street community, to survive the challenges of street life. I was then fortunate to have been supported and encouraged to work in London NHS psychiatric acute wards for men and women for many years, gaining the opportunity to befriend them and hold 1:1 and group therapy sessions for those in crisis, often surviving attempts on their lives. 

My motivation for working in paid and non-paid roles on various assessment, acute, crisis and rehabilitation psychosis units for many years was and is that I can’t live with knowing that there are thousands of individuals in crisis, left to cope with very distressing voices, hallucinations and beliefs in solitary rooms on NHS psychiatric wards. I was given a therapy group by a consultant psychiatrist on a female psychosis unit, which I took up and ran for the following five and a half years.

This was one of the most fulfilling times of my life, working closely with the committed nursing staff and I was trusted to work 1:1 and in often large groups in the activity room, always equipped with a nursing handover and alarm when things became too difficult. However, I was loathed to use the alarm too readily – and in fact, in the five and a half years of voluntary work every weekend when inpatients were often alone and without organised creative activities to distract them from their acute mental health difficulties, I used the alarm once only, when a person would not leave the activity room and two nurses were called to escort them out.

As helpers in these environments, we need to better equip ourselves in relation to our communication skills to be able to engage acutely disorganised people to help nurture trust and containment. I would go so far as to highly recommend every human being to spend at least two years volunteering three to four hours a week on acute wards. It would likely be one of the most growthful and fulfilling experiences you would ever have. 

As a psychotherapist, my experience on a female acute psychiatric ward then also on a male ward and a place of safety, where men and women are brought to a locked ward due to risks to their own safety or that of others in very florid states of mind, I went into the place of safety offering a listening presence, conversation, creative activities and board games. Over time, I was able to sensitise myself to highly vulnerable personal situations and see beyond the aggression, for example, to the frightened individual and speak to this part of their being in a calming way.

This offered understanding and reassurance, always resulting in the individual calming to a more manageable place in themselves where a slightly different conversation could take place, and trust established. Remaining calm and not being frightened of extreme states is key, alongside recognising the normal aspect of the individual through which growth and development are possible.

However, I have heard too many stories of men and women being brutalised. I have seen so many bruises as a result of police contact with these highly vulnerable individuals and this is not to be able to acknowledge that in highly distressed states, the police have a difficult task of bringing these people to safety when the individual doesn’t want to. Despite this, there is still too little understanding or willingness to understand mental health difficulties by the police and hospital staff. Nurses are trained to manage individuals on hospital wards through medication but are not trained enough in how to talk to people on the wards. Too many times, I have seen eight nurses surrounding one person and it just doesn’t look or feel right. On occasions, there have been 10 police officers called to manage one patient. Again, this is extreme by any stretch of the imagination. 

In therapy, I work in private practice with the boundaries and beliefs involved with individuals with symptoms of schizophrenia to start to distinguish and separate out what is going on in their minds, including the distinction between the internal and external worlds, a task for us all. Normalising aspects of life is important, alongside not minimising the fragility and distress that is often a feature.

Trauma is important to think about regarding the person’s history if they are happy to talk about this, which is not assumed. Working at their pace is essential but also seeing opportunities to challenge in a more secure and trusted therapeutic relationship is important too.

If you would like to talk with me about what is on your mind, I offer a free, confidential, 15-minute consultation by way of introduction and the opportunity for you to see if you feel that you want to move or not to arrange an initial session, and if so to see how this goes. I am deliberately available over Christmas and the New Year since I want to be available to those who find this season difficult and to have someone to turn to. Please feel free to contact me by phone or by email, or visit my website, all of which you can do via my profile.

I am trained in multi-therapeutic modalities to equip myself on an ongoing basis to help the most vulnerable in our communities. You will be met with a friendly, non-judgmental and professional approach, where what you choose, want and need are at the centre of our conversations.