Ten things I love after coming out the mental hospital

I wanted to write a more lighthearted blog, I feel my last one was a bit too serious (not many people wanted to read it!) I thought I’d write something a bit more personal – something not just about mental health but about me as a person and about where my life is now and where it might head. Also I wanted to discuss other aspects of my life, like polyamory (I’ve been polyamorous for 14 years!) So I’ll list ten things that are better since leaving hospital.

1. My depression has gone!

I have been depressed off and on since my late teens. However this particular bout of depression was particularly severe. I sometimes could put a face on and carry on like I was okay even if on the inside I basically felt dead, but the longer that went on, the harder and harder it became to “fake it till I make it”, and I started spending days in bed, feeling so disgusting inside that I genuinely felt the only way to free myself was to die. I seriously wanted to die: I planned it. I took an overdose (it didn’t work) so I planned to hang myself. I was prepared to go through the gruesomeness of hanging to achieve death, as I believed that nothing could feel worse than the depression. When I died I hoped I just wouldn’t exist anymore because existing felt too painful. The only reason that didn’t happen was because Howard stopped me, got me help and I was sectioned.

Now six months on I feel free. I am so very glad that he helped me. I was furious to be sectioned but it literally saved my life. That’s what sectioning is meant to do. There is not a moment that goes by that I don’t remember that I’m not depressed. I feel it’s important to fully comprehend that people who have serious mental illness are at risk of dying when their illness is at its most severe. When anyone with that kind of life-threatening illness recovers, they appreciate life in a new way. You never forget that you’ve been so unwell and you never take for granted the feeling of good health. Also you live in fear of it returning. If I feel even a little bit sad for a few moments I think “shit, it’s coming back” and it really panics me. It’s been 44 days that my mood has been stable; I fill in a mood chart so I can see how things are day to day. I don’t know how long it will last; in the past ten years I really haven’t ever felt this well. I hope it will last a long time but I’m making the most of every moment. I’m honestly not sure I could survive another bout of depression as severe and as long-lasting as that.

2. I’m seeing my partner (Howard) more

Without going into too much detail about Howard’s private situation, there were lots of changes for him when I was in hospital. It’s worked out that he now has more time for me. I adore Howard. I think that anyone who knows us will see that clearly. I have never in my life met a person that is so kind to me. He’s done things for me that I never imagined another human would ever do. For example when I was in hospital he visited me almost every day for the full five months. When he was tired and needed a break, he would only take one when he was able to arrange another visitor, making sure that I was never without a visitor even though I never asked this of him. As a result there was not a single day that I went without a visitor. I remember one time he told me that seeing me there was the highlight of his day, which kind of got through the depression and made me feel loved. Now I get way more overnight visits with him and see him a lot more than I used to.

The extra overnight stays are the best. I love going to bed with him and waking up with him in the morning. I love visiting him and being around him. Everything about him makes me happy. When he’s with me, I get a sense of calm in his presence that I’ve never had before. It feels like I’m home. I don’t want this to change back; I want to continue seeing him as often as I do now. I have never felt so happy and in love and I’ve never fully trusted someone to always have my best interests at heart. In the past my trust has always been broken.

3. Less anxiety

One of the things that I suffered from terribly over the past ten years is pretty extreme anxiety. I chart my anxiety out of ten, with zero being none at all and ten being that I’m so anxious I am at the point of vomiting. I regularly (once or twice a week) vomited from anxiety. Before I went into hospital it was daily. I never imagined my anxiety would ever be under control. However, on my new meds regime where I’m able to take a high dose of amitriptyline, my anxiety is under control for the first time in years. It’s so good to just relax! I have days where I get a bit anxious but usually it’s on the lower end of the scale and I now get times when I’m not anxious at all. So my anxiety is a zero on my chart. In the past this just never happened. It’s a very freeing feeling to not have that gut-churning anxiety all time time. I can be more social without freaking out beforehand that everyone hates me, and I’m not constantly worrying like I used to any more. In fact even though I do care what people think, it’s nowhere near as much as I used to!

4. Not sleeping all the time

This is huge for me, because for the past ten years I have slept so much. In my old routine I would go to bed by 10pm, sometimes much earlier, and regardless of how early I went to bed I would regularly not wake up until 11am or 12pm or even later. It wasn’t unheard of for me to sleep until 2pm. I was taking a drug called chlorpromazine and it was making me very, very drowsy. The sleepiness I felt invaded every part of my life. Mornings were lost because even when I did get up earlier I was thinking through a thick fog. I often woke up depressed, likely due to oversleeping and the drug itself. I could never plan a morning activity because I was always unconscious in the morning and it was so unpleasant to wake up early that I just refused to do anything before 12pm, and even 12pm was early.

So why did I continue to take chlorpromazine despite that horrible side effect? The answer is, I cannot sleep without night-time sedation. If I go even a couple of nights without sleep I get manic. My mania is severe and life threatening, therefore I had to take something to make me sleep. The only thing offered to me was chlorpromazine. I tried to take the smallest dose I could but I regularly needed doses of up to 200mgs per night. Chlorpromazine also dulls down all of your emotions so for me everything was muted, especially early in the day. I’d been on it so long that I’d forgotten what life was like without it. In hospital they started giving me amitriptyline which is sedating itself. That meant that once I got up to a higher dose I was able to drop the chlorpromazine, which was such a huge relief; amitriptyline makes me very sleepy a couple of hours after I take it in the evening, and it guarantees me a good sleep, but by morning I feel refreshed and awake and don’t have that horrible hangover effect. I now set an alarm for 8 every morning and aim to be up by 8.30 to start my routine. At the weekend I let myself have until about 9.30. It’s so lovely to get my mornings back, to have a proper length of day, to just feel refreshed after sleep and alive instead of constantly sluggish. I love it when my partners Isaac or Howard stay over and I can wake up with them in the morning, have breakfast and say goodbye to them if they are leaving for work. I’m being very careful not to get into a bad habit of sleeping late everyday now.

