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So there's not been a lot of talk, from what I can see, about how #COVID19 (*esoecially* the new variant) affects #mentalhealth hospitals. Well, let me stick my oar in because it has been a tough year and the last few weeks it has ramped up. Thread 
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I work in a Medium Secure forensic hospital on a Medium Dependency ward. That means individuals with offences related to their mental health. On my ward, it's individuals with chronic, treatment resistant psychotic disorders. Many have been in hospitals for 15+ years...
They often have cognitive and processing difficulties from their illness and residual symptoms. They can't leave the ward unescorted and need permission from the MoJ just to go outside for a walk. It's a difficult, often lonely life. This is where we come in...
As the OT my job is to provide therapeutic activity so they have a sens eof routine, can develop skills and practice basic social and task norms. As an example: it has taken several months of intense work for a service user with cognitive deficits to recognise to say 'please'..
I love my job. And we offer lots of opportunities. We have vocational roles in a shop, café and library. We have a hairdresser. They can take classes, do basic bookkeeping, have drama and music psychotherapy, learn instruments, frame pictures, repair chairs, run an allotment...
Or... They COULD. Then #COVID19 hit. Every ward was quarantined and off ward access stopped. We even stopped handling cash. Everything shut down. We slowly began to adapt provision and open things up again, but they were different. And the differences were profound..
Wards now have 'slots' to access the hospital garden and shops. Where service users could practice a near full day of work, they're now limited to 3x1 hr slots *per week* (as we have 7 wards in our unit). The café was, until last week, closed. This means...
... That even the very idea of interacting socially with friends from other wards has been stopped. Remember, their access off ward is limited. They live with up to 17 others they haven't chosen. Covid has made their world even smaller....
So their chances to rebuild social interaction are now limited. Then cross ward groups stopped, reducing access to vital therapies. Supported accommodation also seized up, slowing down discharges and referrals to rehab wards. They're now going to be here longer despite all...
... Their incredibly hard work. Thankfully we have been able to keep up most of the therapeutic provision but it has been extremely hard. The programme changes every couple of months, there are cancellations & waiting lists. Already understaffed, we're super stretched and very..
... Reliant on students. It shouldn't be this way. At one point I was spending three days a week *just* doing paperwork for the cashless system, *plus* running a full therapeutic programme. But we've adapted and now provide as full a programme as is possible..
... Because we *know*, as evidence shows, this has a major therapeutic benefit. And because the service users deserve as normal a life as we can give them. Plus, the team I work with is *incredible* and just unbelievably dedicated to helping service users recover and move on..
And we had done really well at keeping #COVID19 out, with very few cases. Until #Covid19UK came along. My ward had 2 cases (both staff) in 9 months. Then in the last 3 weeks.... At least *FIFTEEN* (including me). With TWELVE service users catching it. Out of 18....
So suddenly 66% of the ward had it. Thankfully nobody has been very ill. But the already tight walls got tighter. The ward is under strict quarantine with no permanently based staff allowed in. Service users can't leave unless it's an emergency...
*No non permanently based staff allowed in. That means all off-ward access, to socialise, work, go to therapies even just get a haircut or some fresh air... STOPPED. Stuck, with 17 others. And no psychology groups to discuss how they felt...
Even worse, with my catching it, OT provision stopped (remember, no non-ward based staff allowed in). 2 weeks minimum, not allowed off ward. With no activities during the day. 66% tested positive. Over Christmas. Beyond miserable. And then...
... And then we have the workload. Every positive service user has to be isolated in their room, meaning medication, meals, vitals etc all need to be done there. In full PPE and shields. Plus several nurses and HCAs also tested positive. So now you have...
... An already depleted staffing number having to provide more intense levels of care to 2/3 of an already busy ward. While taking extra precautions and supporting the other service users. Can you imagine that? Just when our service users need more support...
... There's fewer staff around to do it. But they get it done. Somehow, I don't know how, they managed. It should be too much. You don't see ventilators in our unit, or A&E doctors crying, but the impact is just as real. But the staff kept coming in as the people under our care..
... Needed care. They can't leave or discharge themselves. A lot of them face huge psychological distress each day, and they can't recover alone. They're anxious & scared about #COVID19, & what it means. They're access to the world is mediated...
... Through us. And we're less available. We've made things work by making them smaller, more ward focused. Less *communal*. And that's the takeaway: their world has gone from restricted to a hospital, to a corridor, to a *bedroom*. The complaints...
... People have had about not being allowed out? That was their world *before* this started. Now even that has shrunk. #COVID19 has stretched our ability to provide them the therapy they need to help them (re)discover independence...
