CARING FOR SOCIETY’S FORGOTTEN
Continuing our series on ordinary people often overlooked by the wider public, Life observes the day’s work of a psychiatric nurse and ponders the current state of mental health services in Thailand
8AM:
Pabhajit Budsuwan has been a psychiatric nurse since 1999. Accustomed to working with mentally ill people, she shows no signs of stress as she clocks in at Srithanya Hospital — the second-oldest psychiatric hospital in Thailand — for her day’s shift. Pabhajit, 48, is deputy chief of the special male inpatient ward, overseeing 16 patients at present. Her job is to take care of everything and everyone here.
“It’s a very tough job especially for newcomers,” says Pabhajit. “When I first moved here, I was terribly scared. But after a while, I began to have more knowledge as to how to handle mentally ill patients and how to calm them down when their symptoms worsened. So I have no more fear now. I just have to be careful and never ignore signs of patients deteriorating.”
One of the most recognised psychiatric hospitals in the country, Srithanya was founded in 1941 and will turn 75 next year. At the start, the hospital only took care of 150 patients transferred from Somdet Chaopraya Institute of Psychiatry, Thailand’s first psychiatric hospital. Today Srithanya — whose mere name often unfairly provokes scorn and giggles in equal measure — has 1,430 beds. Right now there are over 800 in-patients.
8.10AM:
Pabhajit listens to what the night shift nurses have to say about each patient. On some days, when there are serious cases, the handover can take a long time.
“Good morning, Chet*. How are you feeling today?” Pabhajit says. Chet has epilepsy. When he was young, his babysitter accidentally dropped him while preparing him for a shower, and he hit his head. Since then, he has had seizures almost every day. Chet has been at Srithanya for over 15 years. It is his home now.
At Srithanya, patients come with several types of mental and developmental disorders, including depression, autism and bipolar disorder. The majority of patients are diagnosed with schizophrenia — a chronic and severe mental disorder often characterised by psychotic symptoms. Schizophrenia patients hear voices in their head and often suffer hallucinations.
10AM:
“Head that way! Your friends are now planting trees and gardening. But if you feel like you can’t do it, tell the nurses, alright?” Pabhajit directs 30-year-old Jack*, who also suffers from schizophrenia. Jack has been hospitalised for a month. When he first came, his shirt and trouser pockets were full of remote controls. He thought he could communicate with aliens.
According to the World Health Organization (WHO), schizophrenia affects more than 21 million people worldwide. In Thailand, schizophrenia is the most common type of mental illness, affecting more than 400,000 people, according to 2013 statistics from the Ministry of Public Health’s Department of Mental Health. In the same year, there were approximately 1.15 million Thais suffering from all kinds of mental illness.
In Thailand, there are 17 public psychiatric hospitals and psychiatric institutes under the Department of Mental Health. Somdet Chaopraya Institute of Psychiatry in Bangkok has the highest number of outpatient cases per year, at about 136,000, according to 2013’s figures. Nakhon Ratchasima Rajanagarindra Psychiatric Hospital in the Northeastern province of Nakhon Ratchasima has the second highest number of outpatients (118,000). Srithanya Hospital treats the third highest number of cases in the country (116,000 outpatients).
Srithanya, however, is the hospital with the highest number of telephone counselling cases. Its hotline numbers 1667 and 1323 received over 13,000 calls — on average 35 a day — in 2013 alone.
10.30AM:
Pabhajit enters an art therapy session held on the second floor of the special male inpatient ward. There are four patients participating today. Two student trainees are conducting the session.
“Turn the colour paper in front of you into an artwork that tells a story about an important moment in your life,” a student trainee says, giving out instructions. Pabhajit’s job is to supervise trainees and make sure everything runs smoothly.
While doing their art, patients talk to one another. Some of the things they say do not seem to make sense.
10.50AM:
“Code E! Male patient! On motorcycle route!” The warning is announced repeatedly through the hospital’s public address system. There are several important codes every staff member here needs to know. “Code E” means a patient is presumed to have escaped. “Code F” means fighting. “Code Blue” signifies a patient is not breathing. Whatever code is announced, medical staff immediately act as trained. In cases of “Code E”, each ward checks if there is a patient missing.
11AM:
Ek* is sleeping in a locked room, waiting for his electroconvulsive therapy (ECT) at 1pm. Electric currents will be passed through his brain to cause changes to its chemistry. He is locked in there for only one reason — to prevent him from eating and drinking, given six hours of fasting is required prior to treatment.
“I will go back to work after this,” says Ek. After being hospitalised here for three months, Ek hopes he can finally return home after this sixth and final session of treatment. Ek was sent here by a police officer after he was found burning down his own house, and later diagnosed as having schizophrenia. Ek was also drinking excessively at the time.
“Despite a full course of treatment, there is a 60-70% chance that patients will need to return to the hospital if they do not take care of themselves well enough, if society does not give them enough support and if people around them, especially their families, do not understand them,” Pabhajit says.
11.30AM:
Today’s lunch is rad naa moo (noodles with pork in thick gravy). Patients are asked to line up to receive their food serving tray — like the ones used in kindergarten schools. A lot of patients are able to eat by themselves. Some, unfortunately, need feeding, such as patients with autism.
“Today patients request som tum too,” says Pabhajit. “Student trainees make som tum for them just to spice up their days a bit.”
1PM:
Medication time. Patients queue up to get their proper dose of medication arranged for them by another registered nurse at the ward. During the day, there are usually three to four nurses at work. At night, only one nurse is assigned on standby.
Medication for psychiatric conditions can cause unwanted side effects. They range from drowsiness, difficulty swallowing to drooling.
After lunchtime meds, patients go up to their bedrooms to take a nap. Pabhajit can then have her lunch and write her daily medical summary report which is sent to the hospital’s administrative office. This is to help assess difficult and severe cases so that medical personnel can be prepared.
2PM:
Another group activity. This afternoon session is designed for patients to relax. Led by nurses or student trainees, activities can be anything from singing to cooking.
3PM:
Pabhajit talks individually to each patient to encourage them to take care of themselves and take a proper bath before going to bed at night. For her it is paramount to think of patients as her own family and accept them as they are.
“I think attitudes towards the mentally ill have improved, but not too much,” she says. “People still consider the mentally ill as frightening and useless — that they wear dirty clothes and roam around the streets. When these patients are despised and abandoned, it causes permanent scars in their minds.
“To improve national psychiatric issues, the public needs to have better understanding towards patients with mental illness. From my experience, patients who have good families and social support have better chances of recovery than those who live in a society where people do not understand and care for each other.”
4PM:
Pabhajit’s shift is over, but she cannot leave yet. Her last job for the day is to brief nurses on the next shift about each patient and handover if there is anything to be extra cautious about. No one wants to fall victim to mental disorder, she said, but patients need to understand that what they have wrong with them — like with many other illnesses — is treatable.
“Patients must accept that they are sick but that their disorder can be treated,” she says. “They must also learn how to handle their illnesses. On a national scale, improvements in terms of treatments and training for healthcare staff is a must. If facilities are good, patients have a higher chance of recovering and becoming useful to society again. They can return home and take care of themselves to a certain extent. If that is the case, society will think of them differently.”
(*Names have been changed.)
People still consider the mentally ill as frightening and useless — that they wear dirty clothes and roam around the streets