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.

The depression project

Those that have been reading this blog will know that I have a Bipolar type illness.  My exact diagnosis seems to change depending on what psychiatrist I see but it goes between Bipolar type 1, to Schizoaffective disorder which is like Bipolar but with added psychosis during the time moods are stable.  In summer of 2015 a bad Bipolar psychotic depression hit me.   I often get depressed in summer in particular July because it's the anniversary of when I lost a baby and my mood usually dips as the anniversary approaches and stays low for a period of time after that date.  I've spent those dates in hospital twice.  In the summer of 2015 I didn't go to hospital (though I probably should have because I was bad enough and suicidal).  I managed to stay at home and by late August I had mostly recovered.  I think the severe part of my depression lasted just under 2 months.  The difference between Bipolar depression and Unipolar depression is that with Bipolar you tend to feel really tired and sleep a lot and with Unipolar you tend to have insomnia and be unable to sleep.  I tend to sleep and sleep when depressed.  I can take myself to bed and stay there for days.  I don't wash, brush my teeth, I might not eat unless someone really encourages me to eat and at times I don't even take in enough fluids.  I'm very lucky that I have a partner who will encourage me to do things like eating, washing, and getting out of bed.  Along with that I hear frightening voices during the time that I am awake and I am very suicidal and wanting to hurt myself.  When I am awake I'm usually thinking about or planning a way to end my life.  I remember writing suicide notes (I think I still have them on my computer somewhere) and researching ways to die and the best most efficient way to end my life.  It's basically like living in hell.  I really would rather have almost anything else other than depression because there is a very real risk to my life.  I've attempted seriously once, and not as seriously another time.  I'm honestly not sure I could survive that level of depression again.  It's my worst nightmare.

For some reason during the time I was depressed in summer I decided to take some photos.  I didn't take one every day because realistically I wasn't capable of doing that.  Many days were spent in bed without really getting up at all - maybe only to go to the toilet and then crawl back into bed.  I did take some photos in key moments though.  A few very psychotic moments and a few moments of utter despair.  I took them at the time because I was sure I was going to end my life and I wanted people to see how bad it had been.  That it really had been unbearable and that I wasn't being selfish by committing suicide I had just been in unbearable pain.  I wanted the people I left behind, people I knew would feel hurt by my actions to understand in some small way.  I thought if people could see the suffering they might understand.  I kept taking photos though because I realised having a record might at some point be useful.  I haven't known what to do with the photo's until now.  It's painful for me to look at them because I remember emotional agony I was in when each photo was taken but I decided today that I would share the photos here. Please note they are not pretty, depression is ugly. They are also not artistically done.  I wasn't thinking artistically when I took them but they show moments of what its like.  Moments the world rarely sees because I know that I hide away when things are that bad as do many people in that position.   So this is me at my most vulnerable and I'm sharing it here to show what its like.  So maybe the next person who thinks suicide is selfish or depression is indulgence will think again.  It's an illness like any other.  I have very little control over it.  I work very hard to stay well.  I do everything the professionals tell me but sometimes it still hits me hard.  I'll try to give a brief explanation under each photo...

This was taken during a very psychotic moment.  I think I was feeling very afraid about what voices where saying and upset because I couldn't make them stop talking to me.  I was pretty much feeling desperate. 

Taken during the same moments as previous.

A rare moment up and out of bed after having been in bed for a few days.  I think that Rick encouraged me to get up for a while.  I remember feeling really numb and just exhausted and all I really wanted to do was go back to bed.

Sitting up again but feeling like I could hardly move I was so exhausted.  Rick was often kind enough to encourage me out of bed.  Usually by threatening to phone my mental health nurse and have me sectioned so to avoid that and appease him I'd get up and sit on the sofa staring into space.

A common theme is just lying down and staring into space.

I can't be sure because my memory is not brilliant but I believe I was sitting by the laptop writing out suicide notes to the people I love.  Thankfully I love a LOT of people so the process took a while and distracted me from making an actual attempt.

