Those of you who know me will know that I have been a patient in a psychiatric hospital many times over the past decade due to my Schizoaffective disorder. For those who don't know Schizoaffective disorder is like having the mood swings of Bipolar and the psychosis of Schizoprenia I’ve been admitted to hospital for this so many times that I’ve lost count. Recently I spent 5 months in a psychiatric hospital with a severe depressive episode and it was one of the worst periods of depression I’ve ever had.
To give some background back in January I ended up in hospital for mania. After I crashed from this I had a slow depression that crept up on me and eventually left me at the point where I was about to commit suicide. I had several ideas about how to go about this and I was very serious that I wanted to end my life. My major plan was that I would hang myself from a ligature point in my flat. Thankfully (for me) I was open with my partner (Howard) about what I wanted to do and he made sure I was not left alone until he could take me to see my psychiatrist where he basically begged her to take me into hospital. My psychiatrist agreed with him and since I wouldn’t go willingly she sectioned me under the mental health act. I was then brought to hospital and put on a locked ward. At the time this felt like the worst thing ever but looking back I am eternally grateful because it literally saved my life.
I’m going to go through 7 facts on what it’s like being admitted and staying in a psychiatric hospital. Please note I can only give you my point of view of what I’ve seen and experienced. Everyone’s experience is different but there are some similarities.
Everybody gets admitted for different reasons but there is usually a few things that they have in common. Mainly to be admitted you need to be a danger to yourself, or others. People can and do go to hospital voluntarily however a bed is really only given when there is a clear danger. There is a very serious shortage of beds in the NHS for things like mental health. The hospital I was staying in this time recently built a whole new section for their acute wards. They lost 20 beds in the process so that has put a massive strain on an already strained hospital!
It’s not always just being suicidal that makes a person a danger to themselves,mania (when a person may well be presenting as happy) can also be dangerous. For example when manic I had the idea that I could climb onto North Bridge and lean back and be supported by angels to float to the ground. I was elated and appeared incredibly happy; not suicidal in the traditional way at all but I was a very real, serious danger to myself and possibly for anyone who tried to help me or intervene with my plans.
To get admitted usually someone has to come into contact with a medical professional such as a GP, nurse or psychiatrist. Sometimes if the person’s behaviour attracts the attention of the police they will bring the person into a hospital to be assessed. In Edinburgh we have MHAS - Mental Health Assessment Services. I’ve been sent to MHAS before by my GP, sometimes family have brought me into MHAS to be assessed and other times my CPN - Community Psychiatric Nurse has sent me. When I was admitted this time I just so happened to be at a routine appointment with my psychiatrist and because my mental health officer was also there it was easy for them to section me on the spot without involving the police or MHAS. To be sectioned you need to have both a psychiatrist and a mental health officer agree that you need to be detained. Had I refused to come in to hospital though then the police would have gotten involved. This is not because I’d done anything wrong it would just be to get me as quickly to hospital as possible where I’d be safe. Initially I was detained for 28 days but then that changed to a 6 months detention.
It’s also important to note that even if you go voluntary that doesn’t mean you can choose to leave at anytime. In my experience if you are unwell enough to be there at all you are not well enough to simply leave. If you do ask, or try to leave (remember that the door is locked) they will send a doctor first to assess you and most of the time you will then just be sectioned. Once you come into the locked ward and the door closes behind you it’s not easy to leave at all regardless if you are voluntary or detained.
I’ll be honest those first few days after being admitted are the hardest. When you’re used to doing whatever you please to suddenly be confined to a psychiatric ward is terrifying. Over the years I’ve gotten used to it but the anxiety still creeps up on me every time. The feelings of panic that you can’t just leave and you are at the mercy of the doctors and nurses. It is somewhat frightening and it gets to me. Those first few days are the worst.
Passes are just the term that in the psychiatric wards I’ve been in means ‘time out the ward’. The more unwell you are the more restricted your passes. Also they assess how likely it is that you will abscond or self harm or do any other risky things on your pass. Usually (for me) it takes 3 or 4 weeks and then I’m given nurse escort passes. This means I am allowed to leave the ward if I have a nurse with me (often they extend this to occupational therapists as well). So to give an example when I wanted to go to hearing voices group which is still in the hospital but not on the ward a nurse would take me and wait until the group had finished then take me back. If you run away they will simply phone the police. Before you leave the ward they write down a description of what you are wearing etc… I have never absconded but I’ve known other patients who have and it does seem to be the case that they are found very quickly and brought back to the ward and then of course any passes they did have are lost and they have to build up trust again from scratch.
