THE ST. JAMES' JOURNAL

THE WARD
 
THE PSYCHIATRIST decides to admit his patient to hospital. Why does he make this decision? What can the hospital offer, which the General Practitioner, the Out-Patient Clinic and the community cannot? A change of environment, a pause in the way of life which may have caused the illness, or is preventing recovery.
 
In the community one is very likely not understood if mentally 'out of step'. Also the severely ill patient may have to be admitted to protect himself or society. The hospital staff understand the patient's outlook on life itself and is equipped to carry out investigations and treatment with skilled nursing attention.
 
If admitted to St. James' what will the patient find? The fine old Victorian buildings are being modernized and now compare favourably with any other in the country. Modern colour schemes are replacing the dreary brown and cream institution, while contemporary furnishings and modern equipment are included in the transformation. Many of the old restricting walls have gladly been demolished by the patients themselves and the locked doors and padded cells replaced by open doors and understanding.
This material change is also helping with the change of public outlook, which has developed so rapidly in understanding over the past, say, fifteen years. Gone are the old custodial ideas when, to be admitted to The Asylum, was synonymous to a life sentence. Now the staff and most of the patients realise that modern methods and treatments are successful and do relieve many distressing illnesses.
 
In simple words, we encourage an informal friendly atmosphere with restrictions cut to minimum. Because the needs of our patients vary so much, we try to put together patients suffering a similar degree of mental illness. This helps create a better environment and also allows us to open wards where patients may come and go as they wish.
 
On admission the doctor carries out a complete examination and requests any special investigations he feels necessary. Each patient is treated individually, as each has his own background which presents its own problems. The doctor may ask the Psychiatric Social Worker to help with problems at home or at work. He will also advise relatives how they can best play their part in helping his patient back to good mental health.
A course of treatment is then decided upon. There is a wide choice but the pill in its many shapes and colours is becoming predominant. One may feel that as the patient is only taking tablets he does not need hospitalization. But this brings us to our 'therapeutic environment'.
 
The nurses who attend the patients are experienced Psychiatric Nurses who, because of their understanding, are able to help the patient over many difficult periods. In the community, thoughts and actions which do not conform to the normal are seldom tolerated. In hospital this behaviour is understood and allowance made. It is this understanding and patience by Doctors and Nurses which makes the Psychiatric Ward the only place of refuge when one is mentally ill.
Some hospitals feel that the nurse-patient relationship is so important that they provide a Domiciliary Psychiatric Nursing Service to help the patient when he returns to the community.
 
Once treatment is started we have to try to fill our patient's day so that he becomes and remains alert and interested. During the day the Occupational Therapy centres provide many interesting and creative outlets. These include pottery, carpentry, rug making and, in fact, most forms of art and craft.
 
The farms and gardens employ patients who prefer fresh air and active exercise or whom the doctor feels will benefit from an outdoor pursuit. In this sphere I feel we could give added interest to some of our long-stay patients by giving them each a plot of ground for their own personal use. Some of the female patients, for instance, may like to grow flowers to decorate the wards. This could grow to a rehabilitation scheme to train our patients in horticulture. It could also add to the hospital's social calendar and lead to a Horticultural Show, with garden produce, flower arrangements, needlework and so on. However, to return to reality.
 
Various departments in the hospital such as the laundry, needleroom and artisan workshops employ patients in useful occupations. I believe that a factory is envisaged in the future where the patients may learn the skills of industry and produce goods on a competitive basis.
 
For relaxation and leisure there are many alternatives. On the wards we have television and indoor games, while a few patients do work from the Occupational Therapy Department in situ.
 
In the entertainments hall we hold dances, whist drives, film shows and social evenings, including Bingo. There is also a Darby and Joan Club for the not so young.
 
Although we have no gymnasium we hold classes of Physical Culture. Various other groups are now being formed and these include musical appreciation and art classes. The League of Friends provide a well stocked library, which is much appreciated. Coach trips visit other hospitals and places of interest throughout the summer and various other activities are available throughout the year. We would like a swimming pool and a well equipped gymnasium, but these and other desirable luxuries cost money and of course all such activities require staff to be available. Both essential requirements are in short supply and so we do the best we can with what we have.
 
As has already been written, the needs of our patients vary greatly, so this description of the wards, treatment and activities is a very general picture. But we do feel however that here at St. James' we are creating an environment which is far removed from the old Asylum days.
 
We greatly hope that our efforts meet with approval and that the general public will realise that St. James' is a hospital in the true sense of that word, in that we always attempt to return our patient to the community and have no strong 'collector's instinct'.
J. B. E. C.
 
Summer 1962
 

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