5. Isaac

I think people might believe I don’t really love Isaac; I admit that I tend to talk about Howard more just because he’s my longest-standing partner and I have more commitments with him, but Isaac is adorable and funny and kind, and I love him in a very unique way. The days I spend with him and the adventures we go on are always fun and carefree. He is like a tonic to the other serious things I have going on. It’s no secret that after 14 years I don’t want to be polyamorous anymore. The only reason I continue to do polyamory at all is Isaac. I cannot give him up. I love him too much and I enjoy being around him. He was also a huge support when I was in hospital, often taking me out for a few hours and frequently in the car going to see the dogs and hanging out with them in the field near the kennels. We had lots of fun there even though I was often desperately unwell. Isaac can get through my sadness and depression and make me laugh in a way that nobody else can. I need that in my life. Because I don’t have as many commitments with Isaac, it means I’m with him just for the sheer joy of being with him. He has two beautiful children and I feel honoured to be a part of their lives too. I have no idea what will happen in the future in a romantic/sexual way but I do hope that even if one day we break up again we can still stay close friends. What’s even nicer is the rivalry that existed between Howard and Isaac seems to be over. They seem more content with my being with the other and less afraid. I think they both know that they bring different things to my life and that that’s okay. Now I just need to convince them to hang out more so I get to enjoy being with them both in the same place!

6. Being productive

I have been so unproductive the last few years. Even when I thought I wasn’t clinically depressed my mood was often still very low. I remember when people would ask me if my mood was normal I’d say yes, but really it was only a 3 or 4 (5 is normal). 3 or 4 was literally the best it ever got and as it wasn’t as bad as 1 or 2 I just thought that was acceptable and normal, and even I had forgotten what normal was. I never got a long run at being okay; my mood was always on the way up or on the way down. I spent so much time in bed that nothing got done. I remember wanting to go to the outpatient pottery class at the hospital and being unable to because it was in the morning and mornings were something I just couldn’t do. Now I am regularly going to the Monday morning class which starts at 10.30, I’m out the door by 9.15! Seeing friends was a struggle, taking the dogs on a longer walk was a huge effort, I just had no energy. Housework never got done, washing was left until it overwhelmed me. Dishes would pile up, everything was cluttered and stressful. I had really let things get on top of me. Now I’m up early I can do a morning dog walk and be home before lunch. My personal hygiene is better. I put nice clothes on, I wear my makeup and other things that make me feel good about myself! I’m making more effort around the flat and I’m interested in making it a nicer environment for myself. I just feel like I have motivation for the first time in years. I’m enjoying being productive, I want to be productive. I’m not just sleeping my life away or lying in bed staring at the wall for hours. This is probably one of the most important things that has improved and I didn’t even realise that my lack of motivation was part of my mental illness. I genuinely thought I was just lazy and useless.

7. I can feel feelings again!

When other people talk to me about depression they often say they feel sad, or they feel empty or hurt or unhappy. When I feel depressed I feel dead. It’s hard for me to feel anything. The only words I can use to describe how I feel is ‘disgusting’, ‘sluggish’ and ‘muted’. My emotions are very dulled down. This might have been partly down to my medication regime too (chlorpromazine). I did feel love, or at least I knew I loved Howard and I loved Isaac but I couldn’t fully feel it, not in my bones, the way love should feel. Nothing made me happy, nothing made me sad, it was just this dreadful nothingness. I think the only time I could feel anything at all was when I was in physical pain. I could feel that, and it was real and sometimes I would enjoy it when my endometriosis would flare up because then at least I felt something. This is also why in the past I have self harmed though I haven’t done that for years.

Now I feel everything and it’s with such powerful intensity. It’s like the shell has crumbled and underneath everything is red raw. The love I feel for Howard is overpowering. It’s frightening, to actually feel like that about another human being who could possibly hurt me. I care what happens to me. I don’t want to die. Let me say that again. I. Don’t. Want. To. Die …

I’ve spent so many years wishing for death because I couldn’t stand the disgusting, sluggish, dead feeling I constantly felt. It was literally torture. People don’t understand. How can someone commit suicide? Don’t they care about their loved ones and responsibilities they leave behind? I believed everyone would be better off without me. Towards April when I was sectioned, even my dogs. I thought life was absolutely 100 percent not worth living. That I’d rather go through the gruesome process of hanging myself than go on another day. I actually wanted to die in a horrible way because I wanted to feel something/anything before I went. How I never came to any harm is partially down to luck, and partially down to Howard taking me in when he did. I am 100 percent in love with life just now. Everytime I feel an emotion I haven’t felt in a long time it’s like feeling it for the first time again. I feel like I’ve woken up from a nightmare and reclaimed myself.

