Gary Bellamy’s Story Mental Health Nursing Assignment

Assignment Task

Gary Bellamy’s story

I graduated in 1997 with a degree in mental health nursing from a UK university. My first post was in old age psychiatry. Most of my contemporaries had secured their first posts in services considered to be far more dynamic, exciting, and dare I say it, ‘worthy’. For example, drug and alcohol, forensic and acute adult services; areas that were more face-paced, dynamic and damn right dangerous. Old age psychiatry was none of those. I’d made my choice, but it came with a stark warning from most. If not all of my university tutors told me that making old age psychiatry my speciality was something akin to “career suicide”. Nurses didn’t choose to work in old age psychiatry. They were only sent there if they’d screwed up in one way or another. The elephant’s graveyard of nursing. The Cinderella service within a Cinderella service if you like. A dumping ground for patients and staff alike. I didn’t listen and I didn’t want to listen. In my mind, you judged a society by how it looks after its older population.

Equipped with the wisdom of what I’d been told by the supposed thought leaders of my time, I secured my first staff nurse post on a functional assessment unit for older adults. I was fresh out of university and determined to change the stereotype of old age psychiatry. I was going to make it appealing for future generations of nurses and, more importantly, I was going to do it alone. As a medical ‘speciality’, psychiatry had made it into the same building as all the other disease areas that modern medicine lays claim to. That physicality indicated something very important. The house up on the hill model had been torn down through a process of deinstitutionalisation but the fact remained that we were still conveniently tucked out of sight.

When entering the hospital at South Block, you would turn right through a large set of double swing fire doors that then led onto a plain, uninspiring square-shaped corridor; it was here that we housed all of the general in-patient mental health wards. On numerous occasions, as I used to walk through those big swing doors, I’d be met with some curious looks from people as they waited at the lifts to head off to other, more ‘acceptable’ wards and outpatient appointments. Their intrigue was palpable and on occasions, depending on the mix of patients on the ward, it often did feel like I was entering some parallel universe. We’d made it into the big league by virtue of our location, but we were still out of sight and definitely out of our minds. On a positive note, the wards were all open wards. There was no incarceration here. That was, however, in essence, as therapeutic as it got. Being located on the ground floor, and with the majority of the windows draped with dirty grey net curtains to maintain some degree of patient dignity and privacy from onlookers as they streamed into the hospital, it looked out onto what was, in essence, a busy car park and ‘goods in’ delivery yard. The ward didn’t benefit from a great deal of natural light, or peace and quiet come to think of it, and if you wanted to take patients off the ward for a change of scenery and some 1:1 time, it was a bit of a hike to find some green space.

One week into the post as a new staff nurse, I got handed that big bunch of keys by the ward manager from the nursing handover in the morning to the afternoon shift. It signalled that I was in charge of the ward. It was me as the only qualified member of Page | 2 staff, two health care assistants and twenty acutely unwell patients. Two empty beds on an afternoon shift was a frightening thought too. My stabilisers had been whipped off and I was ultimately accountable for everything that occurred during that firstafternoon shift. And so, it continued. It was quite rare to have two qualified members of staff on the same shift and that made it hard, particularly as a novice to learn from more experienced members of the nursing team.

Senior management set precedence for routine on the ward. As did what I thought was something quite nonsensical. Civilian clothes were worn by staff on all the other wards to try to bring some sense of normality to the madness – but not for us apart from working with older adults. We were required to wear shirts and ties. I didn’t particularly relish the idea of being strangled by a patient, so I rebelled and refused. It wasn’t long before I was given a verbal warning and brought back into line.

Patients had to be washed and dressed out of bed unless they had good reason according to the ward manager. They’d get washed and dressed and have to head to the dayroom to sit and wait before they were called for their breakfast, which involved a short walk midway up the ward, out of the doors and corridor and into a dining room. They’d all be sat around the edge of the room waiting to be called and it resembled a giant centrifuge - patients all sat in their Parker Knoll chairs around the edge of the room in silence. That silence was only broken if someone decided to kick off because they’d been accused by another patient of sitting in ‘their’ place or the ward was particularly disturbed. Beds would have to be made by staff on duty and everything made to look ship shape before 9 am. A tidy bed equalled a tidy mind. I’ve always struggled with that concept myself, so needless to say on my watch, beds were rarely made by 9 am.

