Struggling in my first job in mental health

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Prosopon
Posts: 90
Joined: Wed Nov 19, 2014 9:08 pm

Struggling in my first job in mental health

Post by Prosopon » Sat Jan 09, 2016 5:06 pm

Sorry if this is in the wrong forum -- I wasn't entirely sure where it would fit best.

I've recently started my first job in the mental health field, working on an acute inpatient psychiatric ward and I am finding things very tough, so much so that I am now on reduced shifts because my own health has deteriorated. I also cannot begin my psychology conversion course this month, as I had hoped to do, because I'm just not well enough and I need to focus on settling into the job and actually keeping it.

My main problems at work are feeling out of my depth, lack of confidence and major brain freeze when I am facing things that I do not know how to deal with. I also feel unsafe on the ward and ill-equipped to deal with incidents. I have had no training on how to deal with self-harm and suicide attempts and yet am expected to manage these types of situations in my role. I haven’t yet been on the training course for preventing and managing violence and aggression, but am trying to remain hopeful that when I have completed this training, I will at least feel safer at work.

The issue causing me the most distress though is that I am finding I get tongue-tied when talking to service-users and that I cannot seem to engage well with them most of the time. This is very upsetting to me because obviously engaging with others is essential in this line of work. Also, I have so much empathy and a strong desire to help others, plus a genuine interest in people and their stories. I have had some successful interactions but most of the time end up making people feel uncomfortable because of my shyness and awkwardness. This is obviously one of the last ways I want people to feel when I am attempting to reach out to them!

Please, does anybody have any suggestions or advice? My managers and colleagues are wonderful and are supporting me well when they can, but things are so busy at work right now, with huge changes taking place, that sometimes there isn't even time for me to talk to them about my issues. I am wondering if doing some kind of counselling skills course could help me to engage better with others? I also think that maybe I need to do some confidence-building and or assertiveness training, but I don’t even know where to start with that. I so badly want to make a success of this job and I do not want to give up on my dream of becoming a qualified mental health professional. Please tell me that the things I am struggling with can be learned? Can I learn to use my empathy (and my own experience of mental health problems) to engage well with service-users? Can I learn to be less awkward when interacting with others? And can I learn to be more confident? That last one especially might seem like a stupid question but I am in my late twenties now and feel like I have never been confident at anything!
"Is this real? Or has this been happening inside my head?"

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”

~From Harry Potter and the Deathly Hallows.

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alexh
Posts: 393
Joined: Sun Sep 23, 2012 7:57 pm

Re: Struggling in my first job in mental health

Post by alexh » Sat Jan 09, 2016 7:03 pm

It might have suited clinical issues.

Any new role is hard. An inpatient ward is an incredibly challenging place to work! It takes time to feel comfortable. You, like other support workers are being asked to deal with things that are really difficult and probably with inadequate support.

I found a counseling skills course helpful in developing listening skills and using open questions, dealing with emotionally sensitive issues

However, I think if you can find some ways of managing your anxiety and reduce the pressure you're putting on yourself you will thrive.

Prosopon
Posts: 90
Joined: Wed Nov 19, 2014 9:08 pm

Re: Struggling in my first job in mental health

Post by Prosopon » Sat Jan 09, 2016 8:59 pm

alexh wrote:It might have suited clinical issues.

Any new role is hard. An inpatient ward is an incredibly challenging place to work! It takes time to feel comfortable. You, like other support workers are being asked to deal with things that are really difficult and probably with inadequate support.

I found a counseling skills course helpful in developing listening skills and using open questions, dealing with emotionally sensitive issues

However, I think if you can find some ways of managing your anxiety and reduce the pressure you're putting on yourself you will thrive.
Thanks, alexh. I considered that forum but really wasn't sure! I think you are right that I need to find a way to manage my anxiety and reduce pressure.