The next stage with passes is family (then friends) escorted passes. This means that the hospital will allow you to go out with visitors. Depending on how unwell you are depends on who is allowed to take you out and for how long. When I first started getting these passes it was only Howard (my partner) who was allowed to take me out and only for an hour. Gradually this built up to having friends and other family take me out and for longer periods. It was several months until I was allowed to leave the hospital site itself.
If this goes well you are then given limited passes on your own. It starts off just 5 minutes and then 15, 30, 1 hour. When this finally happened for me I found that I was extremely anxious to go anywhere alone and despite wanting my freedom I just didn’t use the passes because I was too afraid. The nurses noticed this and we did graded exposure which means a nurse takes you on a walk, leaves you there and then you have to walk back by yourself. This might seem silly but I was really and genuinely very frightened when doing this. I realise it was important though because if I ever wanted to leave hospital I needed to learn to walk about outside on my own! Eventually I got more used to being outwith the ward and walking around on my own. Patients at the start of their stay are often more restricted to the ward and not doing very much outwith it. Towards the end of a stay (especially if it’s been a long one) a patient starts to spend more and more time away. The last couple of weeks I was spending entire days outside and only coming back in the evening to sleep.
If you have a mental illness and there is even a small chance that you will be hospitalised at some point then it is well worth having a named person. Who you choose as your named person is up to you but ideally it will be someone close to you and it must be someone that you trust knowing all the details about your mental illness and circumstances. Howard (my partner) is my named person. This means he receives copies of any important documents such as notice that I’ve been sectioned or the outcome of any mental health tribunal. He is also invited to attend any important meetings and tribunals. During the time I was in hospital and beyond my mental health officer was able to phone him directly and keep him up to date and more importantly Howard’s input was given consideration when it came to how I was treated. He also at one point had a meeting with my psychiatrist about me without me being there just so he could give his point of view. I felt that they take what he says very seriously and he is a good advocate for me. He is also invited to my discharge planning meeting and when I’m out of hospital he has the contact number for the CMHT Community Mental Health Team and he can call at any point if he is concerned with anything to do with my mental health. Some people might think that this means he can get me sectioned again easily if he wants to. This is not the case, although his view will be taken into consideration a psychiatrist and a mental health officer still have to agree to me being sectioned.
One of the things that’s unavoidable when you are in a mental hospital is the fact that there are other patients. Every mental hospital is different. I am very lucky that at least in the newly built hospital (The Royal Edinburgh) each person has their own room, toilet and shower. In the past though I was in a dorm with 7 other women and this was extremely difficult. It can be hard to unwind and relax when you’re in a dorm and everyone has different mental illness and is at different stages of recovery. I often found in these situations that I wasn’t getting enough sleep which was making my mental health much worse.
Meal times tend to be in a communal area and if like me you need some kind of human contact then some time spent in the communal areas is likely. I’ve been in single sexed and mixed sexed wards. When I was in IPCU Intensive Psychiatric Care Unit it was mixed. The sleeping areas/rooms tend to be separate but the communal areas are not. If I’m honest I don’t like mixed sex wards. I usually feel anxious and vulnerable. I have been sexually assaulted in the past and when I’m unwell enough to need hospital I’m usually in a very vulnerable position. I do not feel comfortable being around men in this situation. Because I have been raped in the past and men are threatening to me in general I am extremely anxious in mixed sex wards. I have a hard enough time with male staff let alone male patients who are unwell themselves and often acting in an inappropriate way. I spent most of my time in the mixed ward on flight or fight mode or hiding in my room and a male patient did barge into my room at least once despite it being against the rules. After I moved from IPCU into the normal acute ward it was all woman and I was able to relax a bit more and feel safer.
Some people make friends when on the ward. I have made friends and there have been people that I have genuinely warmed to and liked. I’ve found though that it’s hard to stay in touch once you are out because at least in my case I’m a very different person when I am unwell and once I’m out I want to leave that part of myself behind. If I bump into people I’ve met in hospital I’ll often say hello (I wish everyone well) but it’s rare for me to stay in touch. I’ve learned a lot about people through being in the wards. I remember some of the roughest looking people on the ward turned out to be the most gentle and kind hearted woman I’ve ever met. I’ve also met some very interesting people and learned a huge amount about mental illness. I would recommend if you are on the ward, do interact with the other patients. In my experience isolating myself only made my mental health worse. I have even picked up some techniques from other patients about how to manage my illness or how to deal with the side effects of my medication.
