Restraint – 10 ways it harms psychiatric patients

Greer Garson, Laurence Olivier, Maureen O’Sullivan & Bruce Lester in Pride and Prejudice

 

Restraint. It’s such a polite word. What does it mean to you? Genteel Victorian ladies in romance novels? Bondage in Fifty Shades of Grey? Artistic photographs from the Held exhibition? Or perhaps the word conjures up the grotesque inhumanity of the face-down restraint and forced medication that take place on psychiatric wards up and down the country every day of the week and which are the subject of mental heath charity Mind’s new campaign. (See below for links to Mind’s campaign, press coverage, commentary and resources.)

The word restraint is reminiscent of Victorian novels of manners such as Jane Austen’s Pride and Prejudice. Of elegant ladies and gentlemen, like the renowned actors pictured above, exercising self restraint to stay within the confines of the social norms of the day. Rather than going “at it like knives on battered settees” (to quote a humorous song), characters manoevre to form genteel and restrained attachments.

Restraint also has connotations of the erotic kind. That’s especially so since the Fifty Shades mommy porn phenomenon brought bondage to the mainstream. By now there’s a Fifty Shades of Grey official pleasure collection, which includes a bed restraint kit, “approved by author” E L James. There’s even a parody novel incorporating Pride and Prejudice, called Fifty Shades of Mr Darcy.

A photograph from the held exhibition by Jane Fradgley

Some think of restraint in mental health settings as an interesting topic for art, fashion, photography and academic discussion. Photographer and fashion designer Jane Fradgley’s exhibition Held (see here and here) has a related symposium on restraint. Her photographs are inspired by the historical collection of “strong clothing” at the Bethlem Royal Hospital Archive & Museum and explore her impressions of restraining garments as facilitating dignity, comfort and protection. That’s straight jackets..

When I hear the word restraint, however, the first thing that springs to mind isn’t Victorian ladies, saucy pleasures or artistic photos. It’s the brutal reality I’ve experienced of being pinned face down by teams of six as a vulnerable psychiatric inpatient. It was done to me repeatedly, to administer medication. There was never a justification. It was done to me without warning. It was done to me without explanation. It was done to me without any shred of compassion. It was done to me routinely, on a schedule I was not told about. It was done to me as a first resort.

It’s too traumatic for me to write about again. However, if you want to know more, read this blog, Treated Like an Animal, where I describe one incidence of face down restraint step by step.

Late yesterday, when I checked twitter,  my feed was filled with references to restraint. It was not good for me: here‘s my reaction. Hours later, after the flashbacks and tears had subsided, I was still sick to my stomach, heart pumping, unable to sleep.

Why had there been so many tweets on my feed about restraint? Because mental health charity Mind was publicising the launch of its campaign around the use of physical restraint in mental health care using the hashtag #crisiscare. As Mind says:

“When people’s lives come crashing down in a crisis, they need help not harm. We’re calling for national standards on the use of restraint, accredited training and an end to face down restraint. Excellent crisis care exists. It can save lives. And that’s why we need it available for everyone.”

It’s an important campaign, and one which must succeed so that the harms like those that were inflicted on me when I was at my most fragile aren’t allowed to be imposed on others in the same way. Here’s my personal experience of the harm done by physical restraint in a mental health setting:

1. It destroyed any chance of developing a therapeutic relationship with ward staff. Staff became my jailers and tormenters, wielding arbitrary power, casually chatting over me to each other as they did their business. All I was interested in while on ward was discharge, not healing: get out, get away from staff and make sure they never came after me again. Fear of psychiatric staff affects me to this day.
2. Mentally I was pushed to a place I would never have gone to had I received care rather than violence. At my most vulnerable, I was brutalised. Like smashing down a sledge hammer again and again on a tender broken wrist instead of enveloping it in a protective plaster cast, these restraints made me much, much worse than I ever needed to be.
3. Each time it was done to me, I was reduced to the state of a cornered animal, running on stress hormones, on fear and instinct. My dignity and humanity were removed. (One time I was carried face down and shoeless through wards and corridors and past men playing snooker, with no explanation. I was so terrified I wet myself and was left in my own urine, watched through a porthole at 15 minute intervals. After some time, I was carried back the same way.)
4. These physical restraints caused distress to other patients, who would hear me crying out in fear as I was manhandled, or see me being taken through the ward face down.
5. I was physically injured by being yanked, pinned down, knelt on and injected. My buttocks were bruised meaning I was unable to sit. I was covered in lumps and great purple and green bruises and finger marks. Although the severe bruising and lumps have healed, two years later I still carry two physical injuries (one serious and for which I still receive treatment). (None of these injuries will be recorded in hospital records.)
6. Two years later, simply hearing or seeing the word “restraint” can bring on overwhelming flashbacks and deep physical responses. Two years later, I can’t even can’t watch light-hearted TV programmes with traffic police in them because, sooner or later, there will be a big scrum when officers pin down a suspect. Just seeing that can trigger the flashbacks too. I can’t even lie on my tummy without it reminding me of being brutally pinned down.
7. Two years post-discharge, the symptoms I still struggle with – and spend a lot of time managing – relate to my treatment on ward (flashbacks and physical symptoms), not what brought me onto the ward in the first place.
8. I have been diagnosed with Post-Traumatic Stress Disorder as a direct result of my ward experiences (I am on a waiting list for treatment).
9. Friends and family are horrified at the barbarism of what was done to me, putting them off seeking psychiatric help themselves.
10. Having experienced what can go on behind closed doors when no-one is looking, I will never go back into a psychiatric ward, no matter what.

