I have now been retired for four years and, apart from being a trustee of the Mulberry Bush Organisation, have not been involved with the provision of therapeutic care for children and young people during that time. Consequently I am unlikely to write any more papers about therapeutic care. However, I plan to occasionally write a blog on this newly designed website (thanks to Fiona Keen for doing the work on it). In my day-to-day life I have experiences which relate to my work in a therapeutic community and fostering organisation.
For example, a few weeks ago my wife, Ann, was admitted to hospital as an emergency. We experienced first hand the trials and tribulations of A & E departments, widely reported on in the media. The staff were very pleasant, efficient and knowledgeable but overwhelmed with the quantity of patients. It was striking the high proportion of patients who were very elderly. The fact that we are living longer is cited as one of the main reasons for the congestion in hospitals but I wonder if another contributory factor is the closure of smaller hospitals and the shift to larger regional ones? I imagine that in the past small, cottage type hospitals would have taken care of the elderly.
When Ann was transferred to a ward, after 12 hours in A&E, she found it a relief to have a proper bed and some space around her. This was short-lived, however, as 24 hours later she was squeezed into another ward with only half the usual space. Ann found it very disorienting to be moved suddenly. That coupled with an inability to sleep in a much noisier environment was distressing, counterproductive and counter therapeutic. The needs of the patient seemed to take second place to the needs of the hospital system.
This experience brought to mind Isabel Menzies’ classic paper, “A Case-Study in the Functioning of Social Systems as a Defence against Anxiety. A Report on a Study of the Nursing Service of a General Hospital”. It was published in the journal Human Relations in May 1960. It’s available to read online.
“It is unfortunately true of the paranoid-schizoid defence systems that they prevent true insight into the nature of problems and realistic appreciation of their seriousness. Thus, only too often, no action can be taken until a crisis is very near or has actually occurred. This is the eventuality we fear in the British general hospital nursing services.”
This quote is from the concluding paragraph of Menzies’ paper and its shocking to think it was written 58 years ago in the light of where we are now.