So apart from not being allowed to leave the ward unless you have a ‘pass’ what other restrictions are there? The answer it that it’s different for each individual. One restriction that almost happened to me a couple of times but fortunately I avoided was to restrict access to my phone. This can be for many reasons. For me it almost happened because I was manic and was posting lots on Facebook and calling and messaging people in the middle of the night. I was also at one point during my manic stay in January inviting random men I’d met on Tinder to come to the hospital for sex. There were actually men who knowing my situation and obviously realising I was seriously mentally ill (I was after all in detained in a mental hospital) who still thought that was an acceptable thing to do! When I’ve seen other people with a phone restriction usually they get some time on their phone but with staff watching. The amount of time you might get on your phone does also depend on how free nurses and nursing assistants are you supervise.
Another restriction that people have that I’ve seen is very difficult is not being allowed to smoke. I don’t smoke thankfully but for people that do they are often really struggling. The ward is completely smoke-free now. In order to smoke you need passes to go out. Usually smokers are given 10 minute passes quite quickly. Obviously if they run away during that time they lose those passes. In the Royal Edinburgh each acute ward has a little garden. Smoking is NOT allowed in this garden but vaping is. If you are a smoker and you think that you might end up on the ward then having a vape on you might be a good idea rather than have to go cold turkey. They do offer smoking alternatives such as gum, patches, inhalators. I am very anti-smoking but even I can understand that when you are seriously mentally ill and living in a mental hospital, it's not the best time to quit! (Saying that I’ve known people who’ve done it). To prevent people smoking on the ward or in their rooms everyone is searched when they first arrive and cigarettes and lighters are confiscated. They search everyone who comes in regardless just to make sure that they don’t have anything on them that can be used to hurt themselves or others so things like razors, over the counter medications, sharp objects, or glass are all taken away. It’s also worth noting that IPCU is a lot stricter. In there, there are a lot of things that you can’t have. I wasn’t even allowed my spare clothes during my weeks in there or my phone charger, or toiletries. IPCU is very restrictive but fortunately most people don’t end up in there or if they do it’s only when their illness is at its most severe.
The other main restriction is visiting times. There are set times that friends and family can visit. For my ward it was 2pm till 4pm and 6.30pm till 8pm. Outwith those times it has to be agreed by the nurses on the ward. Some are stricter than others especially in IPCU because in IPCU all visits are supervised. The bonus of getting friends and family passes is that you are less restricted because you are allowed with visitors off the ward. It took me months to get to that stage though so I was very limited in how much time I could spend with people I care about. An extra note for people with kids. There is a family room separate from the ward that’s quite nice and if you have children usually it’s possible to book that room making it a little easier for children to visit. Obviously I can only talk about the Royal Edinburgh hospital here.
During your time in a psychiatric hospital/ward you will come into contact with different members of staff. The most important one will be your consultant psychiatrist because they make all the basic decisions such as when you are ready to go home, what passes you get and what medication you take. These decisions are mostly based on what the nurses are reporting back about you. I saw my psychiatrist on average about once a week. Sometimes I’d go two weeks but one of her juniors would check how I’m doing and feed back to her. If you are detained and refusing meds it’s not uncommon to be forcibly injected. That doesn’t mean that the doctors won’t listen to your opinion about drugs and which drugs work for you and what doesn’t. My own consultant was very good at listening to me and Howard. I’ve been going through the system for a decade, I’m educated about many of the drugs and have first hand experience on how many of them affect me. The plan they came up with that got me better this time I really felt that I had a say in it. My consultant listened to my views and also Howard's views. In return I was open minded and listened to my doctor and I was willing to try a new medication that I’ve never been on before and that I didn’t know much about. I put my trust in her and it paid off because it seems that this new drug (Lamotrigine) has actually allowed me to recover. I have a very good relationship with my hospital psychiatrist she even gave me a hug after my discharge meeting. Like most consultants she has an air about her of being in charge and 10 years ago I was actually afraid of her! Now that I’m older and had many admissions under her care I have nothing but respect and trust in her. She is very good at doing her job and she has brought me back from the brink so many times.