Sitting in bed, which was a place I spent a lot of time.

In bed again feeling too tired to move.  I believe in this photo I had been in bed for more than 24 hours.

A brief walk to the shops, trying to look normal.

Feeling afraid of voices.

Completely had enough really at this moment.

Lying in bed with curtains closed (common theme)

Attempting to be up and about and acting normal

I'm pretty sure that this is a voices hearing moment.

Honestly?  Utter fucking despair.

Psychotic again.

I remember this one.  I'd sat on the sofa for the entire day just staring at the wall.  

And I'm going to do a photo of me now, to show people that I actually got through it and I'm not depressed anymore.  Light at the end of a long tunnel!!

By September I had started to properly recover.  By the end of September I was pretty much back to normal and from then on things have been mostly good.  I still have the mental health stuff going on in the background but I can feel happy again, I have good people around me looking out for me.  I'm so glad I didn't end my life because some pretty amazing things were about to happen to me.  I still had people to meet and learn from!  Sadly I'm almost certain depression will hit me again.  I have Bipolar it's part of the course but I hope reminding myself I got through it last time will help me get through it again.  I am a little anxious about posting this particular blog because its one thing saying in words how things are but actually showing people myself in that state is a little bit scary.  I am really really vulnerable in these photo's and (vanity speaking here) not exactly pretty!  

A record of one of the most profound experiences of my entire life

I wanted to share something here that happened to me when I was manic that I think I told some of you about but not all.  Anyway it was an amazing experience one of the most profound and thrilling of my entire life and so I wanted to share it so I have a record of it and so people can understand what the good side of mania can be like.  Please don't get me wrong there are a lot of down sides, tons of downsides, but this was something wonderful and I don't ever want to forget it!

Those of you who know me well will know that I have a favourite star in the universe.  I learned about this star from originally from Rick.  (When Rick and I tell each other we love each other we often say as much as V Y Canis Majoris!) its a red hypergiant sitting in the consolation Canis Major.  I love this start because it's so bright (it's known for how luminous it is), and so so so very big! one of the biggest that has ever been discovered so far (though I am sure there are bigger out there somewhere!) but V Y Canis Majoris has really captured my imagination and I think about it a lot.  I imagine how big it is and how bright and awesome and when I'm stressed when I think about V Y Canis Majoris I feel calm again because I realise that compared to this gigantic star I am so tiny, not even microscopic compared to it and it makes my problems and worries seem insignificant which I find comforting.  To put it into perspective our Sun is just a tiny prick compared to V Y Canis Majoris!!! It's huge!!

I thought about Canis Majoris a lot when I was manic and sometimes I would close my eyes and imagine that I was near it.  This imaginary fantasy at the time became for me much more than imaginary.  I would close my eyes and feel my body become a huge comet and this huge comet was zooming around Canis Majoris.  I could feel myself speeding through the air and I really believed I'd become part of the universe away from earth and away from this solar system.  When it would happen I'd just stand there with my eyes closed and my heart racing and my manic mind believing that I was out there in space seeing my star up close.  In my mania I was somehow able to comprehend the enormity of the star and the enormity of the universe in general.  I am incapable of comprehending it now in a normal state of mind but I know that I grasped something fairly profound in that mindset. 

That feeling you get when you are just about to go to sleep and you start falling it felt like that only I didn't startle and stop it I just kept falling and flying and I didn't have a body anymore, I didn't need to breath I was just hurtling along in space beside the star and it was completely exhilarating but with a very profound sense of oneness with the universe at the same time.  I'm frustrated because I can't put this into words the exhilaration and speed and intensity of it where just incredible. 