8. My flat is a lot nicer

My flat has been in a terrible state for literally years, in fact ten-plus years! I was in the horrible situation of owning the flat with my ex and being unable to get his name off my mortgage because I live on benefits, and therefore they wouldn’t give me a mortgage on my own, even though I was clearly making the repayments! As a result of this I was never able to raise the money through remortgaging, and I wasn’t able to get Chris removed from the mortgage despite the fact that he abandoned the flat many years ago and had hardly paid a penny towards it. Howard sorted this out by taking on half ownership himself. I want to stress this is an extremely kind thing for him to do. I’m overwhelmed with gratitude and I have a feeling of security that I now have a co-owner that I can trust. Not only did he do that but he sorted out all the paperwork and worked very hard to make it happen. It took a year! Chris (my ex) was made it really hard by refusing to sign the paperwork. Now finally for the first time ever I am in a position to actually sort my flat out.

Since going into hospital Howard arranged for all the work that needed to be done. This was a lot of work for him. In my depressed state I wasn’t even able to give him any input. I didn’t even care that much what happened or how it looked. Howard encouraged me to pick colours and other such things which I did but I never really believed it would happen.

Now I have a new boiler, new radiators, new flooring in the living room and hallway, new windows and a new bathroom, and now I am out of hospital the kitchen is in the process of being done! Eventually we will decorate the rooms and I’ll have a nice home to be in that I love and that’s not a nightmare. I can wake up in the morning and take a shower in my nice new clean bathroom. My old bathroom didn’t have a shower and I had to take baths that took ages to fill because of the failing boiler. Now I wake up in the morning and hop straight into my nice hot shower and feel clean. I haven’t had a working oven for nine years and my hob barely works. Once the kitchen is finished I’ll have a really decent oven and cooker. I’ll even have a dishwasher (luxury)! It’s going to be amazing. I’m eternally grateful to Howard for his help with all of this. I think it has such an impact on my state of mind to have a nice environment to relax in. It also makes me confident that he is as in love with me as I am with him because it’s such a huge thing that he’s done!

9. Personal hygiene

I feel ashamed to admit this but my personal hygiene hasn’t been good. Depression sucked away any motivation to keep myself clean and tidy. I would regularly go an entire week without washing. If I was staying in bed or not leaving the flat I wouldn’t bother and even if I was going out I wouldn’t bother. I’d even lie to Howard when he’d asked me when was the last time you washed. I’d never say a week ago or more because I knew he’d be appalled. The more depressed I became the worse I got. It was particularly bad when I was in hospital. I remember at the start of my admission in IPCU (intensive psychiatric care unit), I was wearing leggings, a soft dress, a cardigan and socks, basically the clothes I was in when I got sectioned. No bra, no pants. This is disgusting but I was sleeping in my clothes and going about my day on the ward in those clothes. To make matters worse I started my period and I just didn’t bother to sort myself out. I was just bleeding onto my clothes and because they were black nobody noticed. Howard eventually noticed I smelled rotten and I finally showered and changed. The nurses would come into my room and coax me into the shower, remind me to put my pyjamas on at night and day clothes on during the day. I did the bare minimum. I also didn’t brush my teeth for months and now my teeth look a bit more stained than they used to.

Now I shower every day. It’s part of my morning routine. I think having the new shower makes it far more likely that even when down I’ll still wash, because it’s so much easier than running a bath and waiting for it to fill and having to sit in it. Usually I’d sit in it, perhaps wash my hair but then just get out without properly cleaning myself. In the shower it’s far easier to keep clean and I generally like feeling clean now. The idea of going for days without washing seems really yuck! Also I’m brushing my teeth in the morning and night and using mouthwash. Soon I need to finally see a dentist for the first time in over a decade! I’m working myself up to that one.

Lots of things have gotten a lot better since leaving hospital. The biggest change is just how I feel. Depression is crippling. I wouldn’t wish it on anyone. Nobody really knows how it feels to be that depressed unless they have experienced it themselves. Many people who read this blog will understand. Things can get better though. I genuinely thought that it would just never end. I really believed my only option was to end my life. If Howard hadn’t got me to that appointment with my psychiatrist I could very likely be dead or badly hurt. I am in love with life at the moment. With each passing moment I’m aware that I’m alive and that horrible disgusting, sluggish feeling is finally gone. The only negative is that I am very afraid of it coming back.

10. Reclaiming my sex drive

Some of you might think this is too much information but it’s actually very important. Depression and mental illness can and do frequently have a profound effect on a person’s sex drive. I was still having sex (though not as often) when I was ill because it brought me some comfort but I wasn’t reaching my full potential. It was hard to connect with my partners because I felt so numb. My orgasms weren’t as strong. I hadn’t even noticed that they were weaker than usual because it happened so gradually but since I got well I can see a big difference. I believe the chlorpromazine was dulling down those urges for me and sometimes I would need to push myself to have sex because I knew I’d get some enjoyment out of it once I started, but I just never felt properly in the mood. I’ve known people with depression who have lost their sex drive completely and just stop having sex. This has an impact on relationships. Partners can feel rejected you aren’t getting the bonding that comes with being intimate, this is especially hard-hitting if, like me, you usually have a very active sex life.

Now my sex drive is very high again (which is my normal). I’m enjoying reconnecting with my partners in that way and having very good, intense orgasms that I haven’t felt so powerfully in years. I’ve stopped feeling like I have to force it and when I initiate intimacy I genuinely feel in the mood! As a result I feel more bonded with my partners. It’s not just about the physical pleasure that sex brings (though this is good). It’s also, for me, a way to show and express love.

