Tuesday 28 January 2014

The Open Window - Simulated Mental Health Ward

The blues screens arrived over night, slicing the room into claustrophobic cubicles of tense and nervous energy. The chilling light that passed through the screen's opaque skin made you feel as though you were trapped underwater, breathless in a mental health fish tank. Here was a Simulated Ward with experienced facilitators acting as the safety net, the students darted in out of cubicles while the trapped mental health patients roamed their minds in search of answers.

Two days of preparation can never quite ready you for the plunge you are about to take. You can read books, talk to your lecturers, health professionals and even the actors who 'play' the role of mental health patients but this is a 'live' ward situation were the unexpected can happen. Patients react with each other, student nurse's failures and successes impact upon their fellow participants in this mental health dance.

'Sandra and Karen'
The first moments on the simulated ward are quiet and tense, the patients are already in the starting stalls, their minds whirring with back stories, emotions brimming in the imaginations. I am lucky enough to be an observer and sketcher so I placed myself in my favourite patient's cubicle. Jeffrey was sitting nonchalantly beside an open window, and his muse Sandra sat at his feet, love it seems had blossomed on the ward, another permutation in an already complicated mental health story for the nurse's hoping to make a difference here today. Out of the blue Jeffrey announces

"I did it with Joan Collins many years ago!"
We all do a double take as the nurse puts his body between Jeffrey and the open window. Danger averted for a moment but it feels like the nurse has just shut us in the cage with the tiger.
Jeffrey - "Midsummer Night's Dream that is dear boy, Sandra and I were just running through the introduction."
Nurse - "I don't want you to fall out of the window"
Jeffrey - "Joan is delightful. Do you know Faustus?"

Julia Pelle
It seems you need to be a thespian as well as a therapist in this line of work. Bringing Jeffrey back into this world to discuss his problems isn't going to be an easy task. Student Graeme does a jocular and calming job, never shutting the metaphorical window on Jeffrey's humour or hopes. After all the open window represents both the danger and freedom for us all.

Most of us know what it is like to visit or be in hospital and a mental health ward is no different in many ways. Your physical privacy is just a thin veil, shouts and expletives roll through the blue wipe-clean curtains. I can hear Sandra and see Peter confronting a new face on the ward, Tim. The ward explodes with movement. Peter hasn't been taking his medication because it was stopping the important messages hot-wiring in his head. Ward manager Ben tries to help nurse Carmen but it has become too much for her, and tears spring forth. This is the where the simulated environment is so versatile because Facilitator Julia Pelle calls a timeout. She carefully dissects the last volatile minutes, divulging her experience and helping everyone including myself learn from the experience.

You would think that this 'Stop Start' scenario would disrupt the actors rhythm but their characters flow deeply through their consciousness. 'Out of role' I talk to 'Leo' who is John in the real world. He takes these potentially toxic characters home with him over the course of the simulations. "Sometimes I sit at home and I can't get Leo out of my head".
When in character he can often can be heard saying  "This is like a prison in here!" You can not help but contrast the actors who are temporarily trapped in these painful personas and the patients who cannot escape them.

Laurie who plays 'Frances' is an accomplished actress in her own right, with many years of experience with the Teddington Theatre Club and YAT. Her performances always have to be understated when inhabiting the world of 'Frances'. Less is more and she often lures the student nurses into the trap of an over compensating babble on their part.

When Lyndsay plays the role of 'Sandra' she goes to the well of personal experience rather than professional acting expertise. Her performances are never short of intensity and power, with tears and a raw emotion that is virtually petrifying for an observer like myself. Lyndsay finds the whole experience therapeutic and feels a natural affinity with her character. She was never physically abused like Sandra but certainly feels the emotional bruises from her youth.

She has been known to be so caught up in her role, that she once ripped a students t-shirt in a frenzy of Sandra's paranoia. Today she flares up once more but fortunately student Karen competently guides her to calmer shores.

Martin McIntyre
Like all good Lecturers or Facilitators in a teaching role the team on the simulated mental health ward possess an overwhelming nurturing propensity with a wicked streak of course. For the final roleplay of the day they threw a spanner in the works, a Care Quality Commission Inspector arrives in the form of Martin McIntyre.

Student Snowdon
Luckily the students don't have to deal with the real paperwork associated with a mental health ward, lets face it they've probably got enough on their plates in their 3rd year at University, but this CQC Inspector revealed some of the draining resources on their future energies and possibly sanity.

David Tracey
A CQC Inspector arrives unannounced and spends their time directly observing care and talking to patients or people on the ward and their families or carers, as well as staff. I can't imagine the tolerance it must take to balance all these scenarios and practicalities. It is probably why many of the Facilitators at Kingston University have a Zen like aura. None more so than David Tracey who gently rocks back and forth, with eyes closed, a softly spoken mantra on his lips.

Harjinder Sehmi
The final speech of the day went to the perpetually mobile Harjinder Sehmi who had rattled round the ward all day like one of the minions in the popular film 'Despicable Me'. With legs for once planted firmly on the floor, he looked pensively at the students gathered around him. They stared back, a mixture of exhaustion and relief relaxing the muscles but one still had the strength to speak out, "I faced myself in there".

We were all impressed by the students commitment to the Simulated mental health ward but Sehmi had one last pearl of wisdom,

"Within the next few months someone may be giving you the keys to the ward and say....here you go, you are in charge."

In time I know that these students will be keeping the windows locked for the safety of their patients but having the confidence to open them when the time is right for hope and freedom.