You will also come into contact with nurses. Usually everyone has a key worker and that person will guide your recovery, catch up with you regularly and be the person you go to if there are any problems. It’s important that you gel with your key worker and if you don’t it’s perfectly acceptable to ask for a swap. I’ve done this in the past with no real issue. I had two key workers this time and they were so important in my recovery. One word of warning though everything you say to nurses is very likely to go on your notes. Nowadays health professionals have access to a software note taking system called Track so what you say to one nurse will likely get passed on to other professionals involved in your care. Along with talking to you nurses are also responsible for giving out medication. Another thing worth noting is that nurses are often doing 12 hour plus long shifts. They are not immune from making mistakes so if you are with it enough it’s good to be checking what medication they are giving you. In my 5 month stay I was given the wrong medication twice, both times I noticed and it was sorted out.
Along with nurses there are nursing assistants who are there to make sure the ward is running smoothly and be on the floor most of the time which nurses can’t do because they have to write and read notes. I got on well with most of the nursing assistants and I often opened up to them in moments I was really struggling and there weren’t any formal nurses about. They do also feedback anything you say to the nurses so again be mindful that what you are saying is likely being put on your notes.
Each time I’ve been discharged it’s happened a little differently. When I’ve been there on a voluntary basis and it’s been a relatively short admission then I usually get a couple of over-night passes then discharged. It’s worth noting that because of the shortage of beds in mental health wards if you do go on overnight pass they frequently give your bed away which makes it hard if your pass didn’t go well! When it’s been a longer admission and I’ve been detained then usually there is a discharge planning meeting were all the people who have been involved in your care have a meeting to discuss how the admission has gone and what (if any) support you might have in the community. This can be daunting having so many people in one room talking about you. It’s often helpful to bring someone you trust to be there with you. Isaac (one of my partners) attended my most recent discharge meeting and that was helpful because he was able to help me remember what was said and just give me a bit of moral support. Ideally your named person should be there but on this particular occasion Howard couldn’t make it. At my last discharge meeting my Psychiatrist, Psychologist, CPN, Mental Health Officer, a nurse from the ward and myself and Isaac attended.
Everyone feels very different about discharge. When my psychiatrist first told me we were working towards discharge (about 3 weeks before it happened) I was really apprehensive and worried that I wasn’t ready and that I wouldn’t cope at home. I trust my Dr though and she was confident that now was a good time. It’s rare that someone is completely 100 percent well before discharge. There is too much of a shortage of beds for that to be the case but I was definitely no longer a danger to myself anymore. As it stands within the 3 weeks that I waited for my discharge planning meeting my mental health improved even more so that I was as well as possible when I finally was discharged.
Going home after such a long stay is scary. I had become somewhat institutionalised. The hospital routine was really familiar and safe for me. I was used to meals coming at certain times and now even 3 weeks after discharge I’m not really cooking for myself. I was used to having someone about 24/7 and never really being alone. I still haven’t spent a night alone in the flat yet and that’s a bit daunting. The truth is that as much as it’s great to be discharged after so long it’s also scary and it takes time to adapt back into real life. For me after such a severe depression that lasted a long time, I still have anxiety about it coming back. Now I am well and I can see just how close I was to ending my life I am terrified of ever getting that unwell again. My life is literally at risk which I think many people fail to understand with serious mental illness.
I’m doing much better now. I have as close to a normal life as I can get. I hope that the medication combination I’m on now will keep me sane for a long time. Realistically I will get unwell again at some point but I hope I at least get a decent run with my new found stability. I am grateful to the hospital for helping me get better; for basically saving my life. I needed to be there to be safe and get better. I was angry at the time that I was being detained but without that happening I would possibly not have survived. It meant that the people who love me (Howard) weren’t under so much pressure because before I was admitted I couldn’t be left on my own for even 5 minutes! I had a very good and positive experience this hospital stay. On the whole I think I was very lucky. If you are ever in the situation were you need to stay in a psychiatric ward, all I can say is that the hospital is there to help you get better. It’s not prison! It can be scary but it can also be a relief to finally be in a place that is going to let you heal. The stigma around mental illness and mental hospitals/wards needs to be broken. Like physical illness, it can happen to anybody at anytime. Nobody is immune. The experiences I’ve had through being mentally ill, in hospital and coming into contact with other mentally ill people has been profound. It has been life changing in both a positive and negative way. It’s horrible getting so unwell but I really believe that it’s made me a better more empathic person. I hope writing this blog has helped in some way to demystify mental illness and mental hospitals.
