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.

Chris Hart and Fish Bowl Peter

Harvey Wells

As a regular sketcher on the 'live' music circuit I encounter all kinds of performances but last month I was given the opportunity to immerse myself in a new 'cutting edge' experience. On February 5th and 6th 2013 I sketched students, lecturers and 'patients' on a Simulated Mental Health Ward.

My host was the Tutor and Psychotherapist Harvey Wells, who I have previously worked with on many a Public Art project, and most recently on his book 'Therapeutic Interventions For Mental Health Professionals', published by Sampson Low Ltd.

Chris Hart

This was an opportunity to observe the real experience of students diagnosing, managing and interacting with not only one patient but several in a high octane ward scenario. As you can imagine a mental health ward is going to be pressurised, so the stakes were high. In society we're very much aware of recent NHS criticisms and failures in the care of some Mental health patients in the community. Here then was a chance for the professionals of the future to dive into the ward's melting pot. If they got it right it could save a patient's life, if they got it wrong then.... well you already know the wider implications.



David

As I arrived there was a palpable tension in the Sir Frank Lampl Building at Kingston University. It was a unique opportunity for the students and everyone was full of nerves. First the motley crew of Facilitators were being briefed on the day ahead. The man in the middle was the charismatic Chris Hart, he leaned on a grey hospital crutch like a general who arms himself with a battle weary swagger stick. He was very much the Lee Marvin of mental health trying to weave the squad in front of him into the formidable 'Dirty Dozen' of Simulations. There were more than a few Telly Savalas lookalikes too in his bunch. These were practitioners who had been invited from Mental Health's mosaic of professional disciplines, paramedics, hospitals, prisons and universities.

Next I was introduced to the students who were split into smaller Ward teams (12 students), to better tackle the unique challenges ahead of them. They started to discuss the patients in their charge and assign a Traffic Light code for swift and easy action. As the meeting progressed it became clear that all but one of their 10 patients would be RED.

Ben

Now if you hadn't already guessed this was going to be a simulated experience for us all. Meaning that the role of the 'Patient' was going to played by an actor. You would think therefore that this would be like a normal performance where the audience sits back in voyeuristic comfort. Not one bit!

As the students discussed their patients they became more and more tangible.
"He cut his throat 25 years ago, he's very difficult to engage, recently divorced."

"She was very frightened she would be killed. She has assaulted other patients and twice threatened nurses. She self harmed from the age of 12"

The discussions went on for a long time, the layered personalities needed dissecting and assessing. In a break I discussed the phenomenon of the patient's realness with facilitator Kevin, and he remarked
"Sometimes I feel I know these imaginary patients more than the students themselves. The patients start to take on a life of their own the more we discuss them".

The final stage of the day was a nerve wracking experience for all concerned. In a true act of Theatre one student was chosen to conduct a clinical session with a patient while we all looked on. Imaginatively called a Fish Bowl interview, this had every chance of being as slippery as an eel if things went awry.

'Peter' shuffled in and the room went quiet. He was agitated and with hands thrust deep into his pockets he made his excuses to leave before a word was uttered from the nervous student in charge.
"my bus is leaving in 10 minutes"
He was defensive.
"My doctor doesn't know anything about me"
The student did very well to tease more information out of 'Peter'.
"People are talking about angels here, it's a strange place"
"I hear voices on the TV"
This was a difficult experience, through the glass walls of the fish bowl we could see the student flounder a little. He was processing at least 4 different thoughts in his brain...what is 'Peter' talking about? What does it mean? What's the next question? and what should I do to help him!

It felt like an eternity but after 15 minutes the session was over and we all let out our collective breaths. 'Peter' took off his wooly hat and became the likeable actor he really is.
We all felt a little more relaxed but we all knew that tomorrow would bring a bigger challenge.
A Mental Health Ward filled with 10 more 'Peters' and their personal problems and potential explosive actions.

AL.

BUY Harvey Wells' latest book, Therapeutic Interventions For Mental Health Professionals HERE.
(I'll be writing up my second day of Simulations soon, keep an eye out for it)