HRW Synapse, our in-house team of neuroscience specialists, have a wealth of neurology experience from academia, market research, and in the case of Hannah McGill, Senior Research Manager, front line work in the healthcare space. We chatted to Hannah about her experiences working in psychiatric care, and what we can learn as researchers exploring this area on behalf of our clients. 

Hi! Tell us about your work before you joined HRW- where did you work and what was your role?  

Hannah: “I was a Healthcare Assistant at a medium security forensic psychiatric unit. The patients in our care were typically former residents of more secure forensic units such as Broadmoor and entered our unit with a view to rehabilitation and in the longer term, potential release. It is worth emphasising that this was a forensic institution, meaning these were individuals who were convicted of serious crimes, but too mentally unwell to serve their sentences in prison. Many patients were diagnosed with schizophrenia and experienced different ongoing delusions that we worked with them to manage- which could be challenging as these delusions could really impact their perception of the care and activities we were providing for them. 

We had four wards that our residents moved through during their time with us, with decreasing levels of security and increasing opportunities for activities and community integration: I worked in the lower-security wards in a role supporting the psychiatric doctor and nursing teams. My role involved overseeing our residents, and doing activities together such as cooking, baking, playing scrabble, and occasionally taking them on escorted community leave. I was required to be fully briefed by the psychiatric team, and fully understand the patients’ medication and care programme, in order to monitor their wellbeing and behaviour” 

What did you enjoy about your role at the unit? 

“The work was often a lot of fun- it was quite a small unit with about eighty patients, and it felt like a proper little community. Each ward was set-up like an individual house, with its own kitchen, facilities, and staffing team- meaning we worked together closely with the same group. It was a nice atmosphere, and it was very supportive- often out of necessity to mitigate the risks of our work.  

Working with the patients was also a highlight- I was able to build great relationships with many of them, and actually shared a lot of funny moments with them. I got to know them very well, because I saw them day in, day out- you’re there on Christmas, their birthdays, everything. And having moments of connection, such as playing scrabble together, felt quite meaningful in this context. 

How about the things you didn’t enjoy as much? 

“One thing I can’t say about my work at this unit is that it was rewarding to see patients progress positively and graduate out of our care. It was an extremely slow process, and few patients left the facility in my time there. We rarely got to see the longer-term positive impact of our work: and due to the environment of their care, progress made could often slip back quickly for patients who would sometimes regress rapidly and without warning.  

It was also difficult in terms of patients’ involvement in their care. The psychiatrists responsible for their care would have regular MDT meetings and gather feedback from the nursing staff from the ward. Patients were very rarely part of these discussions about their care plan, and Healthcare Assistants like me (who spent the most time with patients) also had limited input. So I can understand the patient’s frustration with this sense of “detachment” from their care. It often felt like there wasn’t much we could do individually for patients given the ratio of staff to residents we had- it was a great unit, but there were always going to be limitations on this basis. Many of the patients were very sedentary, sedated, and unable to engage with activities. 

Finally, the safety and risk aspect of the role could of course also be challenging- this was an all-male unit and as a physically smaller woman I could feel vulnerable” 

Is there anything you learned from your work at the unit that you still draw upon or think about today? 

“I remember taking patients on escorted community leave and being struck by how distant they were from the world- for example, some had never seen electric windows on a car, or had never been to a supermarket. So I learned that when dealing with anyone, and particularly those with complex mental health histories, you never know what is going on for them or where they have come from – and this might impact how we choose to communicate and interact with them. 

I also learned to employ a lot of sensitivity and tact in communications- it was critical to de-escalate situations before they became a problem, and this can come in handy in lots of situations in life!” 

Is there anything you’d advise to those working to run MR in the psychiatric space, based on your experiences? 

“Working with these residents required a lot of patience and time, and I’d recommend taking these into MR with those impacted by psychiatric disorders. Also, it is incredibly hard to capture the full picture of a person’s experience with their condition with something like a 60-minute interview alone. Their life can be incredibly different day to day, and it can be hard for them to communicate a “general” impression of their condition. Their mood, outlook, and reflections can vary enormously, and it can be hard to maintain a very steady state or picture- to capture this accurately requires more innovative and ideally longitudinal methodologies” 

By Catherine Harwood and Hannah McGill


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