To give some background back in January I ended up in hospital for mania. After I crashed from this I had a slow depression that crept up on me and eventually left me at the point where I was about to commit suicide. I had several ideas about how to go about this and I was very serious that I wanted to end my life. My major plan was that I would hang myself from a ligature point in my flat. Thankfully (for me) I was open with my partner (Howard) about what I wanted to do and he made sure I was not left alone until he could take me to see my psychiatrist where he basically begged her to take me into hospital. My psychiatrist agreed with him and since I wouldn’t go willingly she sectioned me under the mental health act. I was then brought to hospital and put on a locked ward. At the time this felt like the worst thing ever but looking back I am eternally grateful because it literally saved my life.
I’m going to go through 7 facts on what it’s like being admitted and staying in a psychiatric hospital. Please note I can only give you my point of view of what I’ve seen and experienced. Everyone’s experience is different but there are some similarities.
1 Being admitted
Everybody gets admitted for different reasons but there is usually a few things that they have in common. Mainly to be admitted you need to be a danger to yourself, or others. People can and do go to hospital voluntarily however a bed is really only given when there is a clear danger. There is a very serious shortage of beds in the NHS for things like mental health. The hospital I was staying in this time recently built a whole new section for their acute wards. They lost 20 beds in the process so that has put a massive strain on an already strained hospital!
It’s not always just being suicidal that makes a person a danger to themselves,mania (when a person may well be presenting as happy) can also be dangerous. For example when manic I had the idea that I could climb onto North Bridge and lean back and be supported by angels to float to the ground. I was elated and appeared incredibly happy; not suicidal in the traditional way at all but I was a very real, serious danger to myself and possibly for anyone who tried to help me or intervene with my plans.
To get admitted usually someone has to come into contact with a medical professional such as a GP, nurse or psychiatrist. Sometimes if the person’s behaviour attracts the attention of the police they will bring the person into a hospital to be assessed. In Edinburgh we have MHAS - Mental Health Assessment Services. I’ve been sent to MHAS before by my GP, sometimes family have brought me into MHAS to be assessed and other times my CPN - Community Psychiatric Nurse has sent me. When I was admitted this time I just so happened to be at a routine appointment with my psychiatrist and because my mental health officer was also there it was easy for them to section me on the spot without involving the police or MHAS. To be sectioned you need to have both a psychiatrist and a mental health officer agree that you need to be detained. Had I refused to come in to hospital though then the police would have gotten involved. This is not because I’d done anything wrong it would just be to get me as quickly to hospital as possible where I’d be safe. Initially I was detained for 28 days but then that changed to a 6 months detention.
It’s also important to note that even if you go voluntary that doesn’t mean you can choose to leave at anytime. In my experience if you are unwell enough to be there at all you are not well enough to simply leave. If you do ask, or try to leave (remember that the door is locked) they will send a doctor first to assess you and most of the time you will then just be sectioned. Once you come into the locked ward and the door closes behind you it’s not easy to leave at all regardless if you are voluntary or detained.
I’ll be honest those first few days after being admitted are the hardest. When you’re used to doing whatever you please to suddenly be confined to a psychiatric ward is terrifying. Over the years I’ve gotten used to it but the anxiety still creeps up on me every time. The feelings of panic that you can’t just leave and you are at the mercy of the doctors and nurses. It is somewhat frightening and it gets to me. Those first few days are the worst.
2 Passes
Passes are just the term that in the psychiatric wards I’ve been in means ‘time out the ward’. The more unwell you are the more restricted your passes. Also they assess how likely it is that you will abscond or self harm or do any other risky things on your pass. Usually (for me) it takes 3 or 4 weeks and then I’m given nurse escort passes. This means I am allowed to leave the ward if I have a nurse with me (often they extend this to occupational therapists as well). So to give an example when I wanted to go to hearing voices group which is still in the hospital but not on the ward a nurse would take me and wait until the group had finished then take me back. If you run away they will simply phone the police. Before you leave the ward they write down a description of what you are wearing etc… I have never absconded but I’ve known other patients who have and it does seem to be the case that they are found very quickly and brought back to the ward and then of course any passes they did have are lost and they have to build up trust again from scratch.
