A Day In The Life Of An NHS Community Mental Health Nurse
To mark Mental Health Month 2021, we ask 26-year-old Eleanor* to take us through a typical day on the job.
Most of us are aware that the UK is in the grips of a mental health crisis. Even before COVID-19 shattered our support systems and overwhelmed an already struggling NHS, things were bad. What we’re less aware of, though, is who exactly has been bearing the brunt of this crisis. Beyond the statistics and the petitions and the Parliamentary debates, who are the people moving the needle each day, helping turn the tide of this catastrophe one person, one phone call, one conversation at a time? We wanted to find out. To mark Mental Health Month 2021, we asked four people from different mental health care professions to walk us through a typical day on the job. Here, an NHS community mental health nurse lays out her daily routine and discusses how she looks after herself while looking after others.
Trigger warning: This piece discusses a number of mental health conditions, including bipolar affective disorder and schizophrenia, and there are mentions of suicidal thoughts.
Eleanor* is an NHS community mental health nurse living and working in London. Her team, who operate in a neighbourhood in the centre of the city, serve local people living with severe mental health conditions including clinical depression, schizophrenia, bipolar affective disorder, and other personality disorders. Each nurse on the team – Eleanor included – holds a caseload of between 25 to 30 patients, whom they work with on an ongoing basis to monitor their mental wellbeing, distribute medication, and help with day-to-day admin they may find challenging: housing and benefits applications, phone bills, GP appointments, and more.
Below, Eleanor, 26, takes us through a typical working day, helping us to understand exactly what this mental health crisis looks like for those tackling it day in and day out.
7 a.m. I’m woken up by my Lumie alarm clock playing Magic radio station at 7 a.m. Magic plays lots of cheesy ’80s hits, so it’s always fun to wake up to. Then I have a shower, eat something for breakfast – usually toast or some cereal – and get dressed.
7.45 a.m. I cycle over to meet my friends for an outdoor coffee on the way to work. This is something we’ve been doing once or twice a week since the beginning of the pandemic (when restrictions allow) to make sure we stay connected. I find it’s the perfect way to set myself up for a good day.
8.45 a.m. I say goodbye to my friends and cycle over to the office. I head to sit down at my desk to check over things before my morning meeting.
9 a.m. Every day my team and I have an hour-long meeting at 9 a.m. This is when all of us – nurses, doctors, social workers, psychologists, etc. – get together and discuss all of the new referrals that have come in the previous day. Referrals can come from lots of places: GPs, hospitals, the police, housing providers.
We also talk about ‘cases of concern’. These are people we’ve been working with and are worried they’re going through something distressing or are showing signs of relapse. The reason we talk about these people in the meeting is, one, because we want advice on what to do and, two, we want to make sure there’s a team gaze on them. So if the nurse assigned to them is away or busy for whatever reason, that patient isn’t just forgotten.
Every day my team and I have an hour-long meeting at 9 a.m. This is when all of us – nurses, doctors, social workers, psychologists, etc. – get together and discuss all of the new referrals that have come in the previous day.
With cases of concern, there are a few options. The doctor might suggest a change to their medication, or a psychologist might advise a particular approach that might help. Or they might suggest referring them to the Home Treatment Team, which is a more intensive team that visits people at home every day. It’s designed to keep people out of hospital. If the person is really unwell, and might be in danger, they may suggest a referral for a Mental Health Act assessment. This is where we gather together two doctors and a special practitioner in order to detain and section someone.
10 a.m. After the meeting, I check my emails. This can throw up a lot of surprising stuff that may change the course of my week. For example, today I get an email saying one of my patients has just had a baby. This is important as the patient has bipolar affective disorder and, for some people, giving birth can be a real flash point for relapse because things get stressful.
