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Communication Problems in a Psychiatric Ward

Updated on July 29, 2017

Patients who have been admitted to a psychiatric ward are usually there for good reason. Whatever mental illness they are suffering from, they have reached a crisis point in their illness and professionals in psychiatry feel it is necessary to admit both for treatment and safety issues. Some who are admitted to such wards may not have been admitted voluntarily and it is fair to say that the large majority do not want to be there.

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The admission can be daunting and even frightening to the point where you actually feel worse for being admitted. You are leaving behind what you know, who you know and your possessions. You may feel so ill that frankly you are in a dream world and at first may not care about anything at all. Everyone has a different perspective on being admitted to a psychiatric ward and a minority may even welcome admission as a safe haven.

Understanding what is happening to you and being understood by others are important factors in how well you will handle being on the ward and can have an impact on your recovery. You need to feel that you can discuss any concerns as they arise, ask any questions and equally you need to feel that you are being listened to and understood. Communication is very important when you are having a mental health crisis to both parties, that of the staff and the patient. So what problems are posed when you don’t feel it’s ok to talk and worse still when there are obvious barriers to communication?

Talking to Psychiatrists

Because of your mental health state you may find that you are not absorbing what is being said by your psychiatrist. This is made more complicated if you are not of the same nationality and have different cultural backgrounds. Your terminology may not be fully understood by your psychiatrist but it is crucial to your treatment. People speak in local dialects and use slang often too. If your psychiatrist misinterprets what you have said, it may have a bearing on how he feels he needs to treat you, or how he sees your illness. By the same token, you may find your psychiatrist difficult to understand at times and this can leave you feeling confused.

Misunderstandings create further frustration
Misunderstandings create further frustration | Source

In the UK we have a problem with a lack of British born psychiatrists and a language or communication barrier does exist to a degree between patients and psychiatrists. I have heard quite a few patients express concern generally about feeling misunderstood by their psychiatrists. The severity of the mental health crisis and the use of strong medications can leave a patient with a cloudy and short attention span. Often a patient will forget half of what was said in a consultation. It is my opinion that after every psychiatrist consultation on the wards, nurses should ascertain if the patient understood what was discussed and try to resolve any confusion.

Talking to Nurses

A psychiatric nurse’s job is to make sure your mental health care needs are met. They are often your first port of call when a personal issue or problem arises on the ward. At all times you should be able to approach a nurse and share your concerns and emotional difficulties. You should have a named nurse who you can approach during your stay but obviously that nurse will have days off, so you need to know that all nurses are available to meet your needs.

I have personally witnessed the unavailability of nurses on a psychiatric ward. I would even go as far as to say that some nurses appear to be bad at communicating altogether. If this was a case of nurses always being rushed off their feet and not having spare time to talk, I could understand why the problem exists. This often isn’t the case. Nurses do spend time chatting idly amongst themselves when there is a lull in duties. They might even be sat watching television with the patients or doing a jigsaw puzzle. Talk time is vitally important to those who are going through severe mental distress. To offload is to unburden and to be sat quietly alone with nothing but the same disturbing thoughts exacerbates the mental illness.

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Nurses should be seeking out those patients who they feel are not communicating also. Sometimes a few kind words and gentle prompting are all a patient needs to share their worrisome thoughts. Sadly it is often the case that nurses have ‘favourite patients’. We are all people at the end of the day and we all get on better with some people than others. There can be clashes of personality on a psychiatric ward between nurses and patients and this can make communication very difficult. Nurses should however, do their best to avoid clashes with patients and certainly should understand that during a mental health crisis there is bound to be frustration, fear, anger and misinterpretation. It is a difficult job at times and patients can be difficult within their mental illness but nurses have had training to deal with these difficulties.

Language Barriers

Can you imagine for one moment what it must feel like to be hearing voices and feeling paranoid with a newly diagnosed mental health disorder? Now can you imagine being admitted to a psychiatric ward with these frightening symptoms and not being able to speak a word of English? How are you to convey how you feel? How can you understand what is being said to you about your treatment…about anything that is happening to you? The simple answer is you can do neither. Medical or mental health interpreters do exist but are they always used? They cost money and money is tight in the health services and is very expensive for a sufferer to consider.

