Transcript: 'I returned to nursing the day the pandemic was declared'

This is a full transcript of 'I returned to nursing the day the pandemic was declared' as first broadcast on 29 April 2020. Presented by Beth Rose

BETH -Hello, and welcome to the seventh episode of Cabin Fever, this week with me, Beth Rose. We're just about getting used to living a very different 2020 to the one we probably all expected. I'm not sure anyone really saw this coming, but can you imagine starting a brand new job on 11th March 2020, the day the World Health Organisation declared a global pandemic? What about if that first day was restarting your nursing career after 12 years of recovery from severe mental illness?

For Hannah McDonald that's exactly what happened. Over the past 12 years she's experienced mental health crises, including being detained under the Mental Health Act, but she's also spent time topping up her medical training, determined to get back to the career she loved, and now she's regarded by the Royal College of Nursing as an expert by experience to support the mental health of all nurses.

Just before we get going, Hannah is really open about her story, from the most difficult times in her life to her brilliant success, but that does mean we talk about subjects like self-harm and suicide.

[music]

BETH -Hi, Hannah.

HANNAH - Hello, hi.

BETH -How are things going?

HANNAH -Yeah, they've going all right. It's quite strange to have started nursing in a completely different time for nursing anyway, never mind for me after 12 years of mental illness.

BETH -Yeah, I don't imagine you ever expected your first day to be the day a global pandemic was declared.

HANNAH -[laughs] No, not at all. And I don't think the people I'm working with expected that either.

BETH -So let's sort of go back to the beginning, or I guess it's more the middling, and it's really horrible to boil someone's life down like this but sometimes it can be a bit helpful. So you have a medical diagnosis of emotionally unstable personality disorder, which is also sometimes known as borderline personality disorder. And I know we kind of hear those names bandied about a bit, but what does that actually mean, to you?

HANNAH -To me, actually when I was first given the diagnosis it was quite horrible, because I think for me it felt like my personality was disordered. It sort of felt like a real stab into the very core of who I was. Actually I was to learn that it meant that I haven't really been emotionally nurtured as a child. And there's been some very big events in my life. By the time I was 18 years old I'd had a friend who had drowned, a friend who had taken their own life, and I had a friend who had been murdered.

And I think that all of those deaths had an impact, but because they were friends nobody saw how much these had impacted me. And actually my understanding now was actually I was somebody who was unable to deal with that grief, and I buried it, to the point that when I did have my mental health breakdown I was completely confused about why I was as unhappy as I was and why I couldn't manage to be a nurse. But I think what it was was that nursing was triggering that pain. For me, my mental illness was undealt with grief, because unfortunately being from quite a large family, I'm one of eight children, I think that nobody really was able to work it through with me.

BETH -So did you pack all of this away?

HANNAH -Yes.

BETH -You were about 18, 19?

HANNAH -Yeah, I was 18 years old. I then moved away from home and it just all got buried. I'm actually by personality quite an optimist, which people find quite surprising when I've had such a serious mental illness, because I was always trying to see the bright side of life and I didn't have that balance because actually I think it's a balance of realising the pain of this world with also a balance of seeing that there are joys in it as well. And that got unbalanced. It just all then fell apart as that pain just got too big and I couldn't manage it.

BETH -And was that when you were working as a nurse?

HANNAH -Yeah, I think so. And I was seeing other people's pain around, and then I just couldn't deal with that emotional pain that was inside me. And I had to deal with my own before I could really effectively look after other people. I think I learnt that in the cruellest way, but I think as nurses I think we need to think about that.

BETH -How did it start becoming apparent to maybe you or maybe your friends, family, your colleagues, that things weren't quite as normal?

HANNAH -I think it was over quite a number of years. I had a friend that I was living with for five years and she said there was always a part that she couldn't get to with me, but I don't think that anybody really knew. That was part of the problem. And when I actually was sectioned, because I was sectioned with my nursing uniform in my bag.

BETH -So on the way to a shift?

HANNAH -Yes, I was to do a shift that day and I had been seeing a psychologist and he was then concerned about me, and nobody I think knew how bad it was. I was secretly hurting myself. And when I was sectioned my manager and the people I work with were absolutely shocked. And I didn't tell everybody and most of them thought actually I may have left work because of having a cancer diagnosis.