After breakfast, they’d trickle back, sit in the same seats waiting for the medicine trolley to be opened up and their medication dispensed. Medicine played a large part in the daily routine and polypharmacy was de rigeur. Lactulose, sennakot and sodium docusate were medications that found their way onto the medication administration record of every single patient, regardless of whether they told you that they could open their bowels without it. It may come as a surprise to you, but fruit, water and exercise were all freely available in the UK in the 1990s. Days spent on the ward for were long and monotonous for patients and that monotony would, on many an occasion lead to anger, frustration which would be dealt with by administering more chemicals.

In an attempt to break up the monotony, the occupational therapists would visit the ward daily but, in my mind, only to infantilise patients with their planned activities. The same activities that I imagined children play at kindergarten. The environment didn’t lend itself too well to any other activities that might be deemed therapeutic either. I was working in a toxic bubble that continued for nearly two and a half years.

A giant medical model where institutionalisation was alive and well and I was part of the problem by reinforcing the status quo. I hadn’t spent four years at university to warehouse older adults with mental health problems, feed them pills and do nothing therapeutic whatsoever. Both consultant psychiatrists paid lip service to the term multidisciplinary teamwork. They didn’t voice it but what they said went. If your face Page | 3 didn’t fit with senior members of the nursing team, you soon knew about it. The poor nursing practice carried out by management was subject to numerous cover-ups. Junior staff who made mistakes on the other hand would be exposed and punished with a roster that was gruelling. The same roster was written by the senior staff nurse who was shagging the ward manager. It may come as no surprise to those of you bright enough to be studying for a law degree in the first place that I failed in my attempt to change the hearts and minds of future generations of nurses coming through the system and make old age psychiatry as glamorous and dynamic that those other areas are supposed to be. It was, if I say so myself, now looking back, a pretty spectacular fail. I questioned medical practice but, in the end, it made me unwell. I wasn’t sleeping very well and felt anxious all the time. I’d get home after an afternoon shift and if I was on an early the next day, I’d just be lying in bed awake all night thinking about work. I wasn’t in a good frame of mind myself. How could I help others as a mental health nurse if I was unwell? In the end, I was signed off sick by my GP.

I remember very vividly returning to work after about six weeks of being on sick leave and the venlafaxine had kicked in. I walked into South Block, turned right through those double doors, down the corridor and onto the ward and lasted about an hour before I was back home. I couldn’t bear it. Of course, the venlafaxine didn’t work. There isn’t a pill to cure the ills created by senior management – it was a toxic culture of blame. It was the environment that was the problem, not me. That and some of the staff.

The patients were never the problem. I hated working there. Looking back, I think there was a bit of self-hate too. Self-hate for being part of a system that was simply replicating the past. I hadn’t spent four years of undergrad training reading, critiquing, and learning about old models of care, just to uncritically apply them to my practice. My exit interview with HR was scathing. The jury is still out on whether the poor practice I witnessed and documented was subject to any further investigations by the Trust. Apologies for the spoiler alert at such an early stage in this narrative, but there have been several times where the machine has been much bigger than me during my working career. I’ve had cause to stumble and fall numerous times, but I don’t want to badge those times as failure. I know that I’ve made a difference in patient care through the roles that I’ve done to date across clinical, academic, and research spheres. People who know me know that I’m often the first to poke the hornets’ nest and if I’ve made just one person take a step back and think differently, then I don’t class that as a failure. One thing was certain in my mind though, I was never going to step foot back onto a ward and work clinically as a nurse ever again, and with that, I allowed my professional registration to lapse.

The largest chunk of my career since then had been spent in a variety of research roles. A mixture of academic and clinical research related roles to be exact both in the UK and internationally. One of the main drivers to be doing research is, in part, not only because I enjoy it and I think I’m fairly good at doing it (I certainly do not like the competitive nature of securing research funding) but because I needed to find a way enable the voices of people, particularly those whose voice is seldom heard, be heard and help inform and change policy and practice. My research has supported older people, people with learning disabilities, women, sexual minority groups to give Page | 4 you a few examples. I haven’t done it alone this time but with groups of like-minded individuals.