Some medications can affect sex drive and ability to orgasm. I’ve heard this from many people, especially those on SSRI antidepressants and heavy-duty antipsychotics. I have been in the system long enough to know now that there are solutions to this problem. There are many alternative drugs that can be taken that are just as or more effective in treating depression or psychosis that do not have this effect. They are not routinely prescribed because they are more expensive, but I pushed for my meds to be changed so I didn’t have this side effect, and eventually my doctor and psychiatrist listened.

Feedback

If you like this blog feel free to send me a friend request on Facebook as Jools Christie (but send me a note saying who you are). Also you can follow me on Instagram. I plan to post more photos there under the name little_miss_black_sheep. I feel like I owe it to everyone who is struggling with mental health to spread awareness and knowledge. I know one of the things I really valued when I was unwell was reading other people’s stories of mental illness and recovery. Do I think I have recovered from schizoaffective disorder? No. I will get unwell again in the future. I’m aware of that, and denying it won’t protect me from it happening. At some point I’ll either get manic or depressed. Either way it will mess things up. What I’m hoping for is a long run of stability. I’m aiming for six months to start with, then build on that. I have lots of blogging ideas but suggestions are very welcome. Comments are appreciated either here or on Facebook. Thank you for taking the time to read this.

7 facts about being a patient in a mental hospital

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.

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.

11 ways to help a loved one in a psychiatric hospital

It's been a while since I wrote a blog.  My last hospital stay was not voluntary (it never is but this time more officially NOT voluntary) and very difficult.   I couldn't face thinking or writing about mental health after that, but recently after talking to friends I thought it might be useful to write a list of things that family and friends can do to help when a loved one is in a psychiatric hospital or ward.  There are things people did for me that really helped make my stay easier and I'm eternally grateful to them for that and it's important to note that the situation and needs can be different than a medical ward.  Also in my experience a stay in psychiatric ward tends to last a bit longer than a typical stay on a medical ward.

Brief update on me, since I got out around 7 months ago I am doing much better.  I still have niggles and issues but much less so nowadays. I've currently not heard voices for almost 3 weeks now, which I put down to getting a better sleep now that my bladder issue has been medicated and I no longer need to get up every hour or more for the toilet.  Since taking that medication and sleeping for more than 3 hours at a time my voices have gradually disappeared - something I never thought would happen after hearing them for years!  They may come back I am not naive enough to think I'm cured, but for now it's nice to have freedom from them.  I feel fairly happy and I'm working  hard to stay stable and well.  My diagnosis seems to change at the moment between Schizoaffective and Bipolar and back again so I use the two terms interchangeably.  I don't mean to cause confusion but actually even I'm confused sometimes so it's difficult.  For people who don't know Schizoaffective is Bipolar with psychotic symptoms even when a mood episode is not present.

So here are 11 points about hospital and what you the visitor and family member can do to make it easier!

1.  Visitors

I put this at number 1 for a reason because for me it was the most important thing that people could do to help me when I was trapped there.  When a person is very unwell and first admitted they might not want visitors, or they might only want close family/friends.  As they start to get gradually better they might be happy to see other people.  I was happy to see almost anyone.  Being trapped on the ward made me feel disconnected from reality.  I didn't have passes (allowed time off ward) for a long time and so my world felt very small.  People coming to see me made me feel more like myself again and not just a crazy person.  You might wonder what to talk about, just chat away normally, tell them about your day, what's going on with people on outside, the person will just be pleased to have familiar company.  Also try not to be late, if you say you are visiting at the start of visiting hours try and be there for then if you know its not going to be till later then tell the person or someone else who can pass it on that you will be later.  Your loved one is likely waiting on you and I found when someone was very late I would start to panic.

Sometimes it's overwhelming for your loved one if all the visitors come together in one visit.  For me more than 2 people could be too much especially at the start of my stay.  If you can coordinate with others about when is best to visit, such as the persons partner/spouse or close relative, and if possible you can ask the person themselves via phone or text when is a good time to come.  If visits are spaced out it means the person gets visitors more frequently rather than everyone at once.

Your loved one might be in hospital for sometime and I know from experience that the longer you are in the less visitors come.  People don't mean to forget but they do a little and often patients that have been in the longest have the least amount of visitors.  It can take a long time to get better sometimes so if a person has been in for a while keep popping in to see them whenever you can.  They will appreciate it so much.

You might not be sure if your friend wants you to visit, asking questions such as 'do I know them well enough?'  Don't just sit there wondering, ask!  They might really love to see you but it's rare that a person in that situation would ask you directly to visit.  If you have no way of contacting them directly ask someone close to them.  In my experience people are usually allowed to keep their phones on the ward unless they are in IPCU which is the equivalent of intensive care for psychiatry.  I was even allowed to keep my phone when I was on constant observation which is the stage before IPCU. You get to keep your phone providing you aren't doing anything with it to harm others or put yourself at risk. When I got out from my last stay some people said to me I wanted to visit but I wasn't sure if that would be ok.  I would have loved to see them especially as I was starting to get well.  Understandably you might not be able to visit for various reasons but you can help in other ways.  Send a card directly to the ward (the person can get mail), send a nice text, or email.  Most phones have internet and often there is internet access on the ward or somewhere in the hospital.