And so I think I was burying it so much, even though we can all look back and say, oh that was a bit of a sign. The fact I wasn't really sleeping properly, the fact I wasn't really eating properly, but actually it wasn't massively obvious, there were like these little signs. You know, I was still sort of functioning and I was doing quite a good job as a nurse, [laughs] but actually it was all coming on top of me and then I just broke. But I would say that that build up was over probably five years, but actually when I look back I had suicidal thoughts from about the age of 12. I didn't act on those until I was 26, so if you're thinking about when did it start it actually started when my first friend died.

BETH -What makes it specifically borderline personality disorder?

HANNAH -They have nine categories, and if you have five or more you're classed as that, and I at that time had five. So I kind of was borderline on borderline in a way. The big thing with me was because I was unable to emotionally care for myself, I kept saying I wasn't angry, and I was very angry. I couldn't quite understand some of the emotions I was feeling, like abandonment. Because our emotional needs haven't been met as children you're wanting people to try and care for you and there's often low self-esteem because you haven't really been lifted up. Another big one obviously is that you've started to kind of self-harm. For me, the way that I describe self-harm is that it was my expression of my pain which I couldn't describe in any other way.

BETH -And when you went to this appointment and the psychologist said to you, "I think we need to detain you under the Mental Health Act"?

HANNAH -He actually did a risk assessment form on me. And he then asked me if I'd ever thought of suicide and I said yes, and then he asked me if I'd done anything towards trying to do that and I went silent. Then he dug a bit and then he realised I actually was hurting myself. Because of that concern he then took me to the emergency psychiatric service and it was at that point where I was then seen by a doctor and then a mental health assessment was then done on me.

And at that point I was so overwhelmed I didn't actually know what was happening to me. Because I was a nurse people thought that I might understand, but actually I didn't, I was a physical healthcare nurse, I worked in HIV, I had no clue what was going on, and then they just said, "We're sectioning you," and that was just terrifying.

I remember just thinking that's it, I'm never going to be a nurse again. In that very first moment my whole world just fell apart. I sort of entered a system where I was meeting people who had been in that system for sort of 20 years and I just thought this is it, this is now my life.

You lose your role. You lose how you see yourself. You lose your hopes because you think who's going to want to have a relationship with me now? And so it's bigger than people think. You then have to deal with the stigma, the self-stigma, but also the losses, physically going into hospital and what you lose.

BETH -And it sounds like it came as actually quite a big surprise?

HANNAH -Yes. And I went through many years thinking what could I have done to have stopped that? Why didn't I get help? Why didn't I go to my manager? And yet unfortunately I wasn't able to. I've had to sort of find compassion in myself that I didn't have the skills to ask for help. I thought it was a failure to say I'm struggling, but at the same time that was 27 year old Hannah, not 40 year old Hannah who's been on the journey that I've been on. You know, I know it's difficult to talk about emotions, emotions can be painful, but that's why I say it's really important that we don't judge each other, because we can't actually help what we feel.

BETH -Did you get any reassurances when you were initially sectioned that this was not the end of Hannah?

HANNAH -There were people saying that to me, but at the same time I didn't believe it. And I used to say at that time I'd rather no hope than false hope. So when people said that to me it felt like a false hope, because in one way I had nurses saying that to me, but what I was seeing was people who'd be in revolving doors of mental health units that were going in and out, in and out, and in and out, and had been for 20 years. So when that's what you're seeing you generally think, well that's the case here. And at that time there wasn't any real peer support so there wasn't any seeing anybody who'd got through it. And that's why for me peer support is massive.

BETH -What's it like, the initial few weeks?

HANNAH -It takes a lot from you. I wasn't allowed to do embroidery, which is massive for me, because of the risk; scissors and needles and things. They're very barren places because of that. That doesn't really work because the more that was taken off me the more I was sitting in a barren room looking around thinking how can I end my life.