In the couple of hours or so since I posted this message I have created an action plan to help myself which includes some short-term goals such as practising pausing and taking a deep breath before dealing with a stressful situation and asking colleagues for advice on engaging service-users; some medium-term goals, such as researching mindfulness and relaxation techniques for myself; and some long-term goals such as completing a counselling skills course. I've even created a list of things I can do on my shift tomorrow which will hopefully make me feel more in control and less out of my depth. I have found doing this has made me feel a little better about going to work tomorrow. I'm still anxious, but at least I'm not dreading it anymore!
"Is this real? Or has this been happening inside my head?"

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”

~From Harry Potter and the Deathly Hallows.

lingua_franca
Posts: 920
Joined: Tue Sep 14, 2010 11:29 pm

Re: Struggling in my first job in mental health

Post by lingua_franca » Sat Jan 09, 2016 9:18 pm

First of all, it takes time to settle into any new job, especially if it's completely different to anything you've done before and you haven't finished the induction training yet. Try not to beat yourself up about the shyness and concentrate on getting to know the ward routine. Set yourself more concrete goals than the generic "Be less awkward", such as "Learning how to respond effectively when So-and-so has been self-harming." There is no generic response in those situations, but if you read patients' care plans and watch other staff who are familiar with the people you support, you will get a good idea of how to react. It takes time. No one walks into a new ward with all the answers. You do need to prioritise training on responding to self-harm and managing risk, so ask your line manager when you're likely to receive that, as you have a duty of care to your clients that is hard to meet without this knowledge. Hopefully this will increase your confidence in the workplace.

Secondly, remember that no matter how experienced you are, patients are likely to be uncomfortable with you anyway because you're quite new - you can't force a relationship with them. Many of them may have had very difficult life experiences which will make it harder for them to trust unfamiliar faces, especially in inpatient wards where staff come and go as if they're on a conveyor belt, and most people aren't at their most sociable when they're unwell anyway. Lots of things could be making the patients uncomfortable right now; one shy new staff member is very unlikely to be the worst. Putting too much pressure on yourself to do everything perfectly at once will only make it harder for you to develop your skills.

When I walked onto my new CAMHS ward a few days ago, one young woman shouted out, "Who are you?! We don't want you here. Go home!" I said, "I'd love to go home and get a good cup of tea, but P [ward manager] wouldn't be too happy if cleared off and left you all, so I'm going to sit in the rec instead." It was not a failed interaction just because she couldn't interact with me positively - she wasn't in the right frame of mind for it and I couldn't push her into one. In that situation the priority was not to get on good terms with her, but to show her that I will be a regular presence on the ward, to avoid making her more hostile (hence the mild jokey comment about wanting to go home), and to let her know where she could find me if she changed her mind and wanted to speak. Later I noticed her peering at me round the door frame. I smiled at her and she swore at me. No problem - she was showing curiosity about my presence, she wanted to have a look at me and listen in on my conversations with the other children. That was the best I could have hoped for on that day. Eventually we will have a rapport. It won't necessarily involve her telling me deep and personal stuff. It could be playing Jenga. It sounds as though you're expecting to have really life-changing conversations about patients' lives and stories, or at least to see evidence that you're making them feel better, but in acute inpatient settings you rarely get that. People here are very unwell and improvements are seen in small increments, so focus on the small things. If you know one patient is a big film fan, for example, maybe talk to them about it. Show consideration and interest, just as you would in any other setting.