2.  Bringing things that the person needs

The person may or may not have had the chance to pack a bag.  It's likely that even if they did pack their own bag it was done in a hurry and things are missing.  Family and loved ones may have the job of bringing practical things in that the person needs.  If you are planning on visiting it could be worth calling the ward, or the persons mobile and checking if they need anything.

Rick used to ask me to pack a bag when he felt hospital was on the cards.  I was always very reluctant to do this because I  hate hospital and I didn't want to go there so packing a bag was the last thing I wanted to do.  When I was on my way to hospital I packed a half hazard bag with stuff for only a couple of nights so Rick had to pack another bag before his first proper visit to make sure I had the essentials.

Think carefully about what you pack.  When packing clothes ask yourself if this is something the person wears regularly?  They are more likely to need and appreciate comfortable clothes.  Underwear, jogging bottoms, leggings, or t-shirts.  Slippers are very handy for walking about ward.  Pyjamas are also important but unlike a regular medical hospital your loved one will be encouraged to get dressed each day.  If there is something your loved one wears a lot then try to remember to pack it.  I always like to wear a cardigan for example so it was nice to have a couple with me.

Toiletries are important, don't assume such things are on the ward as often they are not.  Shampoo, conditioner, deodorant, baby wipes, or perhaps a familiar and favourite perfume.  If the person normally wears make up bring it in.  If they are in a depressed or very psychotic state they may not ask for it but having it there may inspire them to self care.  Often people go into hospital and they are not taking care of themselves, part of being in hospital is about picking this up again.  Although my ward had towels they were tiny and so it was nice to have my own large towels.  A dressing gown is also handy even if person doesn't normally use one because it protects modesty in a ward full of strangers. In my ward the toilet was down the hall from my dorm, that meant travelling in night clothes through the night, a housecoat meant I was warm and covered.  If your loved one is female then sanitary towels or tampons are handy to have as the supply on the ward tends to be cheap and nasty.

Money is also important.  Even if your locked on the ward you can send people to buy things for you and there is a hospital shop that a nurse can take you too.  I used the money I had to buy sweets, magazines and juice.  Little comforts that made my stay that tiny bit more bearable.  When you are in a situation like that the small things start to matter more.  I remember a nurse told me at 9am she could take me to the shop at 3pm when she wasn't going to be busy.  I looked forward to that all day because it meant I could buy myself a diet coke!

Once the person has the practical things that they need you might also think about some other items that will make there stay a little easier.  I found that there wasn't much in the way of recreation and that was hard because it meant I focussed more on my voices or delusional ideas, or when depressed just obsessed and planned ways I could end my life.

Good items to bring in are, iPods, tablets, books (though many people would find reading a book very difficult when unwell), religious items - Rick brought me in a Mala and a small Buddha statue, photos of loved ones, magazines (especially ones with lots of short stories - something I would never read on the outside but passed the long hours on the ward), items of comfort such as a teddy bear from home - but keep in mind that things can go missing so nothing too precious. Gadgets like iPods can be locked in nurses office or little safe in bed-space. Food! Food is always a lovely treat because the hospital food is repetitive and not always tasty.  Fruits like strawberries or grapes (keep in mind your loved one doesn't have a knife to cut things). Chocolate, juice that they like, or their favourite tea bags or nice type of coffee.  Flowers are a lovely gesture to brighten up a persons bed space, and I still have the cards from the people who gave me a card because it helped me so much to remember that I had friends and family who loved and cared for me.  I always appreciated when people phoned me or texted and asked me if I needed or wanted anything.

If your loved one plays a musical instrument bring it in!  They may not be in right frame of mind to pick it up and play at start of their stay but as they get better they will appreciate it.  We had a lady on my ward who played the guitar.  She had everyone up dancing and hugging.  A very rare moment of feeling happy on the ward.

3.  What you should NOT bring to the ward

Think carefully about what you are bringing into the ward.  Anything that the person can hurt themselves with should not be brought in.  If your loved one wants a razor to shave with then ask a nurse if this is ok.  Even electric shavers are a threat as they can be opened up and used to cut.

No medication should be brought in.  Your loved one will be given all their medication they need from the nurses on the ward, such as any psychiatric meds, painkillers and medication for other physical illness.  If your loved one tells you they are not being given the correct medication or that they have asked for a basic painkiller like Paracetomol and it hasn't been given then talk to the nurses.  Be firm if they are missing out medication for physical issue.s I have known this to happen so don't assume that the doctors and nurses have got it right.  Remember you are an advocate for your loved one.

Alcohol is never allowed on the ward.  You may think you are giving your loved one a treat or helping them by bringing in a bottle of wine but in reality you could be making there situation much worse and putting other people on ward at risk.   Alcohol can often interact with many of the psychiatric medications on the ward.  When I was last in hospital a visitor brought a patient some vodka.  After they left the patient drank the vodka and then found and used a blade she had somehow got hold of and slashed her own neck open (she nearly died).  That resulted in her going to IPCU.

Recreational drugs, illegal or legal highs, are never ever a good idea.  I have a very liberal attitude towards most drugs but a psychiatric ward is not the place for such things.  Those kinds of drugs tend to make most psychiatric conditions much worse.  When I was on the ward these drugs were everywhere, I was offered them many times.  I saw people do crazy stupid things on drugs and prolonging their stay because of them.  If your loved one is addicted to something and going through withdrawal then talk to a nurse rather than bring in a drug.  Maybe now is a time to be treated and come off something like that?  Sadly when people are very unwell mentally they have a harder time making wise choices for themselves so if such things are on the ward there is a temptation to try them.