I’ve been working very closely with the Social Services Team, the midwives and the perinatal mental health services on this case. So I email them to make sure we have a really, really robust plan in place to make sure the new mum is safe and feels supported. We need all the professionals involved to know what's happening so there’s no risk that things are going to deteriorate without us knowing. Because, as soon as there's a baby, there's 100 times more risk.
After the meeting, I check my emails. This can throw up a lot of surprising stuff that may change the course of my week.
I also set up an appointment to go and visit this patient at the hospital tomorrow to say hello to her and the baby, but also to assess her mental health because I know her the best out of the people in the team. I write a reminder to myself to take a bunch of flowers as I know she's not in touch with her family and COVID has limited hospital visitors.
10.30 a.m. Once that’s organised, I deal with another email, which tells me that one of my patients has COVID. This is a real blow as he’s already super isolated due to his condition (he lives with schizophrenia) so now things are going to get worse. I write myself a reminder to drop by some food and supplies to him on my way home this evening.
11 a.m. A lot of my day is spent out in the community, visiting patients. I’ll usually set off for those visits around 11 by bike. First up, I visit a lady I’ve been working with for a while. She also has schizophrenia and I see her once a month to give her an injection of anti-psychotic medication.
Generally, we have a really lovely relationship. She's really friendly and warm and she goes to lots of art galleries around London, so we talk about that and it's really nice. But today I can just tell that the atmosphere is different. I go into her house and see lots of what we’re trained to recognise as ‘relapse indicators’: she’s smoking a lot, the flat is really messy, she looks very tired and doesn’t want to make any conversation. These are unique to each patient, and one of the reasons it helps to spend time getting to know people. I can tell there’s been a resurgence in her psychosis and that all the frightening stuff that comes with being psychotic and thinking that people are against you and wanting to hurt you is coming to the surface again for her. I am able to administer the medication but I make a note to discuss her as a case of concern tomorrow in my meeting so we can start planning for if things deteriorate and hopefully we can keep her out of hospital.
A lot of my day is spent out in the community, visiting patients.
12.30 p.m. After that, I cycle to another patient’s flat. This man is a new referral, we’ve never met before, meaning I have to take someone with me – a social worker. We got a referral for this man from a housing association, who have noticed his unusual behaviour around the building and lots of rubbish outside of his flat. And they've got in contact with us to see whether we can offer any support. We've sent him letters and asked him to come in, but he's not replied, so we go round to see him.
The social worker and I buzz the flat a fair few times, but he won’t let us into the building. Eventually we’re able to tailgate in and we knock on the door. He’s very hesitant about opening the door in so I slip a note underneath to explain why we’re there. The language we use is really important; we don’t want someone to feel threatened. Especially because lots of people, especially if they've got mental illnesses like schizophrenia or bipolar disorder, have had really traumatic experiences in the past where they've been very unwell and taken to hospital against their will. We want to make clear that’s not what we’re here for.
Ultimately, he does finally open the door, and his house is in a bit of a state – it looks like he’s been struggling to keep on top of cleaning the flat and opening his letters and he’s looking very thin. He is experiencing intense paranoia which makes it hard for him to focus on everyday things – in particular, he’s worried that there are government people who are out to get him – so his curtains are closed because he doesn’t want anyone looking in, despite living on the 16th floor.
If I can, I try to take a walk around outside [during my lunch hour]. Usually I’ll bump into patients, as I serve the community our office sits within, and that’s really nice. I like catching up with them and hearing how they’re doing.
We sit down with him and just explain that we’d really like to help him, that we can do lots of things, like get his flat sorted, and also maybe help him feel less stressed out by the frightening things that he’s experiencing. I give him an appointment to come and see me later in the week and we leave. I just have to cross my fingers that he’ll follow up on that.
2 p.m. I cycle back to the office to eat lunch. Usually I bring this in myself but, at the moment, we’re getting quite a lot of food gifted to us from big chains, so there may be something yummy from M&S or somewhere on offer. If I can, I try to take a walk around outside. Usually I’ll bump into patients, as I serve the community our office sits within, and that’s really nice. I like catching up with them and hearing how they’re doing.
