Rachel Cullivan

This page contains a winning entry by Rachel Cullivan in the RCPsych Future Archives Competition.

What was psychiatry like in 2020-2021?

Psychiatry in 2020-2021 was just like psychiatry in 2019-2020.

Except with more hand washing – and more masks.

And fear – there was definitely more fear.

It was especially on the faces of the staff – and some but not all of the patients.  Those who were convinced it was a conspiracy and not really happening were less fearful.  In the beginning anyway.

And the windows were open more –so it was colder.

Chairs were spaced out and the smell of alcohol was in the air.  Not the nice kind of alcohol that might be in a tumbler with an ice cube or slice of lemon – but the harsh kind from packets and buckets of wipes.

That was for wiping down the chairs!

And the desks – and of course the Perspex screens that appeared next on the desks.

And there was so much more plastic – and goggles and the tracks of goggle elastic on the hot, sweaty faces of those that had to wear them.

Then there was the rustling of plastic aprons – more plastic – and the sound of psychiatrists swearing as they struggled into the unfamiliar gowns. The nurses were better at that.

And there was the swabbing.  That was new. There was a whole new category of clinician – “the swabber”.  Every ward wanted one of those!

There were a lot more thermometers – with a flurry of beeps twice a day as everyone checked their temperature at the start and end of whatever their shift was. 

And there was no “shifting” – well no affection anyway!

No hugging - with new yellow stickers on the floor to remind everyone of what two meters looks like. 

No long chats either – 15 minutes and not in person unless really necessary.

No visitors!  Well only if they were screen-sized and flat!

No leave to go to the shops or for coffee in town.

A cigarette run twice a day was negotiated to stop withdrawals and potential war!

There was a sudden increase in technology – imagine you could make a Barrister, a Psychiatrist and a Lay Person work far, far away at the end of a telephone!

There was remote working for the Community Teams and remote assessments and treatments for those who were ill but could manage as an outpatient.

Sometimes there were still visits from the Home Treatment Teams but there was a covid questionnaire first and new protocols and temperature checks and lots of handwashing and more masks.  Always lots of those.

And there was illness.

And there was death.

There was a sense of “Thank God not us” when a New Outbreak was announced without our name attached.

There was the sound of a temporary morgue being built one evening and a sick feeling in the stomachs of those who heard the hammering and knew what it meant.

There was no wake or big funeral for the consultant who died and colleagues ran out for a minute to stand in the rain as the hearse passed – two metres and masks – always two metres and masks.

And there were new showers built outside and new scrubs and some were even quite jaunty.

But there were still some older patients who desperately wanted to shake your hand or go outside and wore their mask upside down and broke your heart.

And you worried for those who had come in from “normal world” but would go out in to “definitely not normal world” and who would struggle to adjust. 

And staff and patients and families did adjust to the “online prescription” and the “telecall” and “video assessment” and the “no visiting!”

And upstairs there was handclapping and free pizza and hampers and ice-cream sometimes.

And sometimes they would remember us downstairs in the basement – sorry - lower ground - and send us some sandwiches.

But there was still psychosis and depression and suicidal thoughts.

And there was still medication but no ECT – the Theatres and anaesthetists were for the physically ill.

In fact they came and looked at our ward and wondered if the oxygen points worked and could we become a “medical ward”??? And we wondered where we would go?

And psychiatrists and the trainees tried “online learning” – and found it worked. For some things - but not for everything. 

And we learned about viruses and transmission and infection control.

And then we learned about Covid and psychosis and Covid and depression.

And suddenly there was “Long Covid” 

But we kept going and hoped for a vaccine and “normal”.

And we worried when our patients were not “prioritised”.

And we hoped our community colleagues would not miss something on the phone line or through the screen.

But the admissions kept coming. And the words “lonely” and “isolation” aren’t in DSM or ICD but they were common diagnoses.

And we kept those windows open and those masks on and asked for better broadband and put single rooms and a garden on our wish list at the business meeting.

And the Day Hospitals stayed closed and the Community CBT groups didn’t happen and people were still anxious and obsessional and thinking negatively and technology and paranoid delusions don’t always work well together.

So when the vaccination programme was announced things felt a little lighter.

And the day it started there was a party atmosphere – we had cake with “4 O Clock Tea…”

And the vaccinated staff and patients watched a horse race together and cheered and it felt like the sun was shining for a few minutes.

But we remembered those who had lost the race too.

So in 2021 there is still depression and psychosis and anxiety and patients who want to be admitted and those who don’t – and now there is “Long Covid” too.

But there is recognition and vaccination and new learning – so there is hope and recovery and looking forward to 2022.

And although still with hand washing and masks there is less fear.  

There is definitely less fear.

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