Fast forward to 2019 and I’ve been made redundant from quite a senior role at a UK university. The post was shit to be fair but being told you were being deleted from the structure hurt a bit. Brexit had played its part and UK universities were having to tighten their belts. I was one of the twenty-five posts that were deleted but I wasn’t going to struggle to find another job. Not with my qualifications and experience. Enter COVID19. So, I did struggle to find another job. The virus changed things almost overnight for clinical research in the NHS and, to cut a very long story short I needed my professional registration as a nurse back if I was going to succeed in getting a clinical research post. I certainly didn’t relish the thought of another academic research role. Not for the time being anyway. So, I cashed in my insurance policy, a term I use somewhat tongue in cheek to describe the fact that no other options had opened up to me in a labour market where supply outstripped demand and employers were going for the cheaper less experienced candidates to fill posts and found myself on a ‘return to nursing course’ to secure my PIN as registered mental health nurse.

The academic component of the course was, shall we say a bit farcical but on the other hand, the clinical practice component was a baptism of fire. I spent four months in an acute mental health ward for older adults to regain my clinical competencies. I have never worked so hard in my life. The staff put me through my paces but looking back I had the best time ever. I used to come home after each shift and my feet would literally be on fire. They’d be stinging. That was between October 2020 and January 2121. To say that I was nervous on the day that I started was an understatement, to say the least. I wasn’t sure I’d cut the mustard and succeed. I’d walked away from a world that I used to inhabit more than twenty years ago and vowed never to return. Note to self. Never say never.

I think I can be a bit of a challenge to work with at times. Former colleagues have struggled to cope with my sense of humour. Current colleagues probably struggle still. It can be a little bit twisted on occasions and quite dark. An acquired taste some might say. I blame my nurse training. It’s a coping mechanism for dealing with some of the situations you find yourself in the middle of when you work as a nurse. I’m outspoken too and that still gets me into trouble. It doesn’t come with malice though but with a sense of integrity and I’ll be the first one to call out and question behaviours and practices that serve to benefit those already in power. I’ll give you a couple of examples and then I’m going to leave you to reflect on my musings. 

The ward I’m attached to for the four-month clinical practice placement for reregistration is a mixed-sex, functional assessment acute unit for older adults with mental health problems. I’m on the ward and working at the height of the second wave of the COVID19 pandemic, dressed head to toe in PPE for every single shift. New admissions to the ward have to be nursed in their bedroom and isolated away from the other patients until they’ve been tested for the virus and COVID free. Trust protocol dictates the procedure to follow but those neat little flow diagrams that depict what nursing staff are supposed to do to ensure the ward stays COVID free doesn’t always quite go to plan when patients - particularly mental health patients are involved. On one occasion, the trust policy owner had failed to take account of a Page | 5 situation where a new admission. A 92-year-old Jamaican female was brought onto the ward by two paramedics under compulsory mental health procedures and was wearing a spit gag because she’d attempted to bite the staff escorting her to the hospital. She was angry. Very fucking angry. She wanted to leave immediately and return home to her flat, but the ward is locked, meaning it has a controlled entry and exit system and she can’t get out. In effect, it’s a locked ward. She paces up and down the ward for the rest of the afternoon shift screaming and shouting at anyone and everyone. Some of the frailer patients on the ward are frightened by her and for her. She won’t listen to the nursing staff and we’re unable to keep her isolated in her room according to the infection control protocol. It turned out that she had been sectioned at home, had refused to take oral medication offered to her, and was injected with a sedative in her buttock. This meant she’d already been traumatised by the events that had taken place before her admission. She recounted them to me at every available opportunity she could. The first few days of her admission were distressing for her. I remember arriving for a late shift on the first week of her admission and the ward was in complete chaos. Four staff members stood outside her room. Another member of staff was sat with her trying to persuade her to take her meds but she’s not doing a great job. The nurse ends up storming out of the bedroom with the pot containing a bright blue pill on a tray with a glass of water and barks at a colleague to draw up the equivalent medication for an IM injection. I ask for her to give me the tray. I knock on her door and sit on her bed. I have about three minutes to convince her to take the medication before she’s forcibly injected again. She’s crying and recounting the trauma of being injected with a needle at home.

