A Day in the Life of … Sarah Roche
Mental Health Nurse in the Bedfordshire Mental Health Street Triage Team
Hi, my name’s Sarah. I’ve been nursing in mental health for around 16 years now in a number of different roles. Currently I’m very proud to be one of the two nurses on Mental Health Street Triage team in Bedfordshire
Here is an overview of my life on a typical working day. – I say “typical” but the sentence “no two days are the same” has never been more relevant.
What time does your day start?
As well as nursing I’m also a foster carer for children under 18 in Bedfordshire. I currently have 2 children at opposite ends of the spectrum – a nearly 16 year old sitting exams and a 3 month old baby who’s been with us since 3 days old!! Life is pretty hectic. Luckily for me the baby sleeps very well.
I tend to get up as my (very patient and tolerant) husband takes teenager off to school around 8am – this is usually a lovely hour spent with the baby that I cherish. After that I try to get some type of exercise – either running, or the gym or my home gym I’ve fashioned in the garage, I must admit though I find this hard now given all the other time consuming, exhausting things I have in my life!!
Because of the constant Twilight shifts my eating habits have changed a lot – breakfast is usually around 11am. I’m very lucky and I live less than a 5 minute drive from our office base so I heat lunch at home and drive to the office with it to eat as I set up my desk and emails – not working at a Trust base (we’re based at the Police HQ) means that I only ever work off a laptop that is set up through I Connect and this can take some time!!
What is the first thing you do on arrival at work?
I have an admin hour from 2-3pm where I like to read through my emails first – although I have usually had a check on them at home so I’m aware of any big issues that are happening. I then try to look back at patients I saw or had contact with on my last shift to ensure all referrals have been made/picked up. It’s difficult working such unsocial hours as I can’t refer directly to most services including GP’s I rely quite heavily on our wonderful admin staff to decipher my 3am ramblings.
Usually at 15.00.01hrs the phone and radio’s start going with referrals or requests for information. These come from both ambulance and police via 111, 101 and 999. There is no “usual” type of scenario and can be anything from people having harmed themselves or having thoughts of harming themselves who have contacted the services to third party callers concerned about a neighbour for example.
What is the key objective when you assess someone?
Our emphasis has to be that we are a Triage service – such a high volume of calls to police and ambulance involve mental health that we can’t possibly attend all – we have to signpost a number of these to the most appropriate service at that time. For example someone who has taken an overdose – if this is classed as “toxic levels” then we can’t go to assess at that time, the person has to go to A&E to be medically cleared first and foremost.
When undertaking a triage assessment I have a mental checklist – initially it’s about the current concern/problem that someone is facing, then it’s about assessing the current level of risk, and if there is any to either themselves and/or others, before looking at any future perceived risk. Once all this has been established we need to look at if there is any service available that would be beneficial to refer to and how we can do this. For instance some people prefer to self-refer to services such as The Wellbeing Service for talking therapies, whereas other services, such as Community Mental Health Teams (CMHT) or Crisis Resolution Home Treatment team (CRHT) have to be referred to by ourselves.
It is the most rewarding job that I’ve ever done. However, it’s also incredibly hard emotionally and I think it’s only natural that at times I’m physically and emotionally drained. For a vast amount of the time, we work on our own as mental health professionals. We don’t have a team of peers to discuss cases with at handover or in a daily multi-disciplinary meeting. We need to make on-the-spot decisions and judgements.
What is it like for families and carers when someone is in crisis? We enter people’s lives when they are at their lowest, their most unwell and their most vulnerable. We help far more than the person in question – most of the time there are a number of extremely worried and concerned family and friends. There are times when all parties agree wholeheartedly with our assessment and plans; however there are times when no one involved agrees with us, this makes it very difficult.
What has been the feedback from families?
The feedback that the team and service has received has exceeded all of our expectations. This is from service users, their families, other professionals, other services and beyond.
What do you bring to the triage team that is different from the other members of the team?
At times we need to call for Mental Health Act Assessments and this can be a lengthy process, especially the later in the night or shift it is. We also help facilitate Section 135 warrants* if necessary. Add into the mix that we are very lucky to have some of the most fantastic and experienced paramedics from the County on the service. This means that the ambulance service may need their personnel to attend “Red 1” calls which are cardiac arrests. If we are the most local resource, we have to attend to this. This can be anything from giving CPR to being a drip stand for them! Our mode of transport is an unmarked ambulance. We have everything in the boot from a police shield, to defib, lots of hi-vis coats to traffic cones!!
What else do I bring to the team………….there’s a question. On a personal level, it’s a funky dress sense with a range of different boots – usually Doc Martens, quirky hair styles and colours, and some great meal concoctions!! On a professional basis, I spent the first 12 years of my professional life working in the Forensic mental health service mostly in a secure unit for the mentally disordered offender – my risk assessments were honed in on there. Since leaving forensics, I’ve worked in a number of assessment and triage services which are all predominantly based on Initial assessments, making decisions regarding people’s lives in a 60 minute assessment takes a lot of practice and learning. I have a vast range of experience in a number of services all of which has taught me a range of skills.
Do you finish work on time? Finishing work on time is a very rare occurrence. It’s meant to be a 1am finish. However in my last 3 shifts, one was a 6am finish, the next 4am, so far tonight is looking good for the 1am. It’s difficult, and tiring but I sleep far better knowing people are safe, families are reassured and all of my paperwork is done as necessary.
How do you relax after a shift? After work I go straight home, sometimes I go straight to bed, others I stare at the TV screen until I’m tired, bed is around 3am.
What attracted you to this innovative team?
It’s a fantastic, brand new team that mental health services has been needing for such a long time and I’ve been given the opportunity to start it! I have been waiting for a job like this for just as long. For people to be able to access secondary mental health services on a blue light response is amazing. It appears that this is recognised judging by the response we have had from our peers, colleagues, service users, managers , awards and beyond. Being able to spend every shift working with a number of emergency service workers is exciting and fantastic. Why wouldn’t I want to work on this team?
*The Mental Health Act is the law which professionals use to support people in a mental health crisis. They can use Section 135 of the act to take individuals to a place of safety for a mental health assessment. This is known as being ‘sectioned’.