The Simulated Real World - Kingston University

Alice

The knock on the front door echoed throughout the cold rooms of the Crime House and we all tensed in anticipation. Inside we waited for the nurses to enter and visit their patients, yet this wasn't a ward scene but one firmly placed in the community. What could be more ordinary than a leafy street in suburban Kingston-upon-Thames, although what was going on behind the closed doors was a series of teetering narratives not light-hearted Margo and Jerry tittle-tattle . Who knows how common these unravelling stories are, how often desperation creeps under the crack in the door or for those lives in disarray to be rebuilt piece by piece. This was a chance to see behind those ordinary doors and capture the individual worlds of three people.

Julia Pelle

This is my third and final year as artist-in-residence at the School of Nursing, Kingston University and St George's University of London. Previous years have seen me ensconced in a corner of the simulated mental health ward furiously capturing the drama in sketches and words. Today (01/04/2015) we had the chance to see students working in teams throughout a simulated weekend where patients/clients were rooted between the four walls of a house.

Sharon Putt

Alice was recently returning to the family home after a hiatus, the dynamic of husband and children creating a soap opera of instability; Julian was back in the 'real' world, desperately trying to survive without money and in a barren and inhospitable bedsit; Peter found himself in the care of his parents once again, trapped in a world dominated by the dubious reality of the internet.

Kevin Acott

The day started for the students in a lecture room with the promise of an emotional assault course to come. Lecturers Julia Pelle, Kevin Acott and Sharon Putt set the scene. "This is a proper home visit, you're really going to get it today!"

Mostly in couples and sometimes alone, the students made their way to the Crime House door. This house is usually used by Forensic science students who find themselves quite literally at the scene of the crime. One after another over the course of this simulated weekend (that in reality lasted but one day) each group of students had to visit their patient, assess, advise and help. They would then have a meeting with their counterparts who would be the next people to visit the patient. So it was both an exercise in being the person at the cutting edge of the situation but also the ability to move forward as a team. It meant as an outsider I observed and sketched 3 unattached narratives, like jumping across random pages of a novel.

Martyn Keen

The story I first opened would be a Dashiell Hammett, it is short and full of motivation. I am the detective, not the hard-boiled kind more soft and pliable in the hands of actor Jane who plays the role of Alice. With us in the room is Martyn Keen, the professional who is keeping any eye on proceedings. Our two students accompany Alice into the room but there is another presence here too. It is the room's elephant, who is the shadow of the past.

Alice is here in her house on a weekend pass, so this is a fleeting visit for her too. For the past five weeks she has been on a mental health ward. Alice hugs a child's toy, she rocks gently squeezing it's soft body with an intensity that would rid a lemon of not only its juice but its zest as well. Her voice wavers like a doll, it's as if someone had pulled the ringed cord at her back and her words rise and fall, changing in pitch and emotion.

Student - Olawumi Olatunde

The two students sit across from Alice, directly in her eye line, close but still giving her the space to breathe. There's a hysterical tinge to Alice's voice and they pick up on it immediately. "No, No I'm happy" Alice says, "When I'm upset I'm tearful. No I'm happy". There is talk about a 'chat' with her husband and it's the first shift that pulls the rug from underneath my feet and the elephant stirs again in the room.

Student Olawumi Olatunde asks if Alice has the 'urges' at the moment, and her colleague speaks honestly, helping Alice realise she is teetering on the verge of a 'manic phase'. Tears start to well in Alice's eyes and the most revealing words escape between her lips, "I'm worried they're going to find me out".

It is one of the finest interactions I have witnessed between student and patient. Martyn Keen thinks so too as he launches into a debrief, he tells the students "Alice was more honest with her nurses than she was with her husband or children". Alice is left alone and someone will be here to check on her progress in the days ahead.

Julian

The second visit is to see Julian (actor Nigel) who's numb bottom is aggravating him more than any mental rollercoaster. He has spent another night sleeping on the cold linoleum of his bedsit. Money is an issue and the support that he should be a receiving is a safety net which has more than one hole in it.

Isaac

The students who have to unpick Julian's problems are Isaac and Maddie. They have been proceeded by colleague Danny who has already made Julian promises, for who wouldn't. Julian's situation is heart-breaking, the room is bare, a tin of beans and bottle water sit beside him, the fireplace is boarded up and there's no discernible signs of heat.

Harvey Wells

Isaac and Maddie are caught in the same Groundhog Day as Julian. They go through a check list, making sure their patient is safe but unfortunately not changing his immediate dilemma, there is still no furniture and no money for food. There is a genuine frustration and sympathy for all the people concerned because the 'system' is a tanker of behemoth proportions that doesn't change course easily, let alone in these choppy financial waters.