Tuesday 21 January 2014

Theatre of Dark Dreams - Simulated Mental Health Ward

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.

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.

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.

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.

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".

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.

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.


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!

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.

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.

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 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.


Monday 13 January 2014

Wimbledon and Merton Poets - Critique Circle

Robin Vaughan-Williams
Its been a slow start to 2014 with a quiet blanket of London rain stubbornly lazing across my usual Jazz nights. My dark hours have been spent instead preparing for an exhibition of Art inspired by Poetry at the Village Hall Trust Gallery in Wimbledon this March. The JawSpring exhibition is sending 27 poems from the Wimbledon & Merton Poets to artists around the world and exhibiting the resulting artworks on their doorstep.

Andy V Frost
Before Christmas I took the opportunity to walk straight into the heart of South London's poetry den. So enthused by this experience I came back for more (07/01/2014), this time armed with pens and paper. The Merton Poets meet on the first Tuesday of every month at the Raynes Park Methodist Church CafĂ©. After warm greetings they settle down in a circle and you find yourself facing searching eyes, hands grabbling photocopied poems, all ready to be released. This is both a chance to perform and to have your work critiqued. This was a regular occurrence in my student days, one which wasn't entirely pleasant at the hands of spikey art students. Here there is a energy and frisson when performing but also humour and encouragement for any aspiring poet.

Tony Josolyne

The man who broke the circle by standing first was 'Big Mouth' poet Andy V Frost. He is one of the most vocal of the Merton Poets. This is a man who is a comfortable performer and his growling demeanour translates strongly into his poetic delivery. Frost draws his inspiration from his frequent road trips on his trusty motorcycle but it isn't all leather jackets and Ton Ups. Although he conducted a straw poll on whether to use Capricious or Viscous in his poem 'Aftermath', most eyes fell on the phrase 'Umbrella Graveyard' to describe the suburban streets between Morden and Mitcham.

Partick McManus
Tony Josolyne with the smiling eyes gave us his sweet laden poem 'Lollipop' with its dark ending. You can image the amiable Josolyne as the Lollipop Man in his poem, with his alert brain and welcoming face, but not even his quick wits could have saved the children in this tale. I learn as much from listening to the comment afterwards as the poem itself and these included..."It's like the start of a Hitchcock film, a great build up" and "a timeless feel!"

Alec Linstead
One of my favourite poets took his turn next with 3 little gems. Patrick McManus' creations are brief and sit elegantly on the page like a Greek column. "Tapestry" was my favourite and has already been sent to artist Robert Good for the JawSpring exhibition in March. Patrick Mcmanus has a wicked glint in his poetry and performance, his chin juts out proudly and he likes to stir up proceedings with his literary nuggets.

Keith Drake
Alec Linstead's honeyed voice trapped me in its sweet amber before I even had a chance to digest the meaning of his poem 'Harvesting'. His inspiration was a real moment, a physical place, in fact the privet hedge outside No.7 Latimer Road. The micro beauty of the bee brought a universal appreciation from the poets gathered in the circle.

Humphrey Aylwin Selfe
Keith Drake always sits furthest from the eye of the poetic storm at these meetings. He often gives the impression he is about to slip out of the door and into the dingy suburban night. The light outside was indeed a dirty Chartreuse in comparison to the bright whiteness under the halogen strips. Drake shifts from foot to foot, with one collar up and one down. His poem "Christmas Cards" is about the passage of time measured by friend's yuletide treasures. He received the first big laughs of the night.

Christine Sherlock
With his paper within an inch of his nose, Humphrey Aylwin Selfe read "Firelight" which warmed the others gathered around without ever quite catching ablaze. Robin Vaughan-Williams has rapidly become one of my favourites of the local scene too, not only is this a man who experiments in mixing his genre with Jazz but is obviously keen to collaborate with artists too. We are in the early stages of hatching a plot to combine Poetry, Art and Film. Vaughan-Williams with his dark mop of hair and an intensity of delivery cast his "He stops but his shadow carries on" over us. It was hotly debated, critiqued and universally admired.

John Grant
Rosanne Gomez's "Bird Brain" was a perfect counterpoint to Vaughan-Williams dark themes. Just like her smile, Gomez's poem was playful and alluring. Christine Sherlock followed with the tentative "In Wendy's Garden", but as Keith Drake said, "This is a poem that soothes" and he was right.

John Grant was our Oak, stable and calm. His demeanour was gentlemanly and he had a clarity of speech that projected his ideas effortlessly. His poem 'Bed' was a rib tickler amongst the circle of 15 poets and his line "release the solid ridges of your frown" epitomised this poem's ability to tackle death with an easing touch.

Gerald Hildreth
Jo Silver's poem was an unexpected surprise from a charming lady who seem to be living under a cloud until she released her poem into the room. Her 'Trans Recipe Delicacy' was especially written for the JawSpring exhibition and had a delightful bounce as its food inspired flavours filled our creative palates. As Patrick McManus commented, it was "a juicy poem".

Finally George MacGillivray read out 'From My Window', which was a particular hit with the Wimbledon and Merton Poetry leader Russell Thompson who loved the fact that so much time passed on the page. This is typical of many of the poems tonight. Even though the poems only take 2 or 3 minutes to read, your mind is transported through different terrains, across time zones and dumped back in Raynes Park, your imagination throbbing with the cerebral equivalent of blistered feet.

Experience and meet all these poets at the JawSpring exhibition Private View, 6-8pm, Friday 21st March 2014, The Village Hall Trust Gallery, 26 Lingfield Road, Wimbledon, SW19 4QD.