A member of the family or a friend may speak English and should be able to accompany you, with your permission, to any important consultations or meetings about your care. Sadly, the majority of the time you will be further pushed into a confused state of despair. Imagine not being able to refuse a medication, ask about going home or talk about your fears as these thoughts spring to mind and when there is no interpreter.

A True Case of a Language Barrier Problem

A Chinese lady was admitted to a psychiatric ward and this is what I observed. She was quite heavily drugged up and it was clear she was hearing voices and very distressed. She would curl up into a ball periodically and sob heavily. She spoke no English outside of yes, no and thank you.

One evening a couple of hours before bedtime, two male nurses had come on duty for the night. It’s not good to have only male nurses to talk to and night times can feel worse than day times anyway. I was alone in a room with this lady about three metres away from the nurse’s station. The lady started crying softly and muttering as the voices started. Over the course of about twenty minutes her crying had built up to heavy sobbing and her muttering to a raised angry voice. She looked petrified. She had her hands over her eyes and was rocking as she sobbed.

A small gesture can be so comforting when in mental distress.
A small gesture can be so comforting when in mental distress. | Source

I called over to the nurses to attend to the lady with the hope they could comfort her in some way. They spoke to the lady and asked her if she was ok. She clearly was not and the fear was etched on her face! She could not understand their questions and continued to sob and shout out in Chinese. A nurse turned to me and said that he was giving out medications in half an hour anyway! They walked away.

My heart poured out for this lady. I couldn’t begin to imagine what she must be feeling but I understood what I saw and so I went and sat directly beside her. I took her hand, stroked it gently and kept repeating that everything was ok. Within ten minutes her sobbing had stopped and she even managed to raise a smile. She kept repeating ‘thank you’ over and over. This was enough. To feel that at least someone understood and cared about what was happening to her was enough to calm her. Stroking her hand was the communication and it spoke volumes.

The male nurses saw what happened and said that it would be inappropriate for them to sit and stroke her hand in case it was misinterpreted.

So, communication is not always about the spoken word. It can be a gesture too. A kindly gesture at the right time can mean so much to someone in severe distress. From a smile to a hug, most of us feel better if someone expresses in some way that they care. Sadly the care is too easily left out of the mental health 'care' service.

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    • Mark Monroe profile image

      Mark Monroe 3 years ago from Dover De

      meloncauli

      Nice hub, it speaks to many of the issues and fears people have in dealing with the mental health system.

      Mark

    • meloncauli profile image
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      meloncauli 4 years ago from UK

      I am sorry you had such a bad experience Ybnormal and thanks for sharing it with everyone. I hope things are improving for you now. :)

    • profile image

      Ybnorml 4 years ago

      I really appreciate your article. I bought my ticket to the psychiatric ward after a thankfully failed suicide attempt at age 45 after multiple surgeries on my right leg I was healing from.

      In my experience from my stint in the ward, most nurses were down right mean. I did have a few that were fine but night time was the worst! After I became aware of my surroundings and what I had done I became off and on tearful. I was yelled at by a young nurse. My most positive communication came in the form of my lobotomist, janitor, and a security guard. I was not violent at all ever. I heard insistent gossiping about others and toward the end how much I was hated. I overheard a female nurse say she wished I had been successful and how she would attend my funeral. Called me a b**ch for asking someone to call the number listed on my wall in my room for complaints...Nurse said " if you take her the phone, she will probably just throw it at you...finally I heard someone say along with one security guard to just give me a break but they refused and continued on. I was so relieved when the police officer came to take me to my next destination which fortunately was much improved. Upon reflection, I still do not know what I did to deserve that treatment in that setting. I hope improvements can be made and thanks again for bringing awareness to this. I have friends and relatives that are fine compassionate nurses and medical professionals.

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Hi HCRN. I am sorry you feel disappointed on reading this article and I would like to respectfully reply.

      There will always be good and bad nursing wherever you are in the world. The 'stories' are genuine and only a couple of examples. I could have written a few more but there isn't room in an article such as this.