It's quite restricted in visiting hours, they only allow people to visit between four and eight, and most of my friends by that time were married and having children. Well, anybody with children, visiting hours between four and eight is completely impossible because you're trying to put these children to bed. And so a lot of my friends struggled because a lot of them weren't able to visit me. And so you become more isolated. For me I was watching the busy nurses and it's like one of those film scenes where you have the one person just standing there and then everyone's just busy around them. You just feel useless, and that makes your self esteem go down.

I understand it on one level because they want to try and keep people safe, so it becomes a real balancing game. And interestingly enough the hospital that I then was to go to for five years, so I spent five years in acute mental health units…

BETH -Full time is that?

HANNAH -Yeah, pretty much about 80% of my time, because I couldn't then cope outside of the hospital because my life was just in rubble.

BETH -Did you also find that five years of inpatient care and then you suddenly go outside again and… had your security flipped so you're returning to a very alien world once more?

HANNAH -Yes. And a world that you don't feel part of anymore. And so in some ways you feel safer then, you become quite institutionalised. But actually the hospital is depriving you of so much and so that's why I think you have these revolving doors. I was so fortunate because I got sent to a therapeutic community and so it works very differently. In acute mental health units you might talk to some of the nurses about how you're feeling, in a therapeutic community you have to talk about your feelings with the whole community.

And when I first went I was like, no way, I don't want to tell everybody about how I'm feeling. Actually they are able to help you once you kind of realise the benefits of it, because they understand more than the staff do sometimes and the patients were the ones that began to challenge me and we had lots of kind of group therapy. We live together basically, we cook together and we used to have night contact, so if we thought we were going to have a difficult night then you would sit together for an hour. And it was very different, there were no locked doors, you chose to be there. It had a massive garden, it had knives in the kitchen, and I was allowed to do my embroidery, but interestingly enough I made no attempts on my life at the Castle Hospital, where I'd made quite a number of attempts on my life in acute mental health units.

The difference for me was on the acute mental health ward they contain you physically but not emotionally, where in the therapeutic community they didn't contain me physically, I could have left at any time, but they did contain us emotionally. What was very difficult about it was it's a timed treatment. I was there for 11 months. It's very hard when you leave, but because they do an outreach programme I was then in their outreach programme for three years.

BETH -And did you have somewhere to move to?

HANNAH -I had a flat. And actually the way therapeutic community works is that at weekends you would actually go back to wherever you were living before. They want to try and get you back into life and society. The Castle Hospital, which is an incredible place, it is expensive, but in the long term five years before the Castle Hospital 80% of my time was in acute mental health units, which have cost an absolute huge amount of money. I haven't done five years since leaving the Castle's outreach, I finished in 2016.

I've had no hospital admission, I now only see a consultant psychiatrist. I've now even gone back into nursing, and you think that's not even five years after leaving the Castle, we haven't even reached that yet. So we need to think about long term treatments for people. My treatment was four years, but actually its benefits have been massive.

BETH -And was it that which made your ambition to return to nursing, you could maybe see it a bit more?

HANNAH -Yeah, I think so. And also for me as I tried to return to nursing, it was really hard, you know, it took two years from deciding to apply and applying to do my return to nursing which is like a six months course to actually starting my actual job in the hospice on 11th March. And as I went through it there were obviously some people who really felt that I could do this and then there were other people, you know, doctors that I met who didn't think I could and insisting on me seeing a private psychiatrist for them to say actually I could do this, which I thought, it this had been a physical illness would they be asking me to see a private doctor to say yes, okay you can go back to nursing.

Because there was a part of me that thought oh it's okay if I'm not a nurse again, but then there was another part of me that thought, but this is a real disservice of the Castle Hospital. You know, they're an NHS hospital, this is the treatment they gave me and do you know what, it worked. Do we not believe that actually therapy can work? I became really determined then, I thought I'm not just doing this for me, I'm doing it for them. I'm doing it to show that people can come through serious mental illness and they can learn how to manage their mental health. You know, I may always be vulnerable to mental health difficulties but I know the early signs. This is not a sentence for the rest of my life.

BETH -It's interesting that you were so determined to return to the nursing, even though the previous, definitely five years, were not a nice experience of the medical side.

