Reflecting on the first job that I took in CAMHS and the induction process that new staff took part in. It was a hospital in the private sector in a rural part of the UK, with a glossy website filled with inspiring videos of staff and CYP. Looked great, I thought.

It was a strange time in my life. I was returning to work after several months off as a result of my own struggles, and was desperate for a change in my nursing career. As a result, I approached the new role with a vulnerability and naivety that reflected this.

The induction period was 2 weeks, with subsequent training in deescalation/restraint. I was to be the CTL (B6 NHS equivalent) on the PICU. There was about 15-20 of us, and I was the only RMN. Strange, I thought, but perhaps they’re otherwise fully-staffed with nurses.

The rest of the inductees were taking support worker positions. There was a lot of enthusiasm, but many had little or no experience working in mental health. This is not a sleight on them - everyone has to start somewhere - but this point is relevant for what happened next.

Saying that, I did have some concerns. As mentioned, the hospital was in a rural, fairly inaccessible location. I later found out that recruitment was an impossible task. There was a bit of a “we’ll take anyone” vibe. This played out, eventually, in catastrophic ways.

The moment the induction started the hospital’s culture was laid bare. Interestingly, the hospital had previously been an MSU for adults with learning disabilities - many of the staff had stayed to work with C&YP. The imposing security gates and insidious attitudes remained.

The inductors - two senior support workers - knew they had a captive audience in our group. Many were wet behind the ears and had no CAMHS experience. We were, on the most part, a blank slate. This was key, and is what made what followed particularly damaging.

From the offset, the inductors were all too ready to share stories of violent incidents that had taken place on the wards. They were recounted with a perverse glee, a shock and awe tactic to provide us with an insight into “the realities of working here.”

Assaults, staff hospitalisations, staff abroad being murdered by patients - all tales that featured in the first few days. This set the tone for our expectations of the young people, and our role in relation to them. They were going to hurt us, and we needed to stop that.

Obviously, then, restraint was something we *had* to do. I am reminded of Chapman’s Becoming Perpetrator.

“Our violence was only ever in response to their violence...because they were the initiators of violence, as we understood it, there was nothing we could do to prevent it.”

The stories were also a test. If you were distressed by what was being shared then you weren’t meant to be there in the first place. You were strong if you were up “for the challenge”. There was no room for vulnerability here, or curiosity about *why* these things were happening.

Obviously, there was little discussion about the role staff played in these incidents. There was a tokenistic mention of relational security and what felt, at the time, like a bizarre focus on their suspension policy. It became less bizarre after working on the wards.

At the end of the induction period, most of us were apprehensive. Many were scared and fearful about what to expect. Some, unfortunately, seemed amped up. No-one was quite sure about what it would be like to work with these young people.

Of course those young people were, on the most part, incredibly traumatised young women. They needed skilful, compassionate, validating, careful psychological support to help them manage their distress. Instead they had staff who were on edge, ready to restrain at any minute.

A manifestation of distress? The result of pervasive trauma? The result of our behaviour and our violent use of force? These questions weren’t asked. Indeed, many didn’t know that they even could be. The presenting behaviour was always the explanation.

A lot of that induction group left in the first couple of weeks. Again, the “they weren’t made of strong enough stuff” narrative pervaded the staff room. I stayed put, half hoping that some good work could be done, half immobilised by circumstance.

Those who left were replaced by new recruits. The lack of staff now meant that there was less of induction. They were needed on the wards. Many were actively dangerous. Staff/patient boundaries were non-existent. Here is where I learnt the salience of the suspension policy.

Where was the senior leadership in all of this? They were nowhere. Occasionally the wards would receive a visit from the hospital director or the head of nursing, mainly to review the incidents from the night before (nights were always unsettled).

Other than that, we didn’t see them, nor the MDT. This, along with the lack of senior oversight, fed into an us versus them attitude in the ward staff, creating frustration and division. Ultimately, this was borne out in the care that the young people received.

There were good individuals working there. But that was in spite of the culture and practice that engulfed the hospital. The damage had been done in those first two weeks of induction. But perhaps that’s how they wanted it - why would they want us thinking differently to them?

All of this, of course, affected the young people in the hospital in untold ways. Although incidents were common place, two particularly serious events resulted in NHSE, the CQC, and the provider taking the decision to close the hospital.

There are questions to be asked about NHSE and CQC and their prior awareness as to what was going on. Why hadn’t these issues been picked up sooner? Why did it take this long for action to be taken? I’m not sure I’ll even get answers.

40+ children were uprooted and moved around the country. New PICU and LSU ‘provision’ was magically commissioned. I don’t doubt that similar issues are taking place in these services as we speak.

All staff were made redundant, including myself. All in all, I was there for 4 months. Several years have passed but it remains a difficult experience to process. I wonder how those young people are doing, and hope that they are in the space to heal that they deserve.

This is not an isolated example. We still commission places just like this, with the same culture, attitude, and practice. And we will continue to do so, until those with the power to do say enough is enough. Why, I ask, aren’t we already there?