If your loved one is at risk of trying to hang or choke themselves they may be very limited in what they are allowed to keep with them.  In such instances, things like phone chargers, house coat ties, shoe laces, are all kept in the nurses office and given when supervised.  If your loved one starts asking for extra phone charger or shoe laces then talk to a nurse before you hand it over.  If you have a bad feeling about something then check with a nurse.  Your loved one might protest but checking could save their life.  Please remember people can and do die because of mental illness.

4. Anger

You may feel angry or have mixed feelings about your loved one being put in hospital.  Them being away may greatly inconvenience you or be hard on others.  It is never ever helpful to show this anger to the person who has been hospitalised.  Guilt trips only serve to make your loved one feel even worse than they already feel and may even fuel their mental illness.  Sometimes mental illness is hard to understand.  Why can't the person just snap out of it?  Think logically out of their psychosis?  Stop being manic?  Start taking care of themselves?  Stop threatening to kill themselves or trying to kill themselves?  I can promise you, and I have first hand experience with this, your loved one does not have control over their mental illness anymore than someone with a physical illness does.  They did not deliberately get themselves put in hospital and they are not having some kind of holiday in there.  Being on a psychiatric ward is very difficult.  You're trapped there and you are away from everything familiar and everyone you love.  Sometimes the people around you are so unwell they are scary and threatening.  You may hear about moments of fun, of laughter or joking and this may make you more angry thinking they are obviously having a great time.  There are moments of fun and laughter even in the most dire situations because human nature tries to find a way.  People want to relate to each other and heal.  Those moments are far rarer than the moments of isolation, desperation, fear, loneliness, claustrophobia and mental pain.  Making your loved one feel guilty because you heard them laughing as you came up the stairs to visit is NOT cool.

Do not tell your loved one that they are not allowed to go into hospital if things get bad, or that they better not let that  happen, or guilt trip them in anyway if you start to realise that hospital might be on the cards.  That is as silly as telling someone with a serious infection that there infection better not get any worse because you don't want them to go into hospital!  Telling someone or implying to someone that they shouldn't go into hospital actually makes the risk of suicide higher because they are less likely to ask for help and will feel like they are just a huge inconvenience and people are better off without them.

5. Other patients

I'm going to be honest here.  Other patients can sometimes appear very scary and very unwell.  I'm sure I have appeared this way to other visitors in the past.  You may be horrified that your loved one is sharing a space and dorm with people like this. What kind of influence will they have on your loved one?  Will they become "friends"?  Is that healthy?

What you need to remember is people who are in hospital because of mental health are people too.  They have a life outside the hospital and they have wants, needs, desires and talents.  Even if at this point they appear to be unkempt, crazy, slutty, loud, or deranged there is a very good chance that when they are well they do not appear like that.  I have found that the people on the ward who get better the quickest are the ones who come out and talk to the other patients.  The people who hide in their bed space and spend most of there time alone are usually in for longer periods.  It's surprising how much some human contact and empathy can help.  Other patients often understand what your loved one is going through more than anyone else.  Judging them based on their mental health says more about you than it does about them.  If you see someone acting in a strange way on the ward when you are visiting don't stare, focus on the person you are here to see.   There is a good chance that you will see the same person in a few weeks time and they will appear totally different.

One of the really touching things my Mum did last time I was on the ward was to bring in biscuits and chocolates to share with everyone (not just me) people really appreciated that and looked forward to her visiting because it meant a nice chocolate biscuit.  I was so proud of my Mum because she spoke to other patients and she treated them with kindness even when they where acting bizarre or it was clear that they where really in the grips of there mental illness. 

It is very likely some friendships and bonds will form between your loved one and other patients.  It's up to your loved one who they keep in contact with after they leave the hospital. Rest assured it's rare that those friendships will have a negative impact on your loved one and if it appears to be the case nurses would intervene.  When they are well enough to leave hospital they can decide if they want to keep contact and they also have a choice to carry that on if the person is to difficult to be friends with.  I believe as much as possible it should be the persons choice what to do about keeping in touch with hospital friends. 

6.  Taking your loved one off the ward

As your loved on starts to recover the nurses and doctors on the ward give out a privilege commonly known as "passes"  sometimes passes start with the patient being allowed to leave the ward accompanied by a family member or friend.

You need to feel comfortable doing this.  It is a responsibility and you should feel that you can cope with that.  If you don't feel comfortable do not be afraid to say no, or "not this time"  If you do decide to take them off ward make sure you know exactly how long the person is allowed off the ward with you as they can get in trouble if they are late and may lose future passes.  The police can, and are, phoned if the nurses think the patient has been out too long and may be at risk.

When I started getting passes I was still in a fairly bad place mentally and so I asked to go to a shop and tried to steal some Paracetomol so I could overdose with later.  I'm not proud of that but I'm mentioning it as something to look out for.  Anything they buy in a shop should be safe to take back to ward.  So don't let them buy anything you wouldn't bring onto ward and if they insist then inform the nurse on return.  If your loved one runs away when out on pass just phone the ward immediately (you will not be in trouble).  They usually give you a number just in-case.  Don't waste time looking for them the ward will deal with it usually by contacting the police.  Don't worry your loved one will not get a criminal record for simply running away they will just be brought back to the ward.