2.30 p.m. I get back to my desk for a bit after lunch to check emails. I often spend at least an hour or so per day thinking about my patients’ physical health and how I can help improve that. People with mental illnesses have, on average, 10 to 15 years lower life expectancy than someone without. Physical health is really, really important. So I spend a lot of time either linking them with GPs to get blood tests done, signing them up for the gym or exercise classes, or organising for them to come into my office so I can run basic tests. I also think about patients who might be hard to reach, and try and come up with some creative solutions to ensure they still get the necessary health checks.
I often spend at least an hour or so per day thinking about my patients’ physical health and how I can help improve that. People with mental illnesses have, on average, 10 to 15 years lower life expectancy than someone without.
3 p.m. I sit down for my weekly 1:1 with my supervisor, where we discuss my caseload and what’s going on. My supervisor makes sure to check in on my mental health during these meetings to see how I’m coping. She’ll try to offer support where she can and help reduce my to-do list if I have too many responsibilities at once.
3.30 p.m. I’m about to go into another meeting when I get a call saying one of my patients has been arrested and is in custody. These calls always seem to come at the worst time. I cancel my meeting so I can make sure I have enough time to talk to the police officer and custody nurse through all the different elements of this patient’s illness, as this will help them understand my patient’s behaviour and some of the things she is saying, and I give them some information about my recent contacts with her. They need to interview her, but need to make special arrangements to have an “appropriate adult” sit in with her as she is very vulnerable. I quickly get on the phone to her supported accommodation so I can make sure it is someone she knows and trusts. . Afterwards I make a note to call back early tomorrow morning to make sure everything is OK and to work out how and when she’ll be released.
4.30 pm. Reception let me know that my last appointment of the day has arrived in the clinic. This is a man I’ve been working with for a long time; he has severe depression and has tried to end his life before. He’s in his 40d and living alone, which puts him in a high risk category for suicide, so I’m glad to know he’s willing to accept our support. He came out of a psychiatric hospital a few weeks ago and the Home Treatment Team has been visiting him every day as the transition from hospital back to normal life can be quite difficult and people can easily get overwhelmed. But now the Home Treatment Team is withdrawing and I’m beginning to work with him again.
I’m about to go into another meeting when I get a call saying one of my patients has been arrested and is in custody. These calls always seem to come at the worst time.
It’s a really nice visit because I can see a big change in him. The last contact I had with him was just before he went into hospital, when things were really, really bad. So it’s nice to see him at the other end of that, because I can see how much the illness had taken from him. Today he’s really friendly and warm and funny, and has just got a fresh haircut. Whereas, when I saw him beforehand, he couldn't get out of bed.
5 p.m. I get back to my desk for last minute admin and to pick up my stuff.
5.15 p.m. I stop by Sainsbury’s to pick up supplies and food for my patient who has COVID. I can buy these on the team’s credit card, which is designed for situations like this.
5.30 p.m. I stop by my patient’s flat to give him the bags of shopping. He’s very grateful but we’re not able to chat for long because of the COVID risk. I can tell he’s coping okay, and agrees for me to get in touch with his sister to let her know he’s not well.
I love cooking – it helps me relax and decompress from a difficult day.
6.00 p.m. I cycle home and make dinner. I love cooking – it helps me relax and decompress from a difficult day. I make a ramen recipe I came across over the weekend and my boyfriend comes over to eat with me. We watch a bit of TV and chat for a while.
10 p.m. I go to bed around 10 p.m. Sleep is so important to help me feel emotionally ready for the following day, so I read for a while and then turn out the lights around 10.30 p.m.
*name has been changed to protect the individual’s identity.
To read another piece in our Day In The Life Of series and find out what a typical day looks like for Black Minds Matter co-founder Agnes Mwakatuma, click here.