The impasse is best illustrated in this short exchange. Isaac asks "If we sorted out all your problems out would you feel better?" and Julian replies "Of course." Then after a long pause he adds "You can help me by helping me".

Harvey Wells is overseeing this exchange in his role as facilitator and the pursing of his lips is only interrupted by a pensive tap of his pen before it makes another note in his book. Time is the winner, the turgid second hand ticking variety. The minutes that stick in Julian's room barely escape the firmly shut door nor permeate the condensation that lines the window. It is not just the maze of mental health that makes Time move slower but also the inability to sit on a sofa or watch the TV. Small comforts that we take for granted.

Peter

My third and final chapter was a much more animated affair. Peter is back at home with his parents and there's enough tension between father and son to inspire a Greek tragedy. Conspiracy theories are rife, the internet as we know is a fountain of knowledge but in Peter's hand it is starting to fuel his fears and insecurities.

David Condon

The man who has to help Peter is student David Condon, and he has to decide how much fuel he wants to add to Peter's fire. He is determined to dominate this exchange, he is fluid and forceful, never scared and very impressive. David is a terrier, never letting go of the conversation and yapping at Peter's heals until he relinquishes a ball to chase down.

David Tracey

David has decided that Peter's conspiracy theories aren't to be indulged for too long but by curtailing these conversations he's cutting down on the information he needs. It is a balance of listening, thinking ahead and deciphering the past. It is a skill that is developed in simulations just as this, and it is one you can't help but admire.

Under the gaze of facilitator David Tracey it is David our student who makes the gesture that catches me by surprise. It is the difference between being on the ward and out here in suburban London. David needs to get Peter out of this environment, even it's only for a few hours, away from the addictive conspiracies and the volatile father son dynamic. Rather than a solution constructed of words David offers one made of actions. He will go with Peter himself, out there beyond the boundaries of this secure bedroom and into a world full of permutations which are ready to trip them both up. It is also a world that offers support and friendship, the first steps will be physical, taken together, while the latter ones will be navigated by Peter alone.

AL.

Theatre of Dark Dreams - Simulated Mental Health Ward

'Frances'

This is the second time I've been invited onto the Kingston University and St George's University London's simulated mental health ward. This time last year I took my first tentative steps into this potentially volatile environment, I was unprepared for the process and theatre that awaited me. Since then my artistic life has dovetailed with the course, actors and staff. The sketches from last year formed a successful exhibition, a film which was screened at the BFI London, a loan of work to the Recovery exhibition at the Institute of Mental Health (Nottingham) and a series of articles online and in print.

Chris Hart

The ward didn't feel such a terrifying place this time around. The actors who 'play' the role of mental health patients were familiar friendly faces and their characters had unnervingly settled so completely in my memory that I have since had problems discerning fact from fiction.





Denise

As usual I was welcomed to Kingston University by psychotherapist Harvey Wells and supremo Chris Hart. I will be as clumsy here as his beloved Crystal Palace defence and say that Hart is indeed the heart of the operation. Looking trim and dressed in black from head to ankle he was 'The Shadow', taking phone calls, fighting logistical fires, lurking in the background and despite his slight limp he was a gentle but powerful leader.


Harvey Wells

Harvey Wells travels light on these occasions, attired in creaseless jacket without button or zip, his smooth, sleek and steely persona reminds you of an Imperial Officer from Star Wars. Luckily Chris Hart is no Darth Vader and the simulated ward no Death Star, but the fear on the students faces when they walked through the door was very real indeed.

Kevin Acott

Before the students arrived Hart played host to the other Lecturers and Facilitators who we're the safety net for the next two days activities. These included Denise who raised the stakes early on for the 3rd year students "They should be reasonably sophisticated, we should see some proper skills." Heavy weight thinker Kevin Acott floated intellectually like a butterfly and stung like a bee. His plein-air musings focussed on a new character, Tim, who was going to be vocal about a dissatisfaction with black nurses. Acott is never one to box around the thorny issues and here he was going to punch hard.

Nancy

The simulated ward is an opportunity for the students to test their skills in a live situation, despite the role of patients being played by actors it is a pressure situation. All professionals need to be prepared and this was their chance. For the next few hours they discussed the 'patients' in their care.

George

The first group I hovered around was guided by facilitator Nancy who had taken time away from her job at Springfield University Hospital. Only 6 months previously she sat where these students were, on the cusp of joining the front line of mental health nursing. There was a strong deputy, Karen, and ward manager Kingsley although a little nervous took control of discussions.