      This article wasn't to bring down psychiatric nurses generally, it was to point out where there are flaws that affect patients. In a way you proved my point. This article is about communication and whilst you may be observing and charting, the amount of time communicating verbally is lost. I realise there seems to be more paperwork than ever before and this is not the fault of nurses but when a patient is having a gigantic personal, spiritual crisis, the last thing on their mind is your paperwork or observation. I know how lonely a psychiatric ward can feel as I have been in one many times up to a few years ago.

      I now work closely with service users and I continually hear 'stories' of how little face to face communication is offered. I can only go on what I saw myself and what I hear consistently. ( On one admission, I actually thought one of the nurses was a patient for three or four days because in between walking around she didn't appear to be talking to anyone!)

      I am sure you are a fine nurse. Like I said, there are good and bad. Some are dedicated to their work, others it appears, it's a means to an end - a wage.

      As for looking inward. It is so very difficult to look inward when you have lost sense of the real world and are in such a state that you feel almost childlike in your neediness.

      The article wasn't meant to offend so I am sorry if you feel offended by it. It was merely to point out the importance of communication. Thanks for adding a different dimension to it though because I am sure others reading this article will take what you have said on board.

    • profile image

      HCRN 5 years ago

      Wow...I'm truly disappointed in this post, especially the "stories" of psychiatric nurses. I've been a US psychiatric nurse for nearly 12 years and I've only treated my patients with respect and dignity. Psychiatric patients are often unaware of the extent of observation and charting that goes into caring for them. Therefore, they AUTOMATICALLY assume that nurses are just "watching tv or doing a jigsaw puzzle". Little do you know, we're analyzing your every thought, behavior and reaction to situations, stress, peers, social interactions and the ability to maintain a linear conversation without psychosis or vulnerability, THUS providing us with the information necessary to SAFELY recommend your return to the community where you are TRULY at risk for "miscommunication".

      On top of ALL THAT...we put ourselves at risk for physical violence EVERY day. Verbal assaults are EXPECTED and merely a part of the job. So, next time you're upset with a psychiatric staff person for "miscommunicating", please look inward and might I suggest you accept some responsibility for your own behaviors.

      With respect and sincerity, A Dedicated Psychiatric Registered Nurse.

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Thanks Sid. Yes you are right about medication. Many meds used in psychiatry are so 'heavy' that they squash a persons personality and spirit.

      I like the little story about your great aunt! Thanks again.

    • SidKemp profile image

      Sid Kemp 5 years ago from Boca Raton, Florida (near Miami and Palm Beach)

      This is a phenomenal hub about challenging issues. Voted up and useful. You mention one point that I feel is worth highlighting even more - and it may be more of an issue in the US than in Britain - a patient's ability to understand and communicate can be further reduced by medication, sometimes even more than by the symptoms themselves.

      Thank you for pointing out the value of caring touch. It is unfortunate that nurses are forbidden from doing this instead of being trained in how to do it appropriately.

      Now, for a funny story that supports some of your points. My great aunt was admitted to the hospital after a fall. She was over 90, but mentally perfectly clear. She woke up in the hospital and thought that there were ants crawling on the ceiling. The doctors began to worry that she was hallucinating. No, she'd just never seen the type of tile covered with black spots before, and no one had given her her eyeglasses!

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Thanks for the comment lambservant. Isn't it strange that staff can't do any hands on comforting and yet if a volatile situation arose on the ward there would be many 'hands on' to restrain that patient? Suddenly, manual contact would have no bounds! Misinterpretation can be understood I guess, as in my other hub I explained about abuse and there are fine lines for some people but I would have thought it would be easy to comfort in view of others as then there would be witnesses.

      I agree with the view on night staff. All night staff want is as easy a ride as possible in my opinion. Drug them up and keep them in bed seems the motto! That leaves plenty of time for tv watching and, as I saw on countless occasions, they like to have a nap! Nobody seems to care that actually the nighttime can be the worst time for many sufferers even with a sedative.

      I agree also about psychiatrists and their apparent lack of 'people skills'. It really is almost as black and white as tagged and bagged! I intend to write a hub about this shortly. Thanks again for your comments.