HANNAH -Yes, I think it wasn't a nice experience but at the same time I have a real heart for nursing, and I know that there were nurses in the difficulty of that system who really cared, really cared. One of the things that I had to work through in working in a hospice was actually how different their garden is. You know, our garden, like literally in the mental health unit isn't a garden, we used to call it the yard, and then I went to the hospice and I was like, oh my goodness, it's got this gorgeous blossom tree and it's beautiful and the gardeners come in and they volunteer, and we didn't have that in the mental health unit.

And I had to just sit and cry because I thought it's really great that the hospice has got this but I wish mental health units had this as well. And I don't know whether part of it's because people don't know that there's hope for people with mental illness. And I think that's one of the reasons why I want to share my story.

BETH -As you said, your new job was at a hospice, which to me sounds like quite an emotionally tough job anyway. How did you prepare yourself for that, and also for the first day back at work?

HANNAH -For me I think it's realising that that was my dream, and there was a part of me that was always drawn to it. I was drawn to embroidery and I was drawn to nursing where you have the space to really care for somebody. I mean I was never going to be an A&E nurse. Now, being given the emotional tools I still wanted to be a palliative care nurse, and yes it is, but there's also something very beautiful about palliative care nursing. And it's about trying to give what you can for families and a patient in the last bit of their life.

And also I think for me it's realising it's not my pain and to be able to stand with a family and a patient through that pain is a very privileged position. You know, the nurses that are drawn to that sort of work are very caring. And I've always said if I'm in a caring environment I thrive. And when it came to preparing myself for my first day I was actually really looking forward to it because the lady who interviewed me really just believed in me, I mean she just could see some of the skills that I'd learnt through my own illness that could actually be really beneficial to palliative care which might actually be really helpful.

And that was wonderful, and she was going to be my mentor, so on that first day I was like oh great, I'm going to be working with Margaret. There is anxiety, but to be honest I just sort of went in and said yeah, I've come back to work after 12 years of illness and people don't then normally ask very much. Now some of them are sort of like knowing. It's just been a joy really. And it seems a really strange thing to say when actually it's a tough time for nursing at the moment with everything that's going on, but for me where I thought I would never be a nurse again and I look up into the mirror when I'm washing my hands and I think oh my goodness, we did it. You know, and I say we because it wasn't just me, it was so many people.

BETH -Has the pandemic made hospital care any different?

HANNAH -Yes.

BETH -I guess there's very limited family and friends that visit, so you're even more important.

HANNAH -Yeah, and I think that's the hardest part. We've gone down to just one visitor, and that's really hard for families when they've then got to choose who it's going to be. You're not having those moments where you might have a birthday or an anniversary and you try and do a bit of a party so you have that kind of memory, you're also wearing masks and you're wearing gloves and aprons. Hospice care is all about humanity, and for me that's the toughest part because I know that my mental illness was kind of unresolved grief.

And a really important part of hospice care is not just the patient but it's also the family, helping them have a good goodbye. If you're not able to do that one of my worries, and also one of my worries for like funerals and things when people are not being able to say goodbye, that's really tough, knowing that my mental illness came from grief where I didn't really say goodbye. And I think that it might be quite a struggle if they feel like they haven't been able to say goodbye in a way they would have liked. I find that quite heart-breaking. As the years go on I think that will be some of the pain that is left behind by Coronavirus.

BETH -And we mentioned also that you're now an expert by experience in the eyes of the Royal College of Nursing.

HANNAH -I wrote to the Royal College of Nursing just before I returned to nursing and I said I had been a nurse and I had a real heart for nurses, you know, how do we care for nurses? How do we teach nurses to look after themselves? And so I started doing talks with nursing students at different universities and so then I wrote to the Royal College of Nursing and said look, I'm quite interested in just working with you. And then I worked on their parity of esteem programme which is basically trying to…

Nobody ever really knows what that means, it's just trying to lift up, so it's on an equal level, mental health and physical health, but also we should be thinking of both whenever we look after any patient over anything, if somebody's hurt their foot or something, you know, that might have a mental impact for them because they're a dancer. And when I started working with them I then met the mental health lead and then I became a nurse again she then said, "Look, I'm thinking about creating this new role, the first expert by experience nurse," which basically all that is is that I'm a nurse who's willing to say that I've had a serious mental illness.