These moments would last for perhaps 30 or 40 seconds at a time and then I'd open my eyes and be back on earth and back in reality but with a profound sense of awe that would last for hours in-between.  I believed 100 percent at the time that I was becoming a comet and travelling through space and time to Canis Majoris and I think I believed eventually I'd be able to stay there and I wouldn't' be human anymore.  It was amazing and what's amazing now is even though I'm sane enough to understand on a logical level that this was mania and this was not real I am still left with the intense memories of it.  So I have memories of being a comet and travelling around Canis Majoris.  To some that might sound insane but to me that's a gift.  Nothing will live up to that and as much as I hate having bipolar I'm glad I experienced it.  It's my most vivid and intense experience of mania ever.  As I came down from my high the experiences stopped but one day I hope I get even a glimpse of that again.  It made me see the world in a different light.  It made me see that there is no difference between rock, tree, cat, chicken, human we are all just tiny particles in space.  I often complain about being mad and tell people the downsides but to balance it out I thought I'd share this.  I'm always wary of making bipolar out to be sexy or "creative" because the reality of bipolar is usually hell but I cannot deny that there are moments of beauty.  I feel like I've seen something, experienced something that nobody else on earth has or will.

Coming out

”Not everything that steps out of line, and thus 'abnormal,' must necessarily be 'inferior’."

- Hans Asperger 

This is a blog I have had a lot of anxiety over writing.  I fear being judged, I have shame around this even though I know that I shouldn't.  I feel like I have a lot going on, and people won't understand how things fit together and how it's really not that uncommon to have more than one diagnosis when it comes to mental health and that it doesn't mean that my brain is completely broken or that I should be written off. 

I have been open about my Bipolar/Schizoaffective disorder (it gets called one of the two depending on what psychiatrist I see) for years.  It's hard to hide a mood disorder when you get full blown mania at times or need to spend time in hospital, so I decided a long time ago I would be open about it and as a result I started to be really active in bashing the stigma around mental health, and this blog kind of morphed around that and me sharing my journey.  I have had so much positive feedback it's unreal.  The private messages and comments have usually always been supportive and people have told me they find my openness really helpful.  I'm honoured to be able to help even in a small way.  Sadly I have had a few nastier comments over the years.  People saying I'm making it up, I haven't really been in hospital, or that  I'm attention seeking by being so public, that it's something I should hide, or that I must bring shame on my family.  Those comments hit hard especially when I'm not doing great but I kept going because the good outweighs the bad, and the friends and family I've lost have been replaced with real friends who go above and beyond to be supportive and understanding.  I am also privileged that so many people have opened up to me with their stories that I know are not easy to share.

I am so open about Bipolar issues and that part of my life but I hold back a lot on other things that I struggle with related to mental health that are not connected to my mood.  I have a lot of issues that don't fit in with Bipolar and  over the past few months I have been going through a process of talking to my CPN and psychiatrist about these issues that I still currently face, that are not related to the Bipolar, which is now relatively stable.  My psychiatrist and CPN have felt for some time that there was a strong possibility that I might have Aspergers syndrome and so we began an assessment for that.  I am the first to admit that I knew very little about Aspergers so I was fairly adverse to the possibility of this diagnosis for myself to begin with due to my own misconceptions, but now it has been explained to me the traits that people have, all the difficulties and the quirks, I started to agree with them that it fitted perfectly to describe some of the differences I've felt my entire life, and also the problems I have now as an adult.  In the end it was confirmed that I have Aspergers and my diagnosis of it became "official" I am now in a place where I am okay with that fact.

To give a brief overview of what Aspergers is for people who don't know.  Aspergers is part of the Autistic spectrum.  At the moment (as far as I am aware) the term Aspergers is still being used in the UK but in the US and other countries its being phased on and the term Autistic Spectrum Disorder is used instead.  It is likely the UK will follow suit at some point in the future.  People with Aspergers are able to talk, and often talk a lot, but still have difficulty with social interaction and communication, reading facial expressions and body language, and they tend to like repetitive routines and interests. There is also often sensory problems such as over sensitivity or under sensitivity to sound, touch, smell etc... I am still learning a lot myself about what it entails but I will describe the things I currently have in relation to it to help you understand why I have the diagnosis.  Please note that no two people on the Autistic spectrum are the same and that goes for Aspergers too.  We are unique and as individual and neurotypical people, we have some familiar issues, but it presents differently in every person.

