In our previous research, we found that some patients leave impulsively and in anger following unwelcome news. About one in four absconders left in anger at their treatment. Some of these had long term dissatisfactions with psychiatry, but others left impulsively 'in a huff' following unwelcome events, such as refused requests for leave, discharge, or negative outcomes of Mental Health Review Tribunal hearings.
Bad news from home can also precipitate conflict for patients. Severe examples would be a death in the family, or the termination of a relationship with an intimate partner. But things like the loss of tenancies, a burglary, and illness in the family, childcare issues, can all represent blows to patients. The resulting stress and distress can then be acted out on the ward in increased irritability, aggression, violent incidents, and absconding.
This initiative helps us notice these moments rapidly, and act fast to mobilise psychological and social support for the patient, before the distress turns into a conflict incident.
Be aware of occasions and events that might generate these angry or upset reactions. Either work with the multidisciplinary team in the ward round to express the bad news sympathetically, or intercept the patient after it has happened. Maintain an awareness of what is going on for patients through regular chats with them, and through knowing their general demeanour. If there are small signs of distress, upset or unhappiness, ask if anything is the matter – perhaps particularly after they have had phone calls or received a visit.
Then find a quiet place and give them time to express their feelings, acknowledge their frustration, express sympathy and empathy, perhaps make a friendly gesture like providing a cup of tea, or snack. Answer any questions honestly, giving the patient time, attention, and respect. Showing that you are receptive to patients’ concerns can be achieved by some simple listening techniques such as making eye contact, asking about their worries, and using open ended questions, such as "Tell me more about it".
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Full intervention description of Bad News Mitigation
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