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Community Mental Health Nursing
Nigel Davies
Enrolled Nurse, Diploma of Applied Science Nursing, Registered General Nurse and Registered Psychiatric Nurse
Abstract
It was Wednesday morning, the weather was cold and wet. My first visit of the day was to a thirty five year old single male with a diagnosis of chronic schizophrenia called John (not his real name). I had received a call from a friend of John's the previous day who was concerned about John's current level of wellness. He reported that John was not his usual self, becoming increasingly paranoid and had been missing from meetings held by his local Schizophrenic Fellowship group. John's absence from the group was particularly unusual. After discussion with him and comprehensive reading of John's file, I decided to go see him. As a community mental health nurse I was struck by the fact that he had only had minimum involvement with his case manager over the last two years. His mental state assessment history was sketchy but there was no indication of aggression or violence.
I arrived at John's home to find a house that looked more like the studio set from the television series the Adams Family than a 1990's home. As I approached the perimeter of the house I just stood there in amazement-the front yard was a sea of overgrown bamboo trees totally blocking view of the house from the street. On approach I saw this narrow cast iron gate on one hinge with this narrow path through the bamboo to the house. As I drew near to the house I could be excused for thinking this home was derelict and abandoned.
The windows were either bricked or boarded up. The front door had approximately eight barrel bolts attached to it. I stood there for a few moments as I analysed the environment and my next move. I thought very carefully about what I should do. I was tempted to leave and come back later with another team member for support.
When suddenly the door burst open with this male who I assumed was John standing in front of me dressed in dirty denim clothes with unwashed scraggly hair. I was on my back feet poised for a quick escape when he started to interrogate me, questioning who I was, where I was from and what I wanted. After several minutes of discussion somewhat suspicious, guarded and paranoid, John invited me inside to his lounge room. He pulled up this dirty old wooden chair for me to sit on. As I surveyed the room I saw with my value laden eyes abstract poverty. John only had two dirty old wooden chairs, a black and white portable television sitting on the floor, old bar radiator, old wooden coffee table with eight padlocks, supposedly for the front door. The window had been boarded up and the room was a sea of paper and burnt matches.
After a short time of superficial conversation he asked me to look at something in what I assumed was a bedroom. As I entered this room with its bricked in window I could see in front of me a wall with clear glass plates concreted into it covering the whole wall. To John this was special and it had some hidden significance to him as a person. To me it was another feature of a life style reflecting a bizarre mental state. On leaving this room he invited me into what was once the kitchen. Again the window was boarded up, the back door was bolted with several locks with an old stove leaning against it for extra security. On the other side of the room where the window once was that used to reflect nature's light through, was an old wooden door supported two feet off the ground by bricks. On top of this door was a dirty old ripped sleeping bag-this was John's bed. This room was covered in rubbish with used matches strewn over the floor giving it a parquetry look.
After the grand tour, we returned to the lounge area for a few minutes of superficial conversation. During which time he told me of the torment he was experiencing because some local youths had been writing graffiti on his outside walls. He then asked me to leave and not visit him again.
I left his home with a deep sense of sadness and hopelessness in regards to his living environment. I was confused as to what involvement I should have with him and what practical steps I could take to provide some sort of care. Although one part of me, probably my working class background with my middle class job and values, informed me that his home was not fit for human habitation. Another part of me could see that John was relatively happy and content in that environment and he was surviving at a basic level. He agrees to take medication and see the doctor a few times a year and he regularly attends meetings held by Schizophrenia Fellowship.
For me this experience encapsulates the disturbing, complex and challenging situations being faced by people with a serious mental illness and the people charged with their assessment, care and comfort. It also demonstrates the need for creative theoretical ideas that make sense in practice. How do we relate to people who are profoundly distressed and disturbed? What informs the judgment we make about them and why? How do we translate our observations into the written record and what are the implications of this? The merging of ideas and beliefs I have in relation to what takes my eye, my ear and my world-view inevitably informs what steps I take when helping others.
The above excerpt is taken from an academic paper produced as part of the assessment criteria for the Graduate Diploma of Community Mental Health Nursing at the University of South Australia. This experienced was gained while undertaking clinical experience as part of the course requirements.
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