Since discharge, I’ve learned that restraint is a physically risky process in which people can die, so my fears were justified. Recently I bumped into a woman called Cheryl Prax. I spent 90 minutes listening to her describe her experience of having her arm broken in two places when she was restrained by psychiatric staff (see her speak about it here).

Why am I giving all this personal detail? Because staff may believe that using physical restraint helps them to manage the ward environment in the short term. But perhaps, as caring professionals, they will reflect on the long-term implications, both physical and mental, for those on the receiving end. And perhaps they’ll reflect that some mental health trusts have already banned the use of face-down restraint without losing control of the wards.

And now it’s not just me who’s saying they have had bad experiences being pinned down by psychiatric staff. Now there’s a national campaign from Mind to get rid of this barbaric practice once and for all. See the links below to see what you can do to help. Please help. Because this monstrous practice must stop.

There are numerous links below.

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My thoughts on restraint:

• My first blog post on physical restraint – Treated Like an Animal
• My Storify of tweets about restraint, including links to Mind’s campaign on crisis care
• Another post on the use of restraint – Patients as whistle blowers – the CQC and rooting out bad practice in restraint of psychiatric patients
• I’ve been asked if I’ve complained about the restraints I was subjected to. See here for a partial answer.

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Material related to Mind’s crisis care campaign on the use of restraint:

• BBC – report by BBC home editor Mark Easton on the use of restraint in mental health settings – ‘Excessive’ use of face-down restraint in mental health hospitals – a good overview, with links including a powerful video (under 2 minutes) from Naomi Bell about her experiences of face-down restraint as a teenager (18th June) – this is where the story broke
• Mind
  • Crisis care campaign (main link) – “I was in hospital to get better. Instead I was abused and traumatised.“
  • The campaign story (overview)
  • Briefing for nurses and other front line mental health staff
  • What’s crisis care like where you live? Check how restraint is used in your local area (you’ll need to enter a postcode) – in my area, it’s way above the national average
  • Physical restraint in crisis – the report – “I was manhandled. They didn’t explain anything to me but just threw me on the floor and another person stood over to watch. There was no explanation or communication the whole time.”
  • Real life stories – podcasts, videos and blogs
  • What can you do? Take action
• Code of Practice to the Mental Health Act 1983 – see chapter 15 on physical restraint
• NICE guidelines (National Institute on Health and Care Excellence) – Using control and restraint, and compulsory treatment
• Independent Advisory Panel on Deaths in Custody – includes figures on restraint-related deaths

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Commentary & additional material:

• Cheryl Prax speaks speaks about having her arm broken in 2 places during a restraint
• Community Care – Government considers banning ‘dangerous’ face-down restraint of mental health patients – “Ministers consider ban after mental health campaigners reveal thousands of incidents where patients have been subject to controversial ‘face-down’ restraint” (19th June)
• Mental Health Cop (Insp Michael Brown – Restraint – an excellent blog from a few months ago (April)

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Press coverage of the story:

Nationals:

• Daily Express newspaper – Patient restraint data revealed – “Nearly 40,000 incidents of physical restraint on mental health patients in England were recorded in one year – with more than 3,000 in the “dangerous” face-down position – according to figures released by a charity.” (19th June) – #headclutcher alert!
• Daily Mirror –Mental health charity Mind in call to end “face down” restraint of patients – “Almost 3,500 patients were restrained in a “face down” position in just one year, shocking figures reveal” (19th June)
• Daily Telegraph newspaper – Government considers banning face-down restraint on mental health patients – “Ministers are considering banning the use of face-down restraint on mental health patients in England after it emerged that several trusts are employing the procedure two or three times a day.” (19th June)
• Independent newspaper – Ministers consider ban on face-down restraint in mental hospitals – “Ministers will consider a ban on the use of face-down restraint in English mental health hospitals after new figures that show nearly 40,000 incidents of physical restraint were recorded in just one year.” (19th June)
• Times newspaper (£) – Mental health trusts still using dangerous face-down restraint (19th June)

Locals:

• Hull Daily Mail – ‘Never an excuse for face-down restraint in modern healthcare‘ (19th June)
• Kent Online – Patients in mental health hospitals in Kent are five times more likely to be restrained than national average (19th June)

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The saucy side of restraint, plus art:

• Jane Austen – Pride & Prejudice (download free)
• Fifty Shades of Grey official pleasure collection bed restraint kit
• Ivor Biggun – My brother’s magazine (“at it like knives on battered settees“) – a silly, funny song about mucky magazines before the age of internet porn!
• Held by Jane Fradgley: A Symposium on Restraint (on 31st July at the Institute of Psychiatry in London; the exhibition is on from 10th July to 27th September)

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The education of women, Monty Don and control of global population

Elizabeth Fry on the back of the £5 note

Often I’ll start tweeting about something that piques my interest when I’m listening to the radio or watching something online or see a story reported on twitter. This blog arises from one such instance. Although it isn’t a mental health topic, it is related to an issue I’ve come across in the mental health field: namely people talking about us rather than with us.

