Reprinted from OpenMind 106 Nov/Dec 2000
Diana Rose spent most of 1999 in acute psychiatric care
This is the story of that year
A year of care
On 4 February 1999, I was admitted under section 3 of the Mental Health Act 1983 to my local acute psychiatric unit. There I was to stay for the rest of the year, with a six-week break in the summer. I experienced two committals under section 3, and I also had two spells in the corresponding secure unit. This is the story of that year. It does not make happy reading; but then it was not a happy experience.
I was receiving the sharp end of psychiatry: control and restraint, forced injections, ECT, close observations and seclusion. I do not believe these were delivered with malign intentions. But something about the training and culture of psychiatry makes the administration of such interventions almost inhuman.
Seclusion. There is little in the literature about the reasons for this practice, still less about the experience of it. But can it ever be therapeutic to put someone in a strip cell with no opportunity for communication? The only reason I was let out was that the seclusion room was so cold.
The seclusion room was in the secure unit. This was described by one of my fellow patients as a 'hospital prison'. The main task of the nurses, of whom there were plenty, seemed to be to check, every 30 minutes, the whereabouts of everyone on the ward. They had a chart on which to record people's locations. The rest of the time they spent either in the office, in the pool-room, or walking about swinging bunches of keys. Patients who liked playing pool had some interaction from the nurses; the rest of us had none.
The secure unit practised a peculiar form of physical psychiatry. The main task of the doctors was to take blood. This was in order to check levels of drugs. But conversation seemed quite beyond the doctors, unless it was in the formal setting of the ward round. And the nature of the ward round, as has been said before, makes it very difficult for the patient to have their voice heard. I have a PhD and a reputation for being articulate, but I felt intimidated and unable to speak up in ward round situations. So I settled for blood tests as the preferred form of interaction with medical staff.
Other aspects of the secure unit were merely irritating. The evening meal was served around five o'clock, and dishes cleared away practically before you had finished eating. This was presumably to allow domestic staff to get away early. But this was itself symptomatic of the fact that the unit was run for the benefit of staff and not for the care of patients.
The only positive aspect of the secure unit was a separate, locked unit for women. This was four-bedded with a lounge, bathroom and toilets. But even here, staff made it clear that they resented locking and unlocking the women's space, and I was even told to leave it on the latch if alII wanted was a light for a cigarette (we were not permitted lighters). This horrified one of the senior nurses.
The visiting room was described by one of my visitors as 'worse than the visiting facilities in Brixton nick'.
Back on the acute unit, not much had changed. There was hardly any interaction between staff and patients. The interaction that did exist revolved around trouble. As long as there was something up, I got attention. When things were calmer and I was causing no trouble, I was ignored to the point of neglect. In the last few weeks, as I got ready for discharge, the boredom was crushing, even threatening to bring on another 'relapse'. The bureaucracy of the section 17 form did not help. Nurses communicated, as in other aspects, only to tell you what you could not do.
Some basic needs were not met. For instance, the acute unit was freezing cold. I spent my days in bed, not because of depression or 'lack of motivation' , but because it was the only way to keep warm. Sometimes the food was inedible, and there was not enough of it anyway. Medication was doled out with no information about changes of drugs or dosages. The physical environment was bleak and cramped, and the bathrooms often dirty.
The visiting space in the secure unit may have been awful, but in the acute unit there was no visiting space at all. You sat around the dining tables with your visitors, and had to put up with the constant blare of the television .
And, I have to confess, I did not fare very well with visitors. Stigma surrounds mental illness, and my academic and psychotherapeutic friends deserted me. A new group of friends composed itself - others who had been in my situation, other users of mental health services.
So, for much of the time, I was thrown on the mercy of staff. And, as I have recounted, this was not a merciful place to be. The exceptions were my community keyworker and my partner.
I do not mean to imply that the staff were nasty people. As individuals, they were kind and personable. But in their role as nurses they seemed to forget their communicative abilities and turn into beings 'too busy' to extend the hand of help to people who really were in need of it. The acute ward was peopled by lost souls pacing the ward, holding cups of coffee and smoking continuously. There was not even much interaction between patients, because we came from such different backgrounds and had such different interests. Having said that, there was still more communication between fellow patients than between patients and staff.
When communication did take place with staff, it was awesomely one-sided. It is surely no use to say to someone who believes the food is poisoned 'you have delusions with paranoid content'. This means nothing to them, or if it does mean something it is that their fears are not being taken seriously. Surely some more imaginative form of communication is possible, something that recognises reality for me, and reality for you. Something that does not hide behind the conventions of psychiatry as an excuse not to enter into meaningful dialogue with the patient.
My year in acute psychiatric 'care' did not help me to get over my illness. It merely prolonged my distress. And what is so depressing is that it would not take large amounts of money to make things better.
The culture of psychiatry has to change so that people are not treated as 'cases' or instances of categories, but as people with hopes, fears and aspirations, which need to be dealt with on a human level. Surely it should not be up to patients to say that psychiatric staff need to learn some communication skills?