My first death and an end of another sort

Despite that situation in the early days I settled and became very happy on Lilac. I learned a lot about people as well as the world of work in general, coping with shift patterns, early mornings, late nights and regular weekends. I saw my first death on the ward too, an elderly lady who died in her sleep and was found by the staff when the night shift handed over. I went with Eileen to lay the lady out, in what would now be considered the old fashioned way. We washed her, removed her false teeth and packed her rectum lightly with cotton wool to prevent any faecal leakage. Then she was wrapped in a cotton shroud, with a tiny frill at the neck. The sleeves of the shroud were secured with a bow at each wrist and her hair was combed out. A name bracelet was put first on one wrist and then on the opposite ankle; her big toes were tied together with a small cotton bandage before her ankles were secured with the same. The window closest to the bed was opened (to let her soul slip out, Eileen said) and then she was wrapped in white sheet from head to toe, the loose corners were taped into place and she taken away to the mortuary in a large rectangular metal box on wheels. I hadn't known the patient and there was no family that we knew of but we did our best to care for her respectfully and kindly even after her death. Sadly though, the health service has yet to find a way of transferring the deceased away from a ward in anything other than the rather obvious and eye catching metal box on wheels.

It's not clear what impact a death on a ward full of patients with severely impaired cognitive function has on the patient themselves but the death of a patient on any other ward leaves an inevitable ripple in its wake. Years later, as a Sister on an elderly care ward where deaths were not uncommon, we would sit and quietly explain what had happened to the other patients in the vicinity. It allowed patients to pay their respects and, if needed, raise issues or concerns of their own. Hopefully, we offered them some reassurance as well - that we respected and cared for the dead as much as for the living. It is important to recognise that the patient community on a ward experiences the same events that staff do but from a very different perspective; nurses need to pay attention to this in their actions and words. It doesn't always happen though, I have on occasions seen staff whip round the curtains at the site of the metal box and shoosh away the visitors without a word of explanation :(

Compared to my friends who had stayed on at school I had seen a very different side to life during my time at Napsbury and learned much that was to stand me in good stead in later years. However, I always knew that psychiatric nursing was not for me and when I was eighteen and a half I left Napsbury to work as a nursing assistant in a general hospital. At my leaving do, the duty Nursing Officer presented me with a beautifully wrapped parcel on behalf of the ward team. Everyone clapped as I opened it and much to my embarrassment out fell a black lacy bra and pants! Napsbury, was a truly one off place to work.

There were still other institutions like Napsbury Hospital in England in the 1980s, but the era of providing mental health care in such splendid isolation was drawing to a close. Public concern about the quality of care provided for sufferers of mental ill-health and physical disability in large scale institutions had increased over the years, fuelled by periodic allegations of poor care by the media. Politically, the long slow move towards providing an alternative option through the provision of care in the community started in the 1950s, driven primarily by humanitarian and cost considerations. But it took until 1990 to create the legislation that would enable the large scale changes required to take place. The first concrete steps toward change took place in 1988, on the publication of the Griffiths Report 'Community Care: Agenda for Action', which set out recommendations for determining the responsibility for providing care for long term dependents such as the elderly, the disabled and the mentally ill. This was followed in 1989 by the Government’s response in the form of a white paper called ‘Caring for People: Community Care in the next Decade and Beyond’. This paper endorsed the need to define the individual responsibilities of health and social agencies as well as identifying the need for ‘the development of needs assessment and care management’ and ‘a new funding structure’. The final steps in the move towards a national framework for care in the community, with the needs of individual patients at the heart of the health service structure and the funding set to stay with the patient, were taken on the enactment of the National Health Service and Community Care Act in 1990.

Napsbury at the end

Napsbury was really a unique and special place to work in but society had rightly recognised the need to care for its own in a more humane and more dignified environment and in 1998 it closed its doors for the last time having provided mental healthcare to the people of Hertfordshire and North London for almost a century. The experiences I had there and the people I met have had a huge impact on my life and my career and I thank them all (even the ghastly Jackie) for being such an important part of my formative nursing years.