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Spend a busy day with mental health nurse Steve Howie assessing the steady stream of people who pass through the holding cells of Christchurch Police Station to see whether they have mental health and addiction issues.

NAME: Steve Howie
JOB TITLE: Watch-house Nurse, Canterbury District Health Board 
LOCATION: Christchurch Central Police Station

5.30AM
WAKE

Wake to alarm, shower, eat breakfast while reading Stuff News online.

6.15AM
ON THE ROAD

Travel to work, taking the car today instead of my usual motorcycle ride as it’s drizzling and cold. There’s minimal traffic on the motorway this morning because it is a public holiday and car parking is also easy, so I arrive 15 minutes early for work.

I trained as a registered psychiatric nurse at the former Sunnyside Hospital and have been nursing for Canterbury District Health Board mental health services for 33 years. For the past eight years I’ve been working alongside police custody staff in the Christchurch Police watch-house to assess people in custody for mental health issues, their risks to themselves and others, and for alcohol and other drug issues. In the 18 months prior to the watch-house initiative there were three suicides in the Christchurch Police cells. Since the initiative started in 2008 there have been no deaths in the cells due to suicide or medical issues. My colleague Neil McNulty and I were humbled last year to receive Police District Commanders’ Commendations for our work. Today I am on a 7am to 3.30pm shift.

7.00AM
HANDOVER

I greet my nightshift colleague and receive a verbal handover. There is more than the usual amount of chaos in the custody unit today, with 30 detainees going from the cells to court, two of them requiring further review by the mental health service (MHS) teams at the courts. Two also require a review by me before leaving for court at 8.30am and one detainee needs a review once they are sober enough to be released from custody. There is also a juvenile detainee under youth mental health services, who will need to be notified that he’s in court this morning.

7.10AM
WORK WHIRLWIND BEGINS

The next three hours are a whirlwind of activity, including assessments, the handover of risk issues to court escort staff, and arranging for two reviews by MHS at court for detainees with ongoing mental health and risk issues, as well as communicating risk and health information to the court liaison nurse and the prison health unit.
Unfortunately I missed the Police District Command Centre daily briefing meeting this morning due to the pressure of work. Today is particularly busy for a day shift – on average the watch-house nurse team sees 40–60 people a week, with the weekends usually being busier due to more intoxicated people.

Once the people head to court the watch-house calms down a little and I’m able to review another person, resulting in a referral to the DHB’s Single Point of Entry (SPOE) service for adult mental health services. I also fit in several consultations with police officers dealing with people in the community with mental health issues.
Then two more people are brought into custody requiring my attention. One is threatening suicide and my input is required to de-escalate him to the point where he can be received into custody. The other is a woman who appears to be psychotic, possibly due to methamphetamine use. I decide to observe her for a while in the cell to see whether she improves over time and see exactly what is happening for her.

10.00AM
GRAB COFFEE AND BACK INTO IT

I manage to grab the first coffee for the day and drink this while discussing how best to assess the two new detainees. The next three and a half hours involve assessment of the woman with methamphetamine psychosis, who requires a referral to the DHB’s crisis team for further assessment under the Mental Health Act, plus the assessment of three other detainees not requiring further referrals.

The young man who was threatening suicide settles down rapidly and appears to have been decompensating (deteriorating) behaviourally, which had led to him catastrophising his situation. I also hold several more phone discussions with police on matters involving people with mental health issues in the community.

1.30PM
HANDOVER AND LATE LUNCH

I provide a handover to the court escorts who are taking the man who had earlier threatened suicide to court. No follow-up is possible with this man as he intends to leave Christchurch this afternoon, has no phone or family to contact, and is declining further MHS input. I have a quick lunch and a coffee at my desk.

The crisis team arrives for a Mental Health Act assessment of the woman with methamphetamine psychosis, which requires handover and liaison. A further assessment of a detainee takes me up to 3.15pm, when the afternoon shift nurse arrives to take over. I provide handover for three people who require assessment, plus the ongoing Mental Health Act assessment. Today has been a particularly busy day so I leave 30 minutes late after catching up on documentation.

4.30PM
HEAD HOME

I arrive home after mental de-stressing on the way home. I contemplate a number of concerns around some of the people I have seen today and think about some of the decisions I have made. The job we do carries a lot of risk, given the nature of the people we see, the environment we see them in and the pressure of police and court processes that determine the time available for the assessments we do.

I sit in the sun with a coffee and a book for an hour and say “hi” to my wife, Susie, when she arrives home. We then go for a walk together, and talk a bit about about our respective days at work. We cook dinner, have a couple of red wines and a general chat while we watch a movie on TV.

10.45PM
BED

I head to bed, reflecting on what has been a very busy day for me and contemplating with some trepidation that tomorrow is New Year’s Eve, which is normally extremely busy at work. I wonder what that might bring. ✚