Where the "severe and enduring" have special teams of people looking after them - psychiatrists, psychologists, community psychiatric nurses (CPNs) and support workers. The mantra is one of diagnoses, long term drugging and mental health service land. Remission instead of recovery. For the national recovery movement has somehow passed us by, although there may be posters up in psychiatric wards that have the words of recovery written on them. There are also help booklets for patients and carers, funded by pharmaceutical companies eg on how to live with schizophrenia.
In
the Stanley Kubrick science
fiction film from
1968 there were a series of encounters between the humans and the mysterious
black monoliths. One of the themes was human evolution, another about
information being withheld. It's a film I liken to the psychiatric
system, difficult to understand or get to grips with, only difference is that
the evolution seems to be going backwards in our sci-fi tale. In 1970,
aged 17, when I first had dialogue with psychiatrists as my mother's carer, and
visited the locked ward, I knew it was a system that was alien to me, or I to
it. I didn't believe a word of it and thought I would never be a patient
(lol). Forty two years later and I have engaged with the system in every
decade since, in both user and carer roles. Resisting involvement until recently.
Now it's like being up to my neck in a sticky substance, difficult to shake
off, the more you struggle the more sticky it gets.
Acute
psychiatric wards in 2012 where nurses, who seem nice enough folk, run for
cover to the staff room, like soldiers in the trenches. I have knocked on
their door to make contact, daring to interrupt a "briefing" and been
quickly dispatched. Male nurses invading my personal space, putting their
arm around me, leaning over me. Complaints from me flying thick and
fast. Think it must be ignorance rather than intimidation. But it
feels like the latter. The practice of restraint in the ward setting
spills over into their relationships with patients and visitors.
Assertiveness is seen as aggression and a threat to be dealt with. I've often
felt like I was going to be manhandled/nurse handled out of the ward.
It's annoying.
Male
and female patients all in together, the acute wards now have very acutely ill
people in them, or so I'm told, for others less acute are "in the
community". Patients with complex needs and in distress, a large
percentage with drug and alcohol issues, many revolving-door patients, some
ex-offenders, others depressed, some not with it at all, one or two requiring
24/7 observation. Open wards only locked at night. Police called in
almost on a daily basis to deal with absconders or very distressed
patients. Walking into the ward in their full gear, batons, belts, black
uniform, like sheriffs in a western. Coming to restore law and order to
the madhouse.
A
male patient in the dorm woke up one night to find a female patient coming out
from under his bed. He asked her if she was OK then went back to sleep
again. I raised this issue with staff. They said that it was right
enough and written on the female patient's notes that she had been found in the
male dorm. I also mentioned how she was using the toilet in the corridor
of the mixed ward without closing the door. They took note of this.
A few days later the female patient absconded and police were sent out to look
for her.
A
few of the patients in the acute ward hear voices and fortunately a worker goes
in to visit, from the Hearing Voices Network. This is encouraging.
Not so positive is the use of forced treatment like clopixol acuphase injection, to manage or control distressed
patients. The side effects of this drug can be severe, apart from the
strong sedation that engulfs a person, and it can only be used for up to 2
weeks. I became aware of this treatment in 2010 and think it is a
substitute for ECT, a knock on the head sort of a thing. Shocking
patients back into reality. Instead it depresses them and can make them
even more psychotic. But more easily controlled and manageable.
Another "useful" tool in a ward situation where the only treatment
given is neuroleptic drugs and benzos on request. Therapies are not
available for people in the acute ward. They have to get well enough to
get out of the ward before they are offered any additional treatment to the
drugs. Opting out of drug treatment isn't an option.
If
you have the misfortune to be unco-operative or 'non-compliant' or perceived as
a danger by the staff then you are under threat of being transported to the
locked ward, if you are of the male gender. Only 6 male patients
here. A forensic ward where procedures are flexible, I call it
"making it up as they go along", nice work if you can get it.
They would say it "depends on the patient population". Same
thing in my opinion, changing the goalposts, a destabilising technique.
The ward is in a very old building, not fit for purpose according to reports by
a national watchdog organisation. No rooms with toilets and a seclusion
room where patients are locked in, to calm down or dry out. The only
water cooler in the dining room which is kept locked, you have to ask for a
plastic cup. An activities room only open at certain times. This is
where patients can have the use of a pen to write with, if supervised by 2
nurses. Pens and plastic bottles and straws are dangerous weapons.
They have obviously heard of the saying "the pen is mightier than the
sword".
Patients
even abscond from the locked ward. How do they manage it, you ask?
It's when they are on "time out". They are brought back by the
police. And negotiate their privileges yet again. The circle of
care at the psychiatric hospital. A merry-go-round of locking up and
letting out. I asked an older locked ward patient what he thought of the
RMO (registered medical officer). This was when we were outside the ward
after visiting. He swore and said that he hated him, for the RMO gave him
drugs that made him stiff and impotent. The patient's friend said
"too much information" and hurried him away into his car.
There
are around 94 patients still in medium or long stay psychiatric wards, rehab
they call it, where I live in a small region of Scotland. 45 of these
have been identified as being ready to come out "into the community".
That is, the community of the town or village or countryside that we all
live in rather than the hospital community. Some of these patients have
lived in the hospital grounds for a generation and might have tried before to
come out, with little support and ended up back in hospital again. The
rehab nurses have said to me that the patients won't manage "in the
community". But I think this is institutionalisation of staff and of
patients by staff. Perpetuating the myth of mental illness and the
"severe and enduring" label that expects or ensures compliance and
obedience to psychiatry.