Veteran psychiatric nurse Supanich Polpairin's calm demeanour and comforting voice seems to have a reassuring impact on her female patients who are diagnosed with mental disorders that have left them in a state of emotional limbo.
Besides supervised medication, patients require tender loving care which they often do not receive at home.
On the day Life visited the 52-year-old medical expert, she had her jet black hair neatly tucked in a bun and the light make-up on her face helped to accentuate her large compassionate eyes.
We accompanied Supanich on her morning rounds, as she leisurely strolled through Ward 10 of Srithanya Hospital, one of the country's oldest mental institutions, where she has worked for three decades. Supanich makes certain to check on the well-being of each patient. While gently holding their hands to examine if their fingernails need trimming, she exchanges pleasantries.
When she gets a few minutes to spare, we chat about her work.
"Contrary to popular belief, working with patients with mental problems is not as stressful as it is made out to be," observed Supanich. "Challenging and demanding, yes, but not stressful. I am thankful for having this opportunity to work with them.
"To see them make progress and eventually get back into society is highly rewarding for me. Their personal stories shed light on the need for family members and society to be more caring and sensitive towards each other.
"I always teach my nurses to carry out their duties with dedication and passion, offering medical care and solace to troubled minds, which are often shunned by outsiders."
As the ward she is in charge of services patients on the 30 baht healthcare scheme, largely for lower- to middle-class income workers, it was a pleasant surprise to see each resident spruced up and well taken care of by the staff.
Head nurse Supanich Polpairin on her morning rounds.
As the ratio of nurses to patients is 1:5, she said it was pivotal to have as much information as possible on the patient ID for the nurse on duty. Attached to their sleeve is information on their mental state of mind _ S signifying suicidal tendencies, A for accident prone, F for tendency to fight and E for tendency to escape. This makes it easier to monitor the 32 residents, who are between the ages of 15 and 60, of Ward 10.
Her target is to have each patient leave the hospital after two weeks of medical and counselling supervision due to the increase in patient numbers and limited number of beds. People most prone to mental disorders are often the ones that struggle to control their emotions, she said, adding that by the time they are brought to the hospital most are already hallucinating, an indication that their condition has reached an advanced stage.
As the ward's residents begin to line up for lunch, Supanich observes their behaviour intently. A patient in her teens waves back at her, she returns the gesture with a smile. Thai youngsters are prone to emotional problems at an alarming rate, she observed, and substandard childhood nurturing is believed to be at the root of it.
During a child's formative years, parents often neglect to instil proper survival tactics in them to manage disappointment, she said. So when these children become adults, they tend to have high expectations of both themselves and others, and when situations do not go in their favour, they just snap.
''It is always a good idea to emotionally prepare oneself for things to not go the way we desire, in that way, if it does go well, you can be happy, but if it does not go well you will not beat yourself up over it,'' said Supanich.
''The field of psychiatric nursing is not widely popular among nursing students because mental illness is a social stigma in Thai society. In comparison to other fields of nursing, mental health requires you to go the extra mile. I always tell my nurses that we have to be compassionate towards our patients because being in their position is not easy.
''Mental illness is not like a physical aliment. There is a stigma attached to it that makes sufferers ashamed to ask for help. It is important to be empathetic towards them, treating them as you would a relative.''
Nurses have to also educate themselves outside the classroom to better address the needs of their patients, she observed, by being informed of superstitions and traditional beliefs towards mental disorders.
Schizophrenia, bipolar disorder, psychosis, depression and dementia are the most frequently found mental illnesses among Thais today, she noted, so it is crucial for health workers to also keep themselves well informed of the latest development made in these fields.
For example, Supanich observed that early psychosocial theories identified a problematic maternal relationship as the cause of schizophrenia. Later, other theories addressed social context and unresolved family issues to be the sources. Biological theories then went on to suggest perinatal events, genetics, neuroanatomical abnormalities, and dysfunction of neurotransmitters as key risk factors for the development of schizophrenia. This proves that research continues to show there is much more than meets the eye to mental disorders.
''One of the most challenging aspects for our team is being a good observer,'' admits Supanich. ''As you can see for yourself, none of our patients are showing any outward signs of mental distress. The reason being that our nurses are explicitly trained to observe each patient's behavioural condition. We do not wait for an emotional outburst to manifest first before we treat it. The moment we detect a change in behaviour, the person is put on prescribed medication to control their condition.''
Personal insight and emotional maturity are essential characteristics of a qualified mental health nurse, she explains, while stopping briefly to encourage a bioplar patient who was being discharged on that day to take her medication regularly at home.
In between her afternoon rounds, she shares her concerns for patients that are required to take medication for the rest of their lives.
Group counselling, which encourages the family to join, are opportunities she takes to educate them on the need to have faith in the medication to heal them and help them integrate into society. While the devoted caregiver has another eight years yet before retirement, she hopes it can be used to promote the need for people to pay better attention to their mental health.
''I was drawn towards becoming a nurse for patients with mental illnesses because as a youngster I had to care for my parents who suffered from depression. I have learned so much from each patient that has passed through my ward. My biggest desire is to see Thai society pay better attention to their mental health. If patients are brought to the hospital in the early stages of their illness, there is a greater chance for them to get healed, but if it festers you can end up having to take medication all your life.''
Nursing students sit in on a counselling session to educate patients on coping with mental illness.