The next stage with passes is family (then friends) escorted passes. This means that the hospital will allow you to go out with visitors. Depending on how unwell you are depends on who is allowed to take you out and for how long. When I first started getting these passes it was only Howard (my partner) who was allowed to take me out and only for an hour. Gradually this built up to having friends and other family take me out and for longer periods. It was several months until I was allowed to leave the hospital site itself.
If this goes well you are then given limited passes on your own. It starts off just 5 minutes and then 15, 30, 1 hour. When this finally happened for me I found that I was extremely anxious to go anywhere alone and despite wanting my freedom I just didn’t use the passes because I was too afraid. The nurses noticed this and we did graded exposure which means a nurse takes you on a walk, leaves you there and then you have to walk back by yourself. This might seem silly but I was really and genuinely very frightened when doing this. I realise it was important though because if I ever wanted to leave hospital I needed to learn to walk about outside on my own! Eventually I got more used to being outwith the ward and walking around on my own. Patients at the start of their stay are often more restricted to the ward and not doing very much outwith it. Towards the end of a stay (especially if it’s been a long one) a patient starts to spend more and more time away. The last couple of weeks I was spending entire days outside and only coming back in the evening to sleep.
3 Named Person
If you have a mental illness and there is even a small chance that you will be hospitalised at some point then it is well worth having a named person. Who you choose as your named person is up to you but ideally it will be someone close to you and it must be someone that you trust knowing all the details about your mental illness and circumstances. Howard (my partner) is my named person. This means he receives copies of any important documents such as notice that I’ve been sectioned or the outcome of any mental health tribunal. He is also invited to attend any important meetings and tribunals. During the time I was in hospital and beyond my mental health officer was able to phone him directly and keep him up to date and more importantly Howard’s input was given consideration when it came to how I was treated. He also at one point had a meeting with my psychiatrist about me without me being there just so he could give his point of view. I felt that they take what he says very seriously and he is a good advocate for me. He is also invited to my discharge planning meeting and when I’m out of hospital he has the contact number for the CMHT Community Mental Health Team and he can call at any point if he is concerned with anything to do with my mental health. Some people might think that this means he can get me sectioned again easily if he wants to. This is not the case, although his view will be taken into consideration a psychiatrist and a mental health officer still have to agree to me being sectioned.
4 Other Patients
One of the things that’s unavoidable when you are in a mental hospital is the fact that there are other patients. Every mental hospital is different. I am very lucky that at least in the newly built hospital (The Royal Edinburgh) each person has their own room, toilet and shower. In the past though I was in a dorm with 7 other women and this was extremely difficult. It can be hard to unwind and relax when you’re in a dorm and everyone has different mental illness and is at different stages of recovery. I often found in these situations that I wasn’t getting enough sleep which was making my mental health much worse.
Meal times tend to be in a communal area and if like me you need some kind of human contact then some time spent in the communal areas is likely. I’ve been in single sexed and mixed sexed wards. When I was in IPCU Intensive Psychiatric Care Unit it was mixed. The sleeping areas/rooms tend to be separate but the communal areas are not. If I’m honest I don’t like mixed sex wards. I usually feel anxious and vulnerable. I have been sexually assaulted in the past and when I’m unwell enough to need hospital I’m usually in a very vulnerable position. I do not feel comfortable being around men in this situation. Because I have been raped in the past and men are threatening to me in general I am extremely anxious in mixed sex wards. I have a hard enough time with male staff let alone male patients who are unwell themselves and often acting in an inappropriate way. I spent most of my time in the mixed ward on flight or fight mode or hiding in my room and a male patient did barge into my room at least once despite it being against the rules. After I moved from IPCU into the normal acute ward it was all woman and I was able to relax a bit more and feel safer.
Some people make friends when on the ward. I have made friends and there have been people that I have genuinely warmed to and liked. I’ve found though that it’s hard to stay in touch once you are out because at least in my case I’m a very different person when I am unwell and once I’m out I want to leave that part of myself behind. If I bump into people I’ve met in hospital I’ll often say hello (I wish everyone well) but it’s rare for me to stay in touch. I’ve learned a lot about people through being in the wards. I remember some of the roughest looking people on the ward turned out to be the most gentle and kind hearted woman I’ve ever met. I’ve also met some very interesting people and learned a huge amount about mental illness. I would recommend if you are on the ward, do interact with the other patients. In my experience isolating myself only made my mental health worse. I have even picked up some techniques from other patients about how to manage my illness or how to deal with the side effects of my medication.