7. Voluntary or Involuntary

There are two ways to be admitted to hospital, to go in voluntary of your own accord or to be there involuntary by being sectioned under mental health act.  The type of person who feels angry at a loved one for being in hospital might feel even more angry to be told that they person is there voluntary.  I want to make this clear there is no such thing as voluntary its all semantics.  I've been classified as a voluntary patient and I have been sectioned involuntary, and I have been both within the same stay but on all of these occasions it was never really voluntary at all.  For example I was unwell, very depressed and psychotic, and a suicide risk.  I had slashed up my arms and had no real insight into what was psychosis and what was real.  My CPN (Community Psychiatric nurse) said to me that she felt I needed hospital and because I hate hospital I disagreed and said that I did not want to go and would not go.  She then said that if I did not go she would have me sectioned under the mental health act and would send round the police to take me to hospital if I did not comply.  What choice did I have?  Of course I went to hospital.  When in hospital many times I would ask to leave and then I would be told that if I did I would most defiantly be sectioned, so I would back down.  When I did challenge them and 'called their bluff' I stood at the locked door of the ward (you're on a locked ward whether you are voluntarily or involuntary) and I demanded they let me out.  They tried to persuade me to come back into the ward and I kept demanding they let me out.  I was dragged back upstairs to the main ward, restrained, and temporarily sectioned. Then later that day my psychiatrist came to the ward and officially sectioned me for a further 28 days (note the events of this are cloudy in my mind so its a vague memory of what happened).  I was never really voluntary.  Ironically once you are sectioned you are allocated a mental health officer and you are allowed to challenge your section legally.  If you are voluntary and only staying because of the threat of sectioning then you have no such right.

Even sadder is the fact that there are some people usually with depressive type of illness who are at the end of their tether who go to mental health assessment and actually ask to be put on the ward.   Usually they are turned away. It's actually fairly hard to be admitted when you want to be admitted.  There simply aren't enough beds so you have to be considered very seriously unwell to be given a stay.

8.  Odd behaviour

Your loved one may not act in a way that you are used too when they are in hospital.  They may do or say things that are out of character.  For example when I am manic I can make inappropriate sexual comments and advances towards people that I would otherwise not have this type of relationship with.  I may seem rude, or have ideas that are very strange.  I had a belief that my partner was the Buddha and when unwell I have had many strange ideas that I have believed 100 percent and other people have found strange and hard to deal with.

When depressed I will talk a lot about wanting to kill myself. I might ask a visitor to help me do this such as bringing me things onto the ward that I can use to hurt myself with (you should never comply with such a request).  I may talk back to my voices openly without realising that this is odd or that other people can't hear them.  Because of voices your loved one may believe they have had conversations with people that has never happened.  For example I often hear my partners voice as one of my voices when he is not there.  In hospital I had a long conversation with him about all the things I needed to bring from home for me onto the ward.  Clothes, shampoo and other such items. When he arrived at visiting time he had none of the items I requested and I was really angry because I really needed my things.  He had to point out that we hadn't spoke on the phone that day and so I had been talking to a voice in my head and not a real person.

It's not easy to be with someone when they are in this place.  It would be easier to say ok I'm not coming back till they are better but actually being there during all of that is very helpful.  Familiar people (at least to me) are like little anchors to reality.  Mostly my visitors would divert the conversation if I got too involved with my delusions or suicidal thoughts.  For me it's important that people don't go along with what I'm saying and instead talk about things based on reality.  Ask about the routine on the ward, tell them what happened in your day and just be there. Let them know that you care and that you love them.  The person shouldn't be reprimanded for talking about suicide or delusions.  Accept that this is just part of the illness and that it's not permanent.  Let them talk but don't encourage them to delve deeply, never make out you believe what they believe when its clearly not true. This is very unhelpful and makes things worse.  Most important is to let them know that you care and want them to get better and be well again.

It may also be the case that you turn up to visit and your loved one appears perfectly fine and its hard for you to even understand why they are in there.  Sometimes I would somehow pull it together for a visit and must have appeared ok.  Things can and do fluctuate especially as people start to gradually get better.  Also it can depend on what medication a person has taken prior to visiting.  If I had my PRN meds (Chlopromazine and Lorazipan) before visitors arrived then I may look a little doped on meds but actually I wasn't as erratic externally.  It's also important to note that your loved one might not need this medication when at home and it might alarm you that they are taking something like that on the ward, but when on the ward your loved on is acutely unwell and this type of temporary medication can be very useful short term till things are back on track.  It is NOT appropriate to interfere with that or tell your loved one not to use a PRN med if a PRN has been prescribed.  By doing so you are making recovery take longer and making your loved one suffer even more distress.  If you have a problem or concern about what medication is being prescribed the more appropriate action would be to talk to a nurse or the persons psychiatrist.  Remember medication is reviewed regularly by the doctors.

9. Constant Observation

When a person is very unwell on the ward and is at extreme risk of hurting themselves or others then they may be put on something that is called constant observation.  This means that a nurse or, if needed, two nurses will accompany the person wherever they go on the ward.  It is unlikely if the person needs this that they will have passes or be allowed of the ward at all.  Being on constant is not easy on the patient.  It means you are allowed no privacy.  A nurse comes to the toilet and shower with you and a nurse will watch you sleep.  They basically follow you everywhere and you are never alone.  When I was put on constant I didn't fully understand why and that made it more difficult and frustrating. 