I still remember a lot of the patients that I nursed twenty years ago when I got that first staff nurse post. The 80-year-old woman was persecuted by her visual and auditory hallucinations of Christ trying to rape her, so much so that she possessed the strength to lift a large fire water-filled extinguisher off the wall, above her head and launch it through the staff room window at one of his disciples sat at the table. I remember the gentleman with Parkinson’s disease who’d become psychotic as a result of taking his Sinemet. He was admitted to the ward under Section 2 of the Mental Health Act for assessment and experienced severe bouts of freezing, was at high risk of falls and was at high risk of absconding from the ward within minutes of taking his medication. He was a risk both to himself and others. Then there was Maria. Maria had been diagnosed with schizophrenia in her early thirties. Her admissions were usually marked by compulsory detention, a blanket refusal to accept oral medication and the nursing team risking their relationship with her by forcing her to accept IM injections. She would be seen actively responding to auditory hallucinations that would terrify her. Her recovery would take longer on each subsequent admission but when she started to improve, her mood, attention to her physical appearance and interactions with staff (not patients, she didn’t care much for the other patients). Her challenging behaviours would quickly become a thing of the past. The nursing team would be rewarded with a woman with a big and beautiful heart. She would help nursing staff by answering telephone calls in the main ward office when staff were dealing with other matters on the ward. Preparations for Maria’s discharge would involve multiple agencies to support her. She was particular about the type of accommodation she wanted to live in postdischarge. Maria required intensive support to remain well and out of the hospital. Her discharge plans would be complicated by some difficult family dynamics, in particular, the different expectations about community care held by her four Page | 6 daughters and differing views regarding Mums’ ability to cope in anything less than residential care at a minimum.

I won’t forget those patients, nor the sprightly 90-year-old Jamaican women will stick with me for a long time too. She flirted with me from the minute I met her on the ward. She was complaining about the cleanliness of her room, particularly the floor. So, I got a bucket, some bleach and a mop and dressed in full PPE from head to toe and visa to finish the look off, she made me mop the floor. Twice. I was sweating and she was laughing at me sweating. Her banter or flirting, whatever it was, was harmless but looking back, in that madcap few minutes with the threat of receiving another injection, she listened to what I told her and accepted the path of less resistance. It's an acute ward and the staff use what’s available to them to treat their patients. As a nurse, you’re always balancing risk and safety and ward environments are volatile places. I’m able to convince her to swallow her meds only by laying it firmly on the line what would happen if she refused. I leave her room and the nurses and HCAs are congregated outside on the corridor. One staff nurse is poised ready with a small gauge needle on a tray to carry out a rapid tranquillisation with four other colleagues. I show the nurse holding the needle to the empty pot and a group cheer goes up. That pissed me off if I’m being honest. I’d walked onto the ward, intervened in the care of a patient and prevented her from being forcibly injected. We’d medicalised her distress with a pill but that felt easier to swallow compared to giving her an injection that risked a setback any trust that she might have with the ward staff. I was relieved that she’d listened to me and swallowed that pill but here was a woman who, in my assessment of her current mental state, should not be subject to detention under the mental health act. The use of self can be a powerful game-changer working with patients because I believe that had I not walked onto the ward when I did, that incident would have escalated and set back her care and the trust she had in the nursing team by weeks. We got her taken off her section two. I pushed back really hard on one of the clinical charge nurses for her appeal. It turned out she’s been admitted after a fight with one of her daughters at home. She’d thrown a glass vase at her daughter in her flat and the daughter had called the police. She had six children. One son had been murdered in a knife attack and her other son was stealing money from her. Another one of those cases of a dysfunctional family but I’m not sure whether it’s the role of psychiatry to think it can intervene.

The vast majority of acute general mental health wards operate as ‘secure’ units in the UK nowadays. Most general hospital wards operate using controlled entry and exit systems with some form of an intercom. The small amount of primary research focused on general hospital acute wards on the implementation of controlled entry and exit systems and the levels of absconding, harm to self and others really doesn’t justify the wholesale locking of general acute mental health wards. The paucity of robust evidence requires a proper review. It's fair to say I was shocked when I first got there that locked wards are now the new norm. We’ve set mental health nursing back 20 years in my humble opinion. Locked doors set a precedent for patients. Just by having this system changes the environment. The ability to do anything therapeutic with your patients within a system like this is limiting. Informal patients can’t just go out for a walk when they need to get away for a change of scenery and those who are detained in hospital. I noticed that it makes some of the nurses lazy too. Lazy in terms of communication techniques with their patients. Incidents that Page | 7 escalate into violence where nurses have to intervene and talk patients down are being eroded by a system of controlled entry and exit. We didn’t have that ‘luxury’ if you want to call it that when I was first nursing. I certainly didn’t like what this kind of environment was doing to the nursing students working with me on the ward. People respond to the environment that they live and work in. The response that I witnessed from staff, students and patients didn’t feel overly positive either in terms of cutting-edge mental health care providers or for students as nurses of the future whose ward-based clinical practice has been undertaken in what are effectively prison type settings.

