I am 24 years old and have been a mental health nurse in the NHS for four years. It may be a hot topic in the media at the moment but mental health is still seen as the ugly stepsister of healthcare. And why wouldn’t it be? Dealing with verbal and physical assault on a daily basis, while struggling with funding cuts and a real-terms pay cut, means mental health is not a particularly desirable specialisation to work in. My area – dementia – even less so.

But I do care. I devote my working life to people over 60 living with different types and stages of dementia, and I love it. I am a mental health nurse by trade and a deputy ward manager by title. I do not look after the lovely woman you might encounter on the bus who can’t remember where she’s going, or the pleasantly confused gentleman you see attending his 90th birthday party on an Alzheimer’s Society advert.

When someone you may not recognise tries to remove your clothes and wash you, it can trigger a fight or flight response

No, I deal with the ugly side of dementia. The side that leaves people confused, lost, crying, screaming, kicking, biting, psychotic, anxious, depressed and pleading with me to find their long-deceased mother; those labelled “challenging” by the care system. People like Steve*, a wonderful person whose dementia has left him lonely, incontinent and unable to function without 24-hour assistance. During my training I witnessed Steve, in frustration, bite a healthcare support worker’s arm until he drew blood.

Most patients become aggressive during personal care. It’s terrifying enough to live with dementia, in a world that does not share your view on reality, but when you have someone you may not recognise trying to remove your clothes and wash you, that can trigger a fight or flight response. Everyone I know in my field has been assaulted during personal care; sadly, we accept it as the norm.

The people I look after cannot really be cared for in a nursing or residential care home. The private sector doesn’t want them. So they are placed with me, on one of the few surviving NHS continuing care units in the country. One that is set to close.

“It’s not about money,” I’ve been told to say to distraught families of patients faced with finding a new place for their relatives to live. But how can I, when the official wording of the decision states: “[it] is to do with the costs incurred in running a stand-alone unit, and the desire … to move to a different model of care”.

Some of our staff are facing redundancy. The cooks and cleaners, provided by an outsourced agency, have no choice but to accept termination of employment. Others will be dispersed without much consent to other areas within mental health. Few will be able to stay with our residents – the ones deemed unwell enough to qualify for NHS dementia care; they will be moved to other hospitals, at least a two-hour drive away.



So where does that leave our other residents? There will be 1 million people with dementia by 2025, and the health secretary, Jeremy Hunt, wants the UK to be the world’s most dementia-friendly country. The 2014 Care Act promotes a “care in the community” approach to dealing with dementia, which means caring for people in their own homes to limit the number of costly inpatient admissions. But my patients’ children have jobs and families and are often unable to care for a confused, potentially aggressive, high-risk parent. They break down in tears in front of me, guilt-ridden because they are told to take care of their elderly relatives and cannot.

I will listen to families, I will say goodbye to patients I have nursed for four years, and I will go home and cry

One such daughter asked for my advice recently: should she move her mother to another inpatient unit much further away, or search for a local care home and pray it offers enough support? The majority of my patients will end up in largely underfunded, privately-run homes. I have visited most of these homes in the local area and I know the staff – though well-meaning, despite public belief – lack the specialist mental health and dementia training required to look after my patients. Few are specialist-built, and even even fewer can provide the space and stimulation a person with dementia requires to lead a fulfilling life.

I spend my free time researching homes in the local area for my patient’s daughter, but it’s a decision I honestly cannot make.

Without the specialist care offered by units such as mine, with access to psychiatrists, psychologists, physiotherapists and occupational therapists, people with dementia are essentially discarded. They are sedated with benzodiazepines and antihistamines to stop them wandering the hallways. They become bed-bound, due to a lack of appropriate therapies, or develop behavioural problems because they are bored and without proper stimulation (24/7 Bargain Hunt and Countdown just don’t cut it). They can end up being admitted to hospital or acute mental health wards – confusing and scary places for someone with dementia.

As for me, I’ll be spending the next few months with very little sleep, worried about my clients and their families while I put in overtime to oversee the transition. I will listen to families, I will say goodbye to patients I have nursed for four years, and I will go home and cry.

I hope to get an Australian visa and join hundreds of other UK-trained healthcare professionals overseas where, perhaps, my specialist knowledge will be better put to use. After four years as a mental health nurse in the NHS, I’m done.

*Name has been changed

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact tamsin.rutter@theguardian.com.

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