5 Restrictions
So apart from not being allowed to leave the ward unless you have a ‘pass’ what other restrictions are there? The answer it that it’s different for each individual. One restriction that almost happened to me a couple of times but fortunately I avoided was to restrict access to my phone. This can be for many reasons. For me it almost happened because I was manic and was posting lots on Facebook and calling and messaging people in the middle of the night. I was also at one point during my manic stay in January inviting random men I’d met on Tinder to come to the hospital for sex. There were actually men who knowing my situation and obviously realising I was seriously mentally ill (I was after all in detained in a mental hospital) who still thought that was an acceptable thing to do! When I’ve seen other people with a phone restriction usually they get some time on their phone but with staff watching. The amount of time you might get on your phone does also depend on how free nurses and nursing assistants are you supervise.
Another restriction that people have that I’ve seen is very difficult is not being allowed to smoke. I don’t smoke thankfully but for people that do they are often really struggling. The ward is completely smoke-free now. In order to smoke you need passes to go out. Usually smokers are given 10 minute passes quite quickly. Obviously if they run away during that time they lose those passes. In the Royal Edinburgh each acute ward has a little garden. Smoking is NOT allowed in this garden but vaping is. If you are a smoker and you think that you might end up on the ward then having a vape on you might be a good idea rather than have to go cold turkey. They do offer smoking alternatives such as gum, patches, inhalators. I am very anti-smoking but even I can understand that when you are seriously mentally ill and living in a mental hospital, it's not the best time to quit! (Saying that I’ve known people who’ve done it). To prevent people smoking on the ward or in their rooms everyone is searched when they first arrive and cigarettes and lighters are confiscated. They search everyone who comes in regardless just to make sure that they don’t have anything on them that can be used to hurt themselves or others so things like razors, over the counter medications, sharp objects, or glass are all taken away. It’s also worth noting that IPCU is a lot stricter. In there, there are a lot of things that you can’t have. I wasn’t even allowed my spare clothes during my weeks in there or my phone charger, or toiletries. IPCU is very restrictive but fortunately most people don’t end up in there or if they do it’s only when their illness is at its most severe.
The other main restriction is visiting times. There are set times that friends and family can visit. For my ward it was 2pm till 4pm and 6.30pm till 8pm. Outwith those times it has to be agreed by the nurses on the ward. Some are stricter than others especially in IPCU because in IPCU all visits are supervised. The bonus of getting friends and family passes is that you are less restricted because you are allowed with visitors off the ward. It took me months to get to that stage though so I was very limited in how much time I could spend with people I care about. An extra note for people with kids. There is a family room separate from the ward that’s quite nice and if you have children usually it’s possible to book that room making it a little easier for children to visit. Obviously I can only talk about the Royal Edinburgh hospital here.
6 Staff
During your time in a psychiatric hospital/ward you will come into contact with different members of staff. The most important one will be your consultant psychiatrist because they make all the basic decisions such as when you are ready to go home, what passes you get and what medication you take. These decisions are mostly based on what the nurses are reporting back about you. I saw my psychiatrist on average about once a week. Sometimes I’d go two weeks but one of her juniors would check how I’m doing and feed back to her. If you are detained and refusing meds it’s not uncommon to be forcibly injected. That doesn’t mean that the doctors won’t listen to your opinion about drugs and which drugs work for you and what doesn’t. My own consultant was very good at listening to me and Howard. I’ve been going through the system for a decade, I’m educated about many of the drugs and have first hand experience on how many of them affect me. The plan they came up with that got me better this time I really felt that I had a say in it. My consultant listened to my views and also Howard's views. In return I was open minded and listened to my doctor and I was willing to try a new medication that I’ve never been on before and that I didn’t know much about. I put my trust in her and it paid off because it seems that this new drug (Lamotrigine) has actually allowed me to recover. I have a very good relationship with my hospital psychiatrist she even gave me a hug after my discharge meeting. Like most consultants she has an air about her of being in charge and 10 years ago I was actually afraid of her! Now that I’m older and had many admissions under her care I have nothing but respect and trust in her. She is very good at doing her job and she has brought me back from the brink so many times.