As a visitor you might find it strange to have a nurse standing over you or nearby when you visit.  Please don't let this put you of visiting because your loved one may still very much appreciate a familiar face.  Just go about the visit as you normally would.  Depending on what kind of constant the person is on they might even get some time away from a nurse when you are there and that will feel like a huge relief.

Some nurses on constant are really friendly and will talk to you and make you feel comfortable.  Others will say very little and things will feel very uncomfortable.  Sadly in my experience I had a couple of nurses say inappropriate things this time.  For example when I said that I didn't feel comfortable with someone standing in shower room with me she responded with "Well you shouldn't have got yourself put on constant then." I didn't even fully understand why they put me on constant and so that comment made me feel dreadful.  It's very obvious that having patients on constant puts a strain on the nurses on the ward, and I could easily pick up on this, which reinforced my belief that I was a horrible worthless person and should just end my life.

10.  Nurses and other staff

Not every nurse is nice.  As much as I would love to say that they are all wonderful and helpful and full of compassion and empathy it's sadly not true.  There are good and bad.  I had some really helpful nurses on my ward who I felt I could talk to and be comfortable around and then I had others that seemed to make things a lot harder for me and other patients.

I complained to visitors at the time about how I had been treated by some nurses and because I was so unwell I think my visitors just assumed I was taking things the wrong way.  I'm better now and capable of looking back and I have to conclude that, at least with some of the things that were said or done to me, there where times when I was not treated in an kind or respectful manner and I witnessed other patients being talked down to or neglected.  It is especially difficult when a nurse is nice and friendly to a persons family and then when visiting stops they become a different person.  Please listen to your loved one if they tell you something is not right on the ward.  You are their advocate and they are relying on you to help them.  There is very little power to the patient when they are in hospital.

To give an example I was feeling very suicidal at one point during my stay and decided I could maybe try and talk to one of the nurses.  I had an opportunity to talk to one when he was giving me meds.  After I told him I felt a strong urge to end my life his response was "don't even go there again." The nurses are paid to be there to talk to us about things like this.  I was actually reaching out rather than holding it all in which is a sign for me that I am recovering. His reaction set me back and just made me feel like I couldn't talk to anyone again, which resulted in me feeling even more suicidal.   

Another example is one I'm not proud of, but think its important to share.  I tried to kill myself on the ward (I won't say how because I don't think its helpful to give people ideas), it may not have worked easily to end my life, but it definitely had to ability to really hurt me.  I had my own room at this point and so I did this in my own room away from other patients.  A young student nurse walked in on me as I was doing it and was able to stop me.  I was then told to go and sit in the communal area where nurses could see me.  There were other patients around.  An experienced nurse who obviously had heard what happened came marching up to me and said, "Well that wasn't very creative was it".  I didn't even realise at the time how inappropriate a comment like that from a nurse was.  As I got better I was able to see that this is not a respectful or dignified comment. nor was it helpful.  He was mocking me.  If you know a person is suicidal, has tried suicide or self harm, please do not mock them.  Don't assume they are just attention seeking.  It is hell to feel so bad that you want to die, and people being unkind on top of that just makes it extra hard.

11 Discharge

Depending on how long you have been in, and sometimes it doesn't have to be more than a few weeks, discharge is not always an easy thought.  It's rarely the case that a person is completely well when they are discharged.  Usually it's a case of the person not being a danger to themselves or anyone else, and able to self care enough that they can go home.  They may still have depressive symptoms, they may still be hearing voices, it's not a case of being completely well and back to normal for most.

It seems from talking to people that discharge happens in different ways.  For some it's sudden, for others very gradual with lots of over night passes.  I prefer a couple of over night passes, then discharge. I don't like to draw it out, and my doctor seems to agree that for me that's best. 

Coming home is difficult because for weeks, or maybe months, your loved one has not had much responsibility, either for their own care or for the care of others. There has been support available 24/7 and the hospital routine tends to be very rigid and people get used to that.  Go easy on your loved one, they will need a few days, up to a couple of weeks, to adjust.  Help with things like cooking and tidying, going shopping, and other everyday tasks.  If you live with them it helps to have things tidy and organised, so they are not overwhelmed when they get home.  The easier it is for them to adjust slowly, then less chance there is that they will have to go back in again soon.  If they have children make sure they are getting breaks from childcare, and time to themselves to sleep and rest.  Support them along to appointments and be involved with their nurses/support workers, or whoever else is involved in their care.  Remind them that they should take medication.  The more proactive you are to help, the easier it is.  I am very lucky that my partner, and the people around me, help a lot when I am discharged.  I have Rick who always makes sure the flat is nice and tidy, and he is very proactive in my care and staying well, and my Mum is brilliant for taking me out for shopping and having company through the day.

I hope this blog helps even one person think of something they can to do help their loved ones.  Partners, husbands, friends and family, you all have so much power to make it easier and less scary.  When I look around me at the people I know who have mental illness it's very often the people with good support who do the best in the long run. 

Feel free to write any comments of anything you find helpful from your experience, or your loved ones experience, and also I am up for suggestions for future blogs.

Peace and love,

Jools

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