It's no secret that social interaction is hard for me. I have complained about this many times, long before I was aware of Aspergers, and if you go back through my previous blog posts I wrote a blog many years ago about social interaction that explains Aspergers perfectly. Yet at the time of writing it I did not know I had Aspergers, and instead I felt that even though I knew I was getting some fundamental things wrong in regards to social interaction and communication, I didn't know why.  I thought I was a lone freak with a bad personality and I just had to try harder to fit in more.  Now I know that's not true and actually that's a relief for me.  Making friends, knowing what to say, following conversations are all things I struggle with.  I over share I'm told, and if I'm asked a question I often tell the truth because I can never figure out when to tell a "white lie"  I'm much better at one to one interaction and I usually don't enjoy groups.  If people are sarcastic or use metaphors I often take them very literally, especially if its unexpected.  I can be sarcastic, but I have to think about it and often when I am it's taken wrong and as too dry, blunt, or bizarre.  I write a lot better than I speak verbally, yet my moral views are very set and somewhat black and white, and I understand now this can be offensive.

I don't like change (this is no secret to those who know me) even furniture moving around is stressful and bigger things changing like a house move, or a person leaving and a new person arriving, going to new restaurants or places, are all very unsettling at times - bordering on extreme distress.  I prefer to do the same things over and over, and like for things to stay the same, and I have my little routines of how I go about my day and I like to stick to that, and find it upsetting if something unexpected happens.  I prefer things to be planned in advance.  When new people come along my instinct is to not like them because they are new, and I don't like the unsettled feeling that gives me. I have to fight against that because usually when I get to know people I like them a lot.  I have no instinct as to who is bad for me and who isn't, so I have learned to go through logical steps to make those kinds of important decisions rather than "follow my heart".  I've made mistake by having friends that were bad for me, or who didn't really like me, and I haven't picked up on it, and as a result ended up feeling very hurt when I find out they are mocking me.

I have many sensory issues, but the main one that I find difficult is sound.  Too much noise and I'm overloaded, and feeling on verge of panic.  So being in busy places I usually can't handle for long.  I am terrified of loud noises to the point that I am phobic of them, and have been this way since before I can remember.  I cannot be around balloons, party poppers, Christmas crackers, guns, or anything that is likely to suddenly bang or pop.  Fireworks night and the lead up to it is a nightmare every year.  The anticipation has me freaking out, and I will always have to escape that situation.  I cover my ears when a motorbike or loud car exhaust passes.  I cringe with fire engines, and I seem unable to pick out voices and conversation over background noise.  It all becomes a jumble, and so it sounds like I have a hearing problem, and for a long time I assumed there was something actually wrong with my ears, but there isn't, it's my brain not having the correct filter.  Little noises that other people don't even notice are overwhelming for me to the point that I can't concentrate on anything else.  Often I have my headphones on to drown out the every day world sounds with my familiar music. 

Smell/taste are also different for me.  I am often hyper sensitive in some ways but under-sensitive in others, so I would avoid the perfume counter - where all the smell is meshed into one - but I like to wear a familiar pretty perfume on myself.  Someone cooking a meal that I don't like the smell of drives me crazy, and the worse one for me is cigarette smoke.  I seek out strong flavours in foods, that's likely why I love curry. I usually eat the same food over and over, and it takes a lot for me to try something new.  What I cook and eat is repetitive, and where I go out to eat tends to be to the same places.  Rick is always encouraging me to try new things and gradually I come round to it, but when its familiar I'm much happier. 

