Part 2: Of first days, first roles and responsibilities..........

In my previous blog I ended with me gaining my first role as a fully fledged occupational therapist in September 1983. This was a Basic Grade rotational post in the Norfolk & Norwich Health Authority.

My first rotation was in Mental Health at Hellesdon hospital in the Medium/Long stay area ( we liked a nice solid label in those times!).

The Science bit:

Deinstitutionalisation had started in the 1960s but really took hold by the late 1970s/early 80s. Now, 1983 brought 2 major pieces of legislation that impacted on practice. The Mental Health Act (1983) and The Griffiths Report (1983). What these did was to give more rights to those with mental health diagnosis and began to change the structure of the health service with more devolution to local level. The impact on practice was to start a move towards what eventually became the Community Care Act (1990) moving many patients from the long stay wards of the old mental health asylums and into the community.

Medium/Long stay was part of that transition and included many who had been in hospital a long time. The plan was to prepare them to live in the community. One patient I worked with had been on the ward for 25 years and was admitted due to being a victim of abuse - unfortunately hers was not an isolated story - there are reports of many cases similar and of many completely bizarre reasons for admission - although some stories are either false or exaggerated on the internet - always worth checking a story out for facts. The 19th Century was absolutely brutal in this regard - check this out: I

n the 18th to the early 20th century, women were sometimes institutionalised due to their opinions, their unruliness and their inability to be controlled properly by a primarily male-dominated culture.^[41] There were financial incentives too; before the passage of the Married Women's Property Act 1882, all of a wife's assets passed automatically to her husband.

https://en.wikipedia.org/wiki/Lunatic_asylum#:~:text=Public%20mental%20asylums%20were%20established,opened%20in201811%20in%20Nottinghamshire.

So, my first day arrived. No uniform - just "sensible" own clothes or "mufti" as it was known - we even got an allowance for a few years (I remember spending my £70 on clothes for my holiday - not sure that was what was intended - anyway it stopped soon after).

I had managed to find a flat-share the other side of the city in a great old Victorian house separated into 4 flats. That place deserves at least 4 blog posts all of it's own (what memories - what parties - what a life was led during the (almost) 4 years). However, being the other side of the city meant a 30/40 minute walk into the city and then a bus journey of another 30/40 minutes out to the hospital - an early start - still not sure how I managed it everyday - but I never missed a bus!

I arrived at the alloted time and space to meet with the Head OT who welcomed me back (had been there on placement the previous year) and gave me a tour of the hospital to show me all the changes etc. At 11am we went to "my" department. I was to be the only OT with 2 assistants in an area above a ward where patients attended for the day either from the wards or from the community.

As we entered, the patients were being served on their "tea break" by the OT assistants. Imagine a huge room in an old asylum, high, vaulted ceiling; about 50 chairs hugging 3 walls of the room but only about 14 were occupied with huge gaps in between - all facing into the middle of the room; at one end of the room was a small, open kitchen area, an enclosed office space and a corridor where the loos were. In the middle of all of this were 2 OT assistants pouring team from a large teapot - already garnished with milk. Now this may be a cultural reference but think Hyacinth Bucket (pronounced Bouquet please!) and Miss Marple - Geraldine McEwan's version - there you have June & Violet.

Imagine my complete horror when, sitting down to join them in a cup of tea -as the Head OT made a mightily swift exit - I asked "what usually happens next?" to be told "anything you like dear" !!!

Actually they turned out to be really lovely, salt of the earth, heart of gold sorts. They were used to working on their own as many Basic Grades avoided their area for rotation (the perception was that it was a bit boring/not very glamorous unlike acute in-patient areas and community areas) and if someone did come they usually moved on very quickly, so I really couldn't blame their attitude. I had to learn _very_ fast the art of people management/change management. The first thing I did was extend my rotation term - we were in it together. Over the next few months I introduced assessment, individual treatment goals and plans for patients, note keeping (!!) and a range of interventions that involved more than drinking tea, watching June bake or a sing-a-long, and slowly enabled June & Violet to work with the patients fostering independence rather than entertaining them.

One of the early sticking point was always the layout of the department, I got so fed up being told "you can't....." or "it won't....." that I sent them both out in the minibus with the patients on a day trip, called in a few favours and re-arranged the whole department. Luckily they loved it and could see the value of the things I did - phew - definitely not a textbook move on how to win and influence people - but thank goodness it worked!

I worked there for 9 months until the opportunity came to apply to set up a Forensic occupational therapy service to a newly built medium secure unit (one of the first in the country I think there were only 2 others at the time) the only snag was it was a Head IV position and I had only been qualified for 9 months. The usual path towards promotion included 2 years on rotation, a move to a Senior II position then after more experience a move on to a Senior I role. Head IV roles were similar to Senior I but with staff responsibility. What the heck - I really wanted it and believed that I could do it, so I applied.