An occasional series profiling New Zealanders who have lived lives less ordinary yet largely unknown. For Mental Health Awareness Week, Rebecca Blithe speaks to psychiatric nurse Jim Goodwin about his near 40 years working in mental health.
It's the middle of the night. Jim Goodwin is alone in the forensics unit of Christchurch's Hillmorton hospital. Trapped in darkness, he feels helpless. A heavy sense of foreboding bears down on him. Something bad is about to happen ...
Then, he wakes up.
These are the nightmares Goodwin, 65, endures after 37 years as a New Zealand psychiatric nurse.
"The emotional toll is huge. Huge," Goodwin tells the Herald from his home in Christchurch. His voice is gentle, his remarks calm and considered. "I've had PTSD from my time. Nightmares, flashbacks. Loud noises and people shouting I really struggle with."
Goodwin spent the past decade as a psychiatric nurse in forensics. He cared for patients who had arrived often by way of a court order for psychiatric assessment or via prison and having committed a serious crime.
"Assault, murder - you didn't go there for shoplifting," says Goodwin.
"It was not uncommon for one of us to be attacked. I was fearful to go to work," Goodwin says of Hillmorton, the mental health hospital that has frequented the headlines over the years, plagued by assaults, staffing issues, concerns over facility conditions and safety. Nineteen staff were assaulted last year alone. In July it was reported that 13 had left since March, the resignations said to be due to a number of reasons.
Goodwin "had some pretty serious assaults over the years", including three months off after he was punched in the face.
"We were in a single room with a very large, very unwell, very psychotic patient," Goodwin recalls. "He hit me with a big round-house punch. It broke my nose and the orbit of my eye."
Although he's recovered physically and was grateful of the support from his workmates and charge nurse, he says nothing came from the management above that. He left 18 months afterwards, seeking therapy "away from work. I'm also a sexual abuse survivor, so that plus 37 years of people threatening to assault or kill me, of bad management, I got myself a therapist."
Curiosity first led Goodwin, a farm boy from Fairlie, south of Christchurch, to become a psychiatric nurse almost 40 years ago. "I've always been curious about people. How they work, what goes on in the top four inches. How people are made up."
Goodwin began his work at Hillmorton after graduating in 1983, when it was still Sunnyside Hospital. New Zealand was deinstitutionalising mental health care, shutting the doors on looming old institutions such as Kingseat (which didn't completely close until 1999), and moving patients out, some who had spent their entire lives in asylums.
"I think that was a good thing," reflects Goodwin. "The idea of keeping people in hospital for no good reason, when they could be living independently in the community, that was great."
However, he says some positive elements from that era have been lost. "There was more of a sense of belonging, for patients and staff. In the early days, there was more of a programme. There were more occupational therapists who were busy doing things with people. We nurses would do stuff with them. For some it would just be a walk or a game of tennis. If the patients wanted to, they had things to do. Latterly, there was less and patients would spend a lot of time sitting around. On a good day it was more of an asylum – a safe place to be. These days it's not. It's not. It's just messed up. Dangerous."
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Goodwin holds onto the comraderie of his colleagues over the years. What they experienced together, the intensity of their work, the fear of what they might encounter, Goodwin says, led to friendships closer than most.
"My fond memories are of my workmates. You'd go to work and think, 'Oh, I'm on with Shona. Oh good.' We had our own brand of humour. It was a robust sort of humour. We'd tell poo stories – we've got lots of poo stories. And funny things that happened.
"Psych nurses, we're a bit renowned for keeping to ourselves. I had a birthday the other day and seven or eight psych nurses came. They didn't really talk to other people much. I've read a bit about soldiers and people in wartime and they're like that. The belief is that other people won't really understand or would be horrified by what you've got to say about your work."
Goodwin and his colleagues also wore the myth that mental health staff - "psychiatric nurses in particular and male psychiatric nurses even more in particular" - were "bad people".
"They enjoyed locking people up, they enjoyed restraining, that they were sort of power-tripping bad people. You know, like the people you hear about in the Royal Commission hearings. Abusive, horrible. My experience is, actually, I can't think of any staff who got off on hurting others. People wanted to get on with their patients. They generally wanted to be kind. We liked to see people get well and go home. We didn't enjoy locking the door on someone. A lot of people had a real vocation, wanting to make a difference."
A particular encounter with a patient serves as a reminder to Goodwin of a difference he was able to make.
"There was a woman in her early 50s, who was isolated in her room. She was sitting there, depressed. So, I went and talked to her for about three quarters of an hour. Just about life, you know. I finished my shift, went home and never saw her again. I met her years later and she said, 'That talk with you changed my life. That was the first time someone actually sat down and listened to me.'"
It's those sorts of conversations Goodwin believes need to happen more often.
"I think nurses need to learn how to have therapeutic conversations. They're not taught it in their training, they're taught about CPR and things at the hospital but what's not a priority is how to converse therapeutically with your patient. I learned it by myself. I went and did a form of therapy called psychodrama. I didn't use it at work but it did inform my thinking in how I spoke to people."
As Goodwin reflects on all he's seen, he says he still holds hope for the state of mental health care in New Zealand.
"Sometimes I despair, but my hope would be that we have a massive sea change. I think we need leadership instead of management. Staff need to begin to be seen as a resource, as people who need to be nurtured and cared for," says Goodwin, before asking: "How can you expect people who are getting hammered one way or another all the time to be able to provide care for patients?"
Where to from here?
The Herald contacted Christchurch DHB, which Hillmorton falls under, to find out what is being put in place to mitigate instances of assault and concerns raised about the state of the hospital's facilities.
General manager specialist mental health services, Canterbury DHB, Greg Hamilton, says teams have "worked hard to ensure safety for consumers and staff".
He says a structured programme and training is in place to "address issues and develop safer processes for this working environment, which will reduce the possibility of assault".
"Although no level of violence is acceptable in any workplace, some consumers, especially when unwell, may be unpredictable potentially resulting in assaults on other consumers or staff."
Hamilton says assaults on staff are treated "very seriously".
He says "wrap around appropriate supports [are] aligned to the person's wishes. These involve support from ward staff and management and escalation of serious incidents to the DHB's executive team. The support is ongoing with the goal of supporting recovery and return to work."
When it comes to concerns around the state of facilities and resources, Hamilton acknowledges some of these "are old, not therapeutically ideal and create some risk for consumers and staff. We have begun a process of renewing facilities on the Hillmorton campus, with construction under way.
"Along with a number of regions in New Zealand, we look forward to progressing ongoing development of facilities that will improve the therapeutic environment, continue to improve consumer experience and provide safer environments for our staff."
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633 or text 234 (available 24/7)
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (12pm to 11pm)
• Depression helpline: 0800 111 757 or text 4202 (available 24/7)
• Anxiety helpline: 0800 269 4389 (0800 ANXIETY) (available 24/7)
• Rainbow Youth: (09) 376 4155
If it is an emergency and you feel like you or someone else is at risk, call 111.