I am mostly under-sensitive to touch which means usually I seek out touch and want hugs often or something heavy on me like a dog or weighted blanket.  If I'm upset though, I don't feel ok with anyone but Rick or my dogs touching me.  I'm fairly particular about what fabrics I want touching me too, I hate denim, when I wore jeans I would have leggings under to stop the jeans touching my skin, and now I simply gave up trying to wear jeans because I find them so disgusting to wear.  I pick my clothes mainly based on fabric and touch than colour, and how they feel to wear, rather than how pretty they look (thankfully I have found lot of pretty dresses in nice fabrics that feel nice to wear).  I actually don't like wearing clothes on my lower half and as soon as I can at home I take them off and just have a nightie to cover my modesty :)   I love wool you will be unlikely to ever see me without a cardigan. I simply must have a cardigan on, so I can touch wool to calm myself easily, and because I feel wrong without one on.  Rick has joked that there hasn't been a single day in our nearly 6 year relationship when I have not wore a cardigan, and actually that is the truth.

(I could go on about sensory issues for pages and pages, but I think I've covered the main points)

I also have a hard time recognising faces, so if I only met you a few times then chances are if I see you out of context I won't know who you are.  I'm not being rude. (I think this is related to Aspergers).  I don't really like it when someone changes their appearance suddenly.  Colour change like hair is fin,e but a dramatic cut, or an entire new style, or losing or putting on a lot of weight, make me feel anxious until I get used to it.

I have my special interest which I think you can all guess is dogs.  I have been fascinated with dogs for 9 years now, and yes some might say bordering on obsession, but to me interacting with and learning about dogs has been a great source of enjoyment and a way to relax.  I much prefer the term 'special interest', rather than obsession or fixation. I see this as a positive trait, not a pathological problem that needs fixed, but it seems to be a common Aspergers trait to be deeply into an interest.  My life revolves around my dogs, their needs, and learning about them, oh and taking photos of them!  The only problem is trying new things is a little more difficult, as my instinct is to keep doing what I'm doing, and not venture out into something new.  Rick bought me a camera so I could learn more and get more into photography, not just dog photography.  So far I have stuck to just dogs, but I do plan on joining a photography group for people with Aspergers where the subject matter changes weekly, so that should encourage me to learn more and take more photos that are not just Sunny and Doyle.  I'm working on expanding interests a bit even though dogs are always going to be my main thing.  I talk about dogs a lot and apparently don't notice if people get bored (I'm working on remembering not to do this).  If you ask me a question about dogs in general or how my dogs are doing, expect a long and detailed answer. I love talking about them!  In-case anyone is interested, before my dogs arrived, my special interest was music and all thing piano and singing.  I would like to get back into piano again, but I seemed to lose my passion when I had my first bad bout of depression, and then we got Sunny during that and a new passion arrived :)

Stimming. I stim, that was picked up on in hospital.  Stimming is just some repetitive movements a person does to soothe or express emotion.  I'd rather not say how I stim because I don't want to draw attention to it and feel self conscious.  As a side note, if you know of a person on the spectrum, child or adult who stims, do not tell them not to do it unless they are physically hurting themselves, or someone else.  It's actually important for that person to regulate the sensory overload, and it's just the natural way they move.   It's not nice to be told the way you move is shameful, and suppressing stimming actually takes a lot of energy  and then the person is more likely to get overloaded. 