A final note on the role of advocacy and then I’m finished. So, during the first few weeks of this clinical attachment, I’m asked on three separate occasions if I work undercover for the CQC (the executive non-departmental public body of the Department of Health that regulates and inspects health and social care services in the UK). I was clearly asking too many challenging questions. I was emailing the head of infection control to inform her the policy needed refinement. I emailed the head of estates too when I found out that the policy on the use of controlled entry and exit systems was two years out of date. It’s fair to say that some staff were challenged by my presence but at the end of the day, I do like to push things! I locked horns with the consultant psychiatrist rather too quickly if I look back now. She deserved to be challenged on aspects of her decision-making regarding patient care. What else is the point of having different professional groups involved in patient care otherwise?

I used to make a point of working on a Monday afternoon shift and Thursday morning when she held her regular review meetings and the MDT meeting (where all cross-disciplinary staff are involved) where patients would be reviewed face to face on the ward. I would watch her eyeballs roll to the back of her head despite her wearing a face mask as she clocked sight of me. There I was, yet again, sat waiting to greet her like I did most Monday and Thursday shifts. I was the nursing representative from the team. I’d escort the patients to and from their meetings with her. That was part of my role. I think she thought it was the only role of the nurse in those situations. Perhaps for some but not me! She wanted another nurse I think. One that would simply do what she asked and not challenge her on matters that needed challenging. Try to imagine that you’re a patient on one of these locked wards. Your freedom is severely curtailed in the first place but in addition to that, add further complexity to the situation. COVID19 is in full swing, it’s the height of the second wave of the pandemic and we’re back in another full lockdown. Even if you were an informal patient, leaving the ward of your own free will is strongly discouraged by staff in case. This is because you may come into contact with someone with the virus and end up transmitting it to other patients on the ward who are over 65 years of age, many with existing co-morbid conditions and frail. Patient visitors are banned from the ward until further notice, so there’s no way of getting to see your husband, wife, daughter, or son in the flesh for some time and they’re really worried about you and vice versa. You’re unwell and can’t get a grasp of what’s happening out there in the real world. The ward is effectively in lockdown because some patients have now tested positive and to stop the spread of it any further, everyone has to be nursed in their rooms until the ward is COVID free again. This happened twice while I was working on the ward during the four months and two of our patients died. In care homes for older people in the UK, the situation was a whole lot worse and the Page | 8 system really did fail them. In situations such as these, your advocacy role as a nurse goes into overdrive. Mine did that’s for sure. The cynic in me would say that the consultant had a testbed of patients in front of her very eyes during the four months I spent working there. On one occasion, having exhausted all lines of treatment for an older gentleman who has experienced auditory hallucinations for decades, she prescribed him clozapine. It’s not a particularly pleasant drug and something of a last-ditch attempt at a ‘cure’. It shouldn’t really be used to treat older adults, but she received the go-ahead from the company that produces it and the patient is registered on a national database.

The nurses administer the medication, which is done by titrating it slowly to reach a therapeutic level. The patient has to reach that level but the side effects to get there are harsh. His physical deterioration is difficult to watch. He’s unable to walk, dress or feed himself and he is nursed in his room for safety reasons. I question the treatment regime in a full staff meeting with the nurses. I know some of the others are concerned about his deterioration but feel unable to voice their concerns in a forum like this, so I voice them on their behalf. That was what was so great about my training. I could play devil’s advocate and question practices in a manner that others didn’t or perhaps felt they couldn’t for fear of being reprimanded. There were two ways I could have voiced my concerns about this patient. ‘The patient is clearly demonstrating toxicity to clozapine’ or ‘the consultant psychiatrist is poisoning the patient with clozapine’. I’m not at liberty to reveal which approach I took. Suffice to say that the patient deteriorated further and had to be transferred to a medical ward for treatment and the consultant was given a yellow card by the drug manufacturer for her conduct. You may be asking yourself why the consultant psychiatrist took this decision? The patient had experienced auditory hallucinations for decades but, on the whole, was able to manage them in the best way that he could. He was seen regularly by the clinical psychologist and had learnt a few techniques he could use when the voices became really bad. The question remains is who was bothered more by the voices to risk the near-death of a patient using a drug that is contraindicated in older people?