Thirdly, be pragmatic about your own strengths and limitations. You have mentioned in the past that you are on the autistic spectrum. So am I. This means that I am never going to apply to work in the sort of crisis admissions ward where patients are admitted for a very short time before being referred elsewhere, because I need more time than most to accustom myself to an environment and the people in it, and that's not going to happen if it's always changing. I always request on occupational health grounds that my shifts remain fixed (as opposed to changing from week to week) and that I be given advanced notice of any essential changes. If they can't give me these assurances, then I can't work there. I have skills to offer and my brain contains good stuff, if I do say so myself, but it needs structure in the way a car needs petrol. Not all roles can give me that. They aren't for me. If it turns out that your ward isn't for you, remember that there are other mental health settings and client groups that may suit you better. Your line manager and colleagues seem to think that you can do your current job, though, so be careful not to undermine yourself - listen to other people when they give you positive feedback and encouragement. But also be realistic. If you've never worked in mental health before, how do you know it's your dream? This is not a situation where you will keep or lose a dream, and thinking of it like this will only put more stress and pressure on you. It's a situation where you try something out and learn some useful things.

Finally, be prepared to learn from mistakes. There is no rulebook for working in mental health, acquiring self-confidence, or all the rest of it. You can put supports in place for yourself, you can think of logical ways to approach particular problems (for example, if a patient is very withdrawn and not wanting to talk, why not try a non-verbal way of interacting - looking through magazines together, for example? It still counts!), you can take counselling courses to improve your skills, but you can't magically outfit yourself with the skills you need all at once and you can never guarantee constant 'success' in your job. All you can do is try, and not beat yourself up over the outcome of your efforts. I like Dr Seuss's advice: "If things start happening, don't worry, don't stew, just go right along and you'll start happening too!" It may be that this isn't the job for you, but you can still learn from it. I don't know if I will stick it out in the PICU where I work now; several colleagues have been telling me that transfers to other wards are common because it's so demanding here. If that happens, it happens. I will do my best and see how I go. You can't do more than that.

I hope this helps. :)
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

intime
Posts: 26
Joined: Tue Aug 11, 2015 1:31 pm

Re: Struggling in my first job in mental health

Post by intime » Sun Jan 10, 2016 9:37 pm

So much of being in a new role is about settling in to it. I've fairly recently started working as a support worker for adults with LD and/or MH in a residential setting - for the first few weeks I felt lost. Now though, having been able to build up rapport with the service users I feel way better in my role. I don't have lots of help to offer but there are a few things I thought of.

A. ask stuff. This is such a good way to get practical help. "What do you find works with X?" e.g. if a SU is self-harming ask someone senior to you/longer serving staff "how do you help this person when they feel/do/say X, Y or Z?" That way the SU gets consistency in the approach taken and you get to hear tried and tested methods. Plus you can ask SUs. If they're feeling low then find out from them what's helped before when they've felt that way so you can support them in positive behaviour.

B. see what works for specific SUs. When one of our guys starts swearing he gets told to stop, he knows it isn't appropriate and we don't want to hear it. When another one starts up we just say "yeah alright mate, I've heard worse" really calmly. Never a generic response! This info is likely in care plans so...

C. re-read the files again and again. And then again. They're full of details which are so easy to forget. One guy we work with calls his meds "milk" - such a small thing to remember and yet when we do it avoids so much frustration on his part. Imagine asking for painkillers and being given a drink constantly. It just eases the interaction.

D. be okay with the fact you'll feel awkward. Everyone does in a new workplace. But you get to know them, ask about things you know they like, ask what they're up to that day, be prepared to walk out of a conversation knowing it could have gone better. My first conversation with one of our SUs went "hey I'm X, you're Y right? I just started here" "okay..." "how are you doing?" "fine." "up to much today?" "might go into town" "oh cool, need to go shopping then?" "yeah, obviously" "brilliant, I just need to pop back to the office, nice to meet you." I could honestly have died I felt so awkward but it broke the ice. Fake it til you make it confidence will fool most people. Like lingua_franca said, a successful interaction doesn't necessarily feel like a warm fuzzy.

Prosopon
Posts: 90
Joined: Wed Nov 19, 2014 9:08 pm

Re: Struggling in my first job in mental health

Post by Prosopon » Sat Jan 16, 2016 6:56 pm

Thank you very much for your helpful and detailed response, lingua_franca. I am not expecting deep, life-changing conversations with people, but would like to have meaningful engagements, and I would consider chats about general things to be meaningful, yet struggle with that too. I think I am a better listener than I am a conversationalist! And I have always found "small talk" hard.