BETH -And also generally it's obviously a very difficult time for everyone. Have you got any skills or tools that people could maybe use or think about?

HANNAH -I think one of the things I'm sort of worried about is people who are mentally unwell and at home because it's so isolating anyway, and I think that if you feel able to have people ring in and talk to you. I mean, I know at my ill-est I didn't want to talk to people on the phone, but I know one of the things that helped me is when friends used to send me messages and say they were thinking of me.

When it comes to nurses some of the things that I'm doing for myself is that at the end of a shift I always write down my feelings. Feelings are painful but feelings are actually I think a tool to try and help what's going on for us. So if I feel angry why am I feeling angry? And to explore it a little bit. Which are my feelings? Which have been transferred onto me by maybe a relative or a patient? And I have a little bit of reflection time. That really helps me because it helps me understand what might be really going on for me and deal with that or I might think oh actually, that thing I might need to talk through with somebody.

And then the other thing for me is that I do do mindfulness. And I know it's sort of bounced around quite a lot and some people then say it's not that helpful. The first time I did it I did a breathing mindfulness and absolutely couldn't stand it and thought oh, this mindfulness is a load of rubbish, but actually there's loads of mindfulness techniques. I do mindfulness colouring as well, and it's not just colouring in, it's that you actually think about how hard you're holding the pencil, how much you're pushing down on the paper. My brain then goes out of that ruminating thinking, it takes you to thinking what am I feeling now?

BETH -You mentioned a couple of times your embroidery as well, and before nursing you went to the Royal College of Needlework?

HANNAH -Yeah. Part of me wanted to be a nurse and I had this absolute love for embroidery ever since I was about six years old. I would just do little cross stitches and I just loved it. And I went and visited when I found out about the Royal School of Needlework with my school and I just fell in love with it. I mean it's at Hampton Court Palace and it was all these embroidery techniques that I had never seen before. And actually now it's a real joy to have my embroidery; it's my relaxation.

Not only that, being associated with the Royal School of Needlework has meant that I've done some amazing projects. One of those was actually when I was really, really unwell. Friends from the Royal School of Needlework who really tried to support me said, "Come and work on this project." And my friend said, "I can't tell you what the project is," but she said, "as soon as you walk in you'll know what it is." So I walked in and everything was white, there was white lace everywhere, and it was actually the Duchess of Cambridge's wedding dress.

BETH -Oh my god.

HANNAH -And I only worked on it for eight days, I only worked on it for eight days, because I was so unwell, and it was and it was a wonderful, wonderful thing to work on. But actually what then happened was that I went back into hospital and the Duchess of Cambridge actually came after her wedding to visit the Royal School of Needlework and I was actually under section so I never actually did meet her, sadly. And at that time when I said that I'd worked on her dress one of the nurses actually thought I was deluded.

And I remember and so now I actually use it as a story to say that you lose your identity with mental illness, you really do, and it's really nice you've asked me about the embroidery because that actually was a really beautiful thing for me to work on at that time when I was really, really unwell. And I'm really thankful that the Royal School of Needlework allowed me to work on it. It will go with me for the rest of my life that I got to work on that project.

BETH -Thank you so much, Hannah, for chatting about all of your experiences and thank you also for being one of the many brilliant people working so hard on the frontline. That's it for this week's Cabin Fever. If you do want any information on mental health support there are places like Mind and Rethink you can visit. And also Rethink is carrying out a survey to get a real time snapshot of the nation's mental health during this pandemic. I'm sure they'd love it if you got involved too. Don't forget, there are also other Ouch original podcasts to listen to. You can catch up with Kate Monaghan and her family as they reach the midway point of their initial 12 weeks of shielding. That's on The Isolation Diary, and there's a whole load of other brilliant Ouch podcasts, non Coronavirus related, just waiting to be listened to on the BBC Sounds app. Also, do get in touch, we're BBC Ouch on Facebook, @bbcouch on Twitter and [e-mail] on email. Speak to you soon. Bye.