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.