I think I relate to what you said about struggling on a ward where patients come and go very quickly. While we do have some long-term service-users on our ward, the majority are here for only a very short time and it is hard to build relationships. It can be difficult to go onto the ward and find several new faces. I think I am pushing myself to the limit in this job.

Also, I think I just referred to it as a dream because that's what it is really. I suppose once I know this is the right career area for me, I'll make the dream a goal! I love that Dr Seuss quote and you are right, I can definitely learn from this job. I am learning something new on every shift. I think maybe part of the problem is that my brain is so overloaded right now.


Thank you for the great advice, intime. It might sound crazy but I rarely even have time to read care plans. I am rushed off my feet from the moment I come on shift and sometimes I don't even get a break. A lot of the time I end up staying 20, 30 or even 40 minutes after the end of my shift because there is too much work! I am hoping things will settle down soon. It is a newly opened ward and they are still recruiting and I think all the staff are just trying to establish some kind of routine and order. But I will somehow find time to read more care plans, especially of our more long-term people.


Actually, since I posted my first message I have had at least two very good shifts, and my last one was possibly my best yet. I feel like I helped a lady who was very distressed, and I have built up quite a good rapport with another person, who even asked when I would next be coming in and seemed happy that it would be soon! I was also able to be firm and calm with another lady who was becoming aggressive. I even started to feel confident on my last shift and felt I was not only working hard, but doing a good job too! Hopefully I can continue to build on that. I think the replies to this thread have made me realise that I have been putting too much pressure on myself and that I have been comparing myself to my colleagues. I am learning it's okay to take things at my pace and that things will not come to me as quickly and easily as they might to other people. This line of work is hard anyway, but even more so for someone like me, with my difficulties. I need to stop dwelling on the things I feel bad at and remind myself of all that I have achieved, and when I think about it, I have achieved a lot. I have a lot to learn, but I'm starting to think I can do this job... maybe!
"Is this real? Or has this been happening inside my head?"

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”

~From Harry Potter and the Deathly Hallows.

Purplebear
Posts: 30
Joined: Wed Mar 25, 2015 12:56 pm

Re: Struggling in my first job in mental health

Post by Purplebear » Mon Jan 18, 2016 4:28 pm

Prosopon wrote: My main problems at work are feeling out of my depth, lack of confidence and major brain freeze when I am facing things that I do not know how to deal with. I also feel unsafe on the ward and ill-equipped to deal with incidents. I have had no training on how to deal with self-harm and suicide attempts and yet am expected to manage these types of situations in my role. I haven’t yet been on the training course for preventing and managing violence and aggression, but am trying to remain hopeful that when I have completed this training, I will at least feel safer at work.

The issue causing me the most distress though is that I am finding I get tongue-tied when talking to service-users and that I cannot seem to engage well with them most of the time. This is very upsetting to me because obviously engaging with others is essential in this line of work.

Please tell me that the things I am struggling with can be learned? Can I learn to use my empathy (and my own experience of mental health problems) to engage well with service-users? Can I learn to be less awkward when interacting with others? And can I learn to be more confident? That last one especially might seem like a stupid question but I am in my late twenties now and feel like I have never been confident at anything!
I've not read all the posts above so don't know if this will be helpful or just a repeat of what other people have said! But I thought would reply as I started a job on an acute psychiatric inpatient ward 6 months ago and this is my first job in mental health too - similar scenario!