Having multiple diagnosis is not that uncommon I know this and yet I still feel bad about it and feel people will judge me.  When I was in hospital and we were bored - which was a lot of the time - the patients would often discuss diagnosis, and frequently people had 2 or more things going on at once.  It's also fairly common for it to take a while for psychiatrists to work out the correct diagnosis if there is more than one thing, as they all interact together and figuring it all out is not easy. I have 3 things, 2 formally diagnosed and one other thing so under control that I rarely need help, though I can bring it up with my CPN if I need too.  Having a great CPN is extremely helpful, my own really is an amazing woman with a enormous amount of empathy and understanding. I feel a lot of shame of the fact I have multiple issues,  often I feel like I am a burden both to the ones I love and to society in general.  I have been judged and had some very nasty comments about that in the past.  It makes me afraid to talk and be open.  Aspergers would have been there since childhood, but when I was a child it wasn't as well known, and so picked up on much less, especially in girls.  That isn't anyone's fault, but I am glad things are changing and the professionals are picking up on it, and getting support for Aspergers and other Autistic children.  I feel that if I had been understood at that age in school I might have got bullied less, or at least had more support with bullying.  As it stands, I remember telling a teacher about being bullied and her response was "if you just helped yourself by trying to fit in more you wouldn't have this".  The problem is I didn't know how to, I couldn't help not fitting in. The entire social structure that I faced as a teenage girl was something I didn't understand, and it hurt to be told it was my own fault that I was being bulled to the point I felt suicidal. 

The positive about the Aspergers being a formal diagnosis now is that I can actually access help.  So perhaps I can learn ways to manage some of the difficulties so it doesn't impact my life so negatively. Perhaps I will also learn to embrace the positives it brings. Maybe I can meet some people that think the way I do, because for a long time I have felt very alone, and odd, and just not fitting in anywhere.  I'm lucky that in recent years I have made some friends that like me, for me, and who I feel connected with for the first time ever. But it's still not easy.  There is a service my psychiatrist is talking about referring me too called Number 6.  It's a place that provides support to people with Aspergers, and High functioning Autism.  There are groups and hang out sessions, and support workers to help with things like benefits, housing, and finding and keeping employment.  I'm not going to knock back this help.  I'm going to see this diagnosis as a key to getting support to live a better life, and meet more people like me. I now have an understanding about why I am like this, and I realise now that most other people are not the same in regards to repetition and sensory issues, and it's therefore hard for them to understand where I am coming from when I get very upset over these things.  I also realise that I cannot continue to fake being like everyone else.  It's draining. I always fail, and it then results in people not getting to know the real me.  I need to learn how to interact as I am, in a way that typical people can relate too, without having to pretend to be typical.  Maybe telling people is the first step, or maybe its a huge mistake. I guess I'm about to find out!

Please don't misunderstand my intention in coming out about this.  I am not using this as an excuse.  I'm not going to just use it as a free past to say any offensive thing I fancy, but what I hope people will understand is that I cannot change this.  The way I am, is just the way I am, and telling me to try harder to be social and not say the wrong thing, is like telling a deaf person to just try and hear better the sounds around them.  What my hope is, is that the people who know me will understand that I think a bit differently to most people, and I have some extra challenges with communication, so if you aren't sure what I mean with something I've said ask me to clarify.  You will find that usually my intent is kind, even if my words came out wrong or I seemed blunt. I also want to clarify that people on the Autistic spectrum, including people with Aspergers, do feel things like love and empathy, and are not a robot without feelings or kindness.  Sometimes it's just hard for us to pick up on peoples emotions when they are being subtle about it, and so it can seem like I don't care. But actually it's more likely that I haven't picked up on the fact anything is wrong.  When I do know someone is suffering I will try and help, but like anyone else I help other people by thinking, 'what would I want in this situation?' But often what I want is very different from what others want or need.  What I'm hoping is that people can meet me half way if they understand the cause. 

I don't see this as a bad label that will hinder me.  Not knowing and understanding this hasn't helped me, so now it's time to try something different.  I will accept the help that's offered to help me get more social, be less isolated, and work on things like doing better in employment or voluntary work. I want to see this as an opportunity to understand myself, and how my mind works, and find ways to have a peaceful mind that work for me, so I can be a better person, a better friend, partner, daughter, and be able to engage with new people, and build new relationships.  I am hoping that rather than dwell on it as another horrible diagnosis, I want to see it as a step closer to finally understanding why I appear a bit odd at times, or rather why the entire world is odd compared to me.  Hopefully it will lead to a more positive future.

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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