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Thanks for the comment gsidley. I guess you are right because that's exactly how it appears. I think it almost boils down to discrimination by the actual staff.

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Thanks greatstuff. No, I believe that years ago, a lot of our psychiatrists chose to work in other countries as the pay was better! We then employed a lot of psychiatrists from countries where prospects were low and these psychiatrists were happy to work for a lower wage her in the UK...something like that! I do know that a minority of training psychiatrists every year in this country are white British. It's sad. I don't know why the problem still exists, maybe it is still the same reasons. You are lucky in the UK if you get a white British psychiatrist.

    • lambservant profile image

      Lori Colbo 5 years ago from Pacific Northwest

      On many psychiatric wards here in the US touching of any kind is not allowed. I got in trouble once for patting a sobbing man's shoulder. The secretary insinuated I was hitting on him. How utterly ridiculous. I can understand to a point why touching is risky. Some people hate being touched, and some misinterpret. But I think in your case it was a perfect example of human touch working powerfully to soothe a deeply hurting woman. Bless that poor woman.

      I don't like it when they only have men on night shift. I think it's wrong but it happens all the time. I also notice that many of the graveyard shift workers don't know diddly about working with psychiatric patients. They know how to give out meds, tell you to go back to bed, read magazines, and talk together loud enough to keep some patients awake.

      Also, all three of the places I was at offered interpreters during the day shift if at all possible. We had one white psychiatrist, one Chinese, and the rest middle eastern. The all spoke in English but could interpret in their native language if necessary. Otherwise they had to call someone in. Great job bringing up the language barrier. Very important.

      Perhaps you have noticed this too, but I have found that the majority of psychiatrists in hospitals have very little bedside manner, and you are nothing more than a diagnosis, or a set of symptoms, beneath them . Here in the US we can ask for another doctor. There are no guarantees, but you have the right to ask and get one if one is available. I have done it twice.

      This is a good topic to write about because of the stigma of psychiatric hospitalizations. It can be scary your first time. Blessings.

    • gsidley profile image

      Dr. Gary L. Sidley 5 years ago from Lancashire, England

      Another great hub offering astute insight into some of the deficiencies in psychiatric provision.

      I do believe that another contributor to poor communication within psychiatric wards is the over-reliance on diagnostic labels. It's as if, once a person has been diagnosed with "depression" or "schizophrenia" or borderline personality disorder," the assumption is that there is nothing further to learn from communication with the patient; all that is required is the medication to treat the illness.

    • greatstuff profile image

      Mazlan 5 years ago from Malaysia

      Another excellent article meloncauli. I suspect not many doctors want to be in the psychiatric ward and local doctors prefer to work in other 'challenging and exciting' wards, hence foreign doctors are hired for this ward. It happens here, in my country and it could be the same in UK?

    • meloncauli profile image
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      meloncauli 5 years ago from UK

      Thanks for your comment leahlefler. I am glad a translator was brought in for that situation. Of course we can come across these communication problems in other areas too.

      Om Paramapoonya - thanks. Without good communication, misunderstandings are common and frustration builds.

      Thanks eHealer. Here in the UK we desperately need more psychiatrists who fully understand both our language and culture.

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Excellent read and well written. The communication problems are so dynamic and complex in mental health. As a nurse, I understand how difficult it can be to assure communication. Great hub, voted up and interesting, useful. Thanks for sharing!

    • Om Paramapoonya profile image

      Om Paramapoonya 5 years ago

      This was such a fascinating read, especially the moving story about the Chinese lady. Even mentally healthy people can find it difficult to communicate with others sometimes. I can totally see why communication can be a real uphill struggle for psychiatric patients.

    • leahlefler profile image

      Leah Lefler 5 years ago from Western New York

      Oh, meloncauli - the story about the woman who couldn't communicate because of a language barrier broke my heart. Thank goodness you were there to communicate through the language of touch - we ran into a similar problem when my son was hospitalized for surgery - a little boy was next door and very seriously ill. His mother couldn't speak the language, and was terrified - the doctor would come in and simply speak louder, as if she couldn't hear. It was terrible. Fortunately, a translator was brought in shortly thereafter!