I was wondering if you know when you're going to have training for managing violence and aggression yet? We had "breakaway" training which taught deflecting punches/kicks etc, as well as more serious things like getting someone to let go if they try to strangle you. Even though we got given that training at induction, I still feel anxious now about whether I've forgotten the techniques and what I'd do in an actual situation - and know a lot of nurses and HCAs who feel the same kind of worries! Hopefully once you receive self-protection and restraint training that will help reassure you? In the meantime it might be worth asking a colleague for some basic guidance on the techniques needed to protect yourself, and also perhaps googling verbal de-escalation techniques. It might not eliminate the anxiety, but at least an increased knowledge-base can be a source of reassurance. Despite having training, me and other staff members in my workplace still feel anxious when we have agitated patients, mainly because physically we're small, light and not very strong, so if things did get bad, we would struggle with restraint or deflection of an attack. I think that's normal for working on a psychiatric ward and I don't think that bit of worry ever goes away - at least I've not encountered a member of staff who doesn't fret about it! If you have an alarm, just always remember to check it's in good condition and working, every time you go on shift!

With respect to self-harm and suicide attempts, the first time I came across someone self-harming, I panicked! I actually gasped and froze. Then I just asked her to stop and then pulled my alarm and more senior staff came and helped her stop. After that, I found confidence came with being familiar with the patient/building rapport/learning from observing what other staff do. It sounds like you have a supportive team, so I guess the best advice is just to rest assured that your team should have your back when things get tough and will help you. And you can always learn from them what the right thing to do is.

Also, in answer to your question, definitely you can learn to overcome the tongue-tied feeling/anxiety/sense of awkwardness when interacting with service users. You can definitely build that confidence. :) One thing I've often found is that some patients really don't want to talk beyond a "how are you?" - and that's fine. Training yourself to feel comfortable with silence and just sitting with patients might be helpful? It can feel super awkward, but it gets better. I've often found that if I go and sit in the communal area at work, patients who need/want to talk will often initiate, and then either I'll chat to them or just listen to what they need to get off their chest and just empathise or ask a few questions to continue the conversation. Another thing is, some people are genuinely just happy for you to be there - I know psychotically depressed/anxious patients who have reported that just having someone present helps, or that having a casual day-to-day chat helps them cope with preoccupations. So if you struggle with chitchat, maybe just try to ask about something they're interested in, extract a little bit of info on what they might like to talk about (even to the point of straight up asking, what would you like to talk about?).

One thing I've always found helps me is reading patients' notes before getting into a serious interaction with them: knowing their history, previous psychiatric episodes, any risks etc, and what they've been like recently. Knowing things about them can help you feel more relaxed around them: you know what to expect! There should be no surprises then. I don't know if you do this already, but I know lots of people who don't have or make time to do it, and it really does make it so much harder and uncertain. That said, even if you read that someone's got a history of aggression, it totally doesn't mean you'll see any from them - I've met patients with a history of violence when unwell who have been absolutely lovely and easy to chat to. It just means you know what to watch out for and can go in armed with that knowledge.
* I just read that you struggle to find time to do this - I think it really, really does help. If you can find any time to do this, even if it means staying an extra half hour after work or something, then I'd recommend doing it. It just gives you a picture to go in with and will truly guide your interactions with patients. Handover should give you a brief lowdown, but the notes are usually better. Every time there are new patients, maybe just try your best to make time for this? I very rarely go ahead and have a serious conversation with a patient I don't know from adam - I make a beeline for the office and read their notes first!

If nothing else, perhaps one of the most important pieces of advice someone gave me is to not show fear - even if you're feeling it. That's easier said than done, I know. But when I've had to de-escalate people, not showing fear (relaxed body language, no tensing etc) has helped - the reason being is that when some people become aggressive, they target people they know they can scare. People lay off usually when they can see you're not intimidated and remain calm and firm in response to aggression. I know it's hard - your heart will probably still be racing! But just acting as if you are not scared is enough.

I just read your last post and it sounds like things are getting better for you already :) Good stuff! Hope this helps reassure you! Last but not least, take good care of yourself. :) Bit cliche, but ultimately it's very true that you need to take care of yourself first before taking care of others. :)

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