A final note on the role of advocacy and then I’m finished. So, during the first few weeks of this clinical attachment, I’m asked on three separate occasions if I work undercover for the CQC (the executive non-departmental public body of the Department of Health that regulates and inspects health and social care services in the UK). I was clearly asking too many challenging questions. I was emailing the head of infection control to inform her the policy needed refinement. I emailed the head of estates too when I found out that the policy on the use of controlled entry and exit systems was two years out of date. It’s fair to say that some staff were challenged by my presence but at the end of the day, I do like to push things! I locked horns with the consultant psychiatrist rather too quickly if I look back now. She deserved to be challenged on aspects of her decision-making regarding patient care. What else is the point of having different professional groups involved in patient care otherwise? I used to make a point of working on a Monday afternoon shift and Thursday morning when she held her regular review meetings and the MDT meeting (where all cross-disciplinary staff are involved) where patients would be reviewed face to face on the ward. I would watch her eyeballs roll to the back of her head despite her wearing a face mask as she clocked sight of me. There I was, yet again, sat waiting to greet her like I did most Monday and Thursday shifts. I was the nursing representative from the team. I’d escort the patients to and from their meetings with her. That was part of my role. I think she thought it was the only role of the nurse in those situations. Perhaps for some but not me! She wanted another nurse I think. One that would simply do what she asked and not challenge her on matters that needed challenging. Try to imagine that you’re a patient on one of these locked wards. Your freedom is severely curtailed in the first place but in addition to that, add further complexity to the situation. COVID19 is in full swing, it’s the height of the second wave of the pandemic and we’re back in another full lockdown. Even if you were an informal patient, leaving the ward of your own free will is strongly discouraged by staff in case. This is because you may come into contact with someone with the virus and end up transmitting it to other patients on the ward who are over 65 years of age, many with existing co-morbid conditions and frail. Patient visitors are banned from the ward until further notice, so there’s no way of getting to see your husband, wife, daughter, or son in the flesh for some time and they’re really worried about you and vice versa. You’re unwell and can’t get a grasp of what’s happening out there in the real world. The ward is effectively in lockdown because some patients have now tested positive and to stop the spread of it any further, everyone has to be nursed in their rooms until the ward is COVID free again. This happened twice while I was working on the ward during the four months and two of our patients died. In care homes for older people in the UK, the situation was a whole lot worse and the Page | 8 system really did fail them. In situations such as these, your advocacy role as a nurse goes into overdrive. Mine did that’s for sure. The cynic in me would say that the consultant had a testbed of patients in front of her very eyes during the four months I spent working there. On one occasion, having exhausted all lines of treatment for an older gentleman who has experienced auditory hallucinations for decades, she prescribed him clozapine. It’s not a particularly pleasant drug and something of a last-ditch attempt at a ‘cure’. It shouldn’t really be used to treat older adults, but she received the go-ahead from the company that produces it and the patient is registered on a national database. The nurses administer the medication, which is done by titrating it slowly to reach a therapeutic level. The patient has to reach that level but the side effects to get there are harsh. His physical deterioration is difficult to watch. He’s unable to walk, dress or feed himself and he is nursed in his room for safety reasons. I question the treatment regime in a full staff meeting with the nurses. I know some of the others are concerned about his deterioration but feel unable to voice their concerns in a forum like this, so I voice them on their behalf. That was what was so great about my training. I could play devil’s advocate and question practices in a manner that others didn’t or perhaps felt they couldn’t for fear of being reprimanded. There were two ways I could have voiced my concerns about this patient. ‘The patient is clearly demonstrating toxicity to clozapine’ or ‘the consultant psychiatrist is poisoning the patient with clozapine’. I’m not at liberty to reveal which approach I took. Suffice to say that the patient deteriorated further and had to be transferred to a medical ward for treatment and the consultant was given a yellow card by the drug manufacturer for her conduct. You may be asking yourself why the consultant psychiatrist took this decision? The patient had experienced auditory hallucinations for decades but, on the whole, was able to manage them in the best way that he could. He was seen regularly by the clinical psychologist and had learnt a few techniques he could use when the voices became really bad. The question remains is who was bothered more by the voices to risk the near-death of a patient using a drug that is contraindicated in older people?

Gary still lives and works in London, albeit in a clinical research role now. For a few years, Gary and his partner lived in Tamaki Makaurau where he did amazing research on social isolation of older adults.

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