You will also come into contact with nurses. Usually everyone has a key worker and that person will guide your recovery, catch up with you regularly and be the person you go to if there are any problems. It’s important that you gel with your key worker and if you don’t it’s perfectly acceptable to ask for a swap. I’ve done this in the past with no real issue. I had two key workers this time and they were so important in my recovery. One word of warning though everything you say to nurses is very likely to go on your notes. Nowadays health professionals have access to a software note taking system called Track so what you say to one nurse will likely get passed on to other professionals involved in your care. Along with talking to you nurses are also responsible for giving out medication. Another thing worth noting is that nurses are often doing 12 hour plus long shifts. They are not immune from making mistakes so if you are with it enough it’s good to be checking what medication they are giving you. In my 5 month stay I was given the wrong medication twice, both times I noticed and it was sorted out.
Along with nurses there are nursing assistants who are there to make sure the ward is running smoothly and be on the floor most of the time which nurses can’t do because they have to write and read notes. I got on well with most of the nursing assistants and I often opened up to them in moments I was really struggling and there weren’t any formal nurses about. They do also feedback anything you say to the nurses so again be mindful that what you are saying is likely being put on your notes.
7 Discharge
Each time I’ve been discharged it’s happened a little differently. When I’ve been there on a voluntary basis and it’s been a relatively short admission then I usually get a couple of over-night passes then discharged. It’s worth noting that because of the shortage of beds in mental health wards if you do go on overnight pass they frequently give your bed away which makes it hard if your pass didn’t go well! When it’s been a longer admission and I’ve been detained then usually there is a discharge planning meeting were all the people who have been involved in your care have a meeting to discuss how the admission has gone and what (if any) support you might have in the community. This can be daunting having so many people in one room talking about you. It’s often helpful to bring someone you trust to be there with you. Isaac (one of my partners) attended my most recent discharge meeting and that was helpful because he was able to help me remember what was said and just give me a bit of moral support. Ideally your named person should be there but on this particular occasion Howard couldn’t make it. At my last discharge meeting my Psychiatrist, Psychologist, CPN, Mental Health Officer, a nurse from the ward and myself and Isaac attended.
Everyone feels very different about discharge. When my psychiatrist first told me we were working towards discharge (about 3 weeks before it happened) I was really apprehensive and worried that I wasn’t ready and that I wouldn’t cope at home. I trust my Dr though and she was confident that now was a good time. It’s rare that someone is completely 100 percent well before discharge. There is too much of a shortage of beds for that to be the case but I was definitely no longer a danger to myself anymore. As it stands within the 3 weeks that I waited for my discharge planning meeting my mental health improved even more so that I was as well as possible when I finally was discharged.
Going home after such a long stay is scary. I had become somewhat institutionalised. The hospital routine was really familiar and safe for me. I was used to meals coming at certain times and now even 3 weeks after discharge I’m not really cooking for myself. I was used to having someone about 24/7 and never really being alone. I still haven’t spent a night alone in the flat yet and that’s a bit daunting. The truth is that as much as it’s great to be discharged after so long it’s also scary and it takes time to adapt back into real life. For me after such a severe depression that lasted a long time, I still have anxiety about it coming back. Now I am well and I can see just how close I was to ending my life I am terrified of ever getting that unwell again. My life is literally at risk which I think many people fail to understand with serious mental illness.
I’m doing much better now. I have as close to a normal life as I can get. I hope that the medication combination I’m on now will keep me sane for a long time. Realistically I will get unwell again at some point but I hope I at least get a decent run with my new found stability. I am grateful to the hospital for helping me get better; for basically saving my life. I needed to be there to be safe and get better. I was angry at the time that I was being detained but without that happening I would possibly not have survived. It meant that the people who love me (Howard) weren’t under so much pressure because before I was admitted I couldn’t be left on my own for even 5 minutes! I had a very good and positive experience this hospital stay. On the whole I think I was very lucky. If you are ever in the situation were you need to stay in a psychiatric ward, all I can say is that the hospital is there to help you get better. It’s not prison! It can be scary but it can also be a relief to finally be in a place that is going to let you heal. The stigma around mental illness and mental hospitals/wards needs to be broken. Like physical illness, it can happen to anybody at anytime. Nobody is immune. The experiences I’ve had through being mentally ill, in hospital and coming into contact with other mentally ill people has been profound. It has been life changing in both a positive and negative way. It’s horrible getting so unwell but I really believe that it’s made me a better more empathic person. I hope writing this blog has helped in some way to demystify mental illness and mental hospitals.
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