'Sandra'

The hot topic is 'Sandra', who has had an abusive stepfather, drinking heavily at 12 years old, cannabis at 14 and cocaine at 15, self-harming at 18, in and out of hospital since 19. Her threatening behaviour is getting out of control and the students look nervous because her notes show that she is thinking of assaulting one of them. Karen says "We need to find out who she wants to thump!". It is a timebomb that pulses in everyone's mind. This scenario is going to play out in a ward environment during tomorrow's session and the endless permutations weigh heavy. Another student, Chris, openly expresses her fear of being isolated "I find the simulations so difficult, there are the blue screens everywhere and I get lost in my bubble?". Chris Hart explains why they are right to be wary "Sandra is a disturbed woman, she will act upon her ideas". Just in case the students doubted the worth of this interaction with Sandra, Facilitator Nancy confides "We have this situation on the ward I work on, we have to restrain someone every day".



Rebecca

Now is the time for action, or for the outsider like me, now the theatre begins. Today they must prepare for the all-action simulated ward with a fish bowl exercise. One students is allocated a patient and he or she must tackle them in isolation. I mislead you here, in fact while student George welcomes Sandra into the room the other 10 students observe from the wings. Eagerly they analyse and sympathise with their fellow student, who try to block out all exterior distractions.

'Mary'

I flit between the groups not wanting to miss any of the action. First I dip into the smouldering encounter between George and Sandra, the latter is relatively calm, her words crackle like sparks from a shorting fuse box, "They're getting on my fucking nerves! I wanna go home". Suddenly wires are blown when George says to Sandra "I've heard from someone else that you have a problem with one of the nurses here". These are not the wisest words to say to some who is paranoid, and Sandra flares up.

It couldn't be more of a contrast in the other group, Rebecca talks to Mary, who lies limp in her chair, face turned into a corner and avoiding eye contact at all costs. Rebecca tilts her head, she chews and plays with her bottom lip as Mary mumbles "I managed to get a razor and hurt myself.....What is there to like about me.....I don't see myself getting any better."

Karl and Frances

The encounter between Rebecca and Frances highlights the problems of trying to converse with someone at such a low ebb and often doesn't want to talk either. It is a common theme as I eavesdrop on another nurse/patient conversation.



Karl

Nurse Karl is as nervous as his patient Frances, taking control of his emotions he forcefully commands the situation. Like a terrier with a bone, he isn't going to be side tracked from his intended goal, but Frances moves away, putting up her hand into his eye line. This is like a game of Chess, Karl cannot move his chair forward without threatening Frances, so he perches on the edge of its lip. Tenaciously he ask again and again "What's going on Frances?" She is not interested. Stalemate!

'Peter'

Karl needs to tease the frightened and hurt Frances from the burrows of her mind. His breakthrough is a simple one, diabetic biscuits, and the tension dissipates. Karl takes a breath, his face colour decreases from crimson to vermillion and he marks a minor victory. It will take many more visits before he earns the trust of his patient. This is an increasingly common situation with patients being moved from ward to ward and an ever rotating role-call of staff.

Oke

Talking isn't a problem for the next two patients, Peter and Jeffrey. Oke watches the former, head very still, his focus is so constant that you think he might well be able to unfurl Peter's crossed arms through telekinesis. Peter is wary, he is convinced that there is a subversive plot in operation and when Oke tests the subject of his patient's wellbeing there is a passionate response "Medication eats away at your brain!" Another impasse, but the game of mental health chess isn't over yet.

Louise

As an artist you long for the gritty and emotional but also the flamboyant. Jeffrey is one of my favourite patients, a man who has an acute awareness of the mental health system he inhabits. He is a man that cannot be contained by mere walls, life is a stage darling, and as a frustrated thespian he means to test the boundaries of a nurse's intellect, humour and knowledge. You find yourself lulled by his voice, it is like listening to the cricket commentator  Henry Blofeld as he talks around anything other than the subject in hand.



'Jeffrey'

Jeffrey has met his match in Louise, who stood out from the pack the last time I sketched in the simulated mental health ward too. With a knotted brow and unwavering eye contact she tries to negotiate the distracting humour of her patient. She mirrors Jeffrey's movements, both twiddle their thumbs. Louise lets her patient roam on his mental health lead, but keeps drawing him back to reality. This is a theatrical double header that could play on the Edinburgh Fringe if it wasn't so tragic, or maybe it would be a roaring success because it so.

"Oh my dear, it's extremely annoying that you keep saying the word Alcoholic."



Martyn Keen

Facilitator Martyn Keen pulled my active imagination back down to earth with his last debrief of the day. "You think you are engaged with Jeffrey because he talks a lot but he's keeping everything on the surface.....but you need to keep hold of the tiger!" He shared his own experience of a patient who was as charismatic as Jeffrey, deemed harmless to others but unfortunately not to himself. It was a stark reminder that although this is a simulated environment it was no game of chess we were playing here.

In the next few days I'll be writing about what it was like being in the active simulated ward with all 7 patients simultaneously doing their thing.

AL.