The programme in question was broadcast earlier today on BBC Radio 4. It was episode 1 of a series of 30, called Shared Planet. The presenter is horticulturalist Monty Don, with whom I engaged in a couple of twitter chats. This is how it began:

Do men in the media notice, when they’re discussing a topic that most intimately affects women, that there are no women at the table? This morning, I stumbled across the end of a programme called Shared Planet, the first episode in a 30-part series which this week was about global population growth.

I heard an all-male discussion on population growth, women’s reproductive choices and the need to educate women. No women spoke. The presenter, horticulturalist Monty Don, concluded that the solution to reversing global population growth was educating women. Women needed, in the words of one of the male experts, “a more rational attitude towards their reproductive life.” Had I really just heard that? It seemed a simplistic conclusion phrased in patronising terms.

I wonder whether a woman presenter would reach the same simplistic conclusion. I wonder whether a woman scholar would describe uneducated women as irrational. I don’t know the answer to either question. But one thing I do know is that, if you’re discussing women’s reproductive choices and women’s education, women’s voices should be heard.

Just at that point, a tweet popped up from the Women’s Room about female scientists who had been overlooked for recognition, and about the removal from the country’s currency of the only female historical figure, Elizabeth Fry (pictured at the head of this blog post).  The Woman’s Room was set up last year because:

“For two days in a row, in October 2012, the [BBC Radio 4] Today programme ran a segment on a female issue. On both days, the issue was discussed exclusively by men. The BBC claimed that they had been unable to find female experts despite their best efforts.”

There is now a database sortable by region and area of expertise listing over 2,000 female experts. The aim is to enable local media to find local female experts and also for women to be able to get together and form local networking groups.

What did I learn from my twitter conversations with Don? That he may not have listened to the final edit of the programme. Take a look at the conversation and see what you think. On the plus side, he’s now had the Woman’s Room drawn to his attention so hopefully next time he’s presenting a programme with a female focus he’ll consider including a woman’s voice too.

 

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• My twitter conversation with Monty Don
• BBC Radio 4 – Shared Planet – episode 1, The Problem of Population (the relevant part starts around 20 minutes in)
• Monty Don‘s website (though nothing is happening there yet) (twitter: @TheMontyDon)
• National Geographic – 6 Women Scientists Who Were Snubbed Due to Sexism – “Despite enormous progress in recent decades, women still have to deal with biases against them in the sciences” (19th May)
• The Women’s Room – about the project and the banknotes campaign

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What’s it really like to live with mental illness? Drama, danger, misery … or sedation

My photo taken during a dawdling riverside walk

Media coverage – and public perception – of mental illness can focus on drama, danger and misery. Yesterday’s media splash surrounding Stephen Fry was a case in point. What gets lost is any sense of what life can be like managing a mental health condition day to day.

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With that in mind, here are some reflections on a current bugbear of mine – a humdrum hindrance – namely fitting a life around the sedating effects of the psychiatric medication I am currently taking. There’s absolutely no drama, danger or misery in what follows.

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At breakfast

I wrote the following sitting in bed yesterday morning, where I’d returned to eat breakfast:

Being on a medication that has a sedating effect is like being a hostage in your own body: there are restrictions you’ve just got to accept. You can’t go about your life freely. You can’t get up when you want or do what you want. You have to wait patiently.

As well as the lingering sleep which the medication induces, I have to factor in “dawdling time” in the morning – time when I can expect nothing much of my brain and need to move with deliberate slowness so I don’t bump into, trip over or drop things.

I’d like to leap out of bed with the dawn like I used to, but I can’t. I’m forced to sleep longer and then, on waking, move around slowly. I’d like to be able to get on with the tasks of the day, but I can’t. I’m clumsy and my brain isn’t fully working yet. In the morning, I’m slow in body and mind for hours.

I’d like to set the alarm then be out of the house half an hour later – fed, watered, washed and dressed – like I used to, but I can’t. For a morning appointment now, I need to factor in ninety minutes after waking before I’m ready to leave the house.

I’d like to ring the water board to say, “Please don’t cut off the water”, but I can’t coordinate speech yet. So I’ll just have to sit and push the worry aside till the fog clears. I had to answer the door to my nice postman this morning. He’s grown used to my monosyllabic and expressionless morning ways. I’m guessing he thinks I’ve just become rude.

This morning I fell over when I got out of bed, poured an iron supplement onto my cereal rather than into the glass and forgot to shut the fridge door yet again. I’ve broken so many tumblers in the morning, I’m down to my last one. Clumsy brain, clumsy body.

I know there are things I need to be getting on with. But I also know I can’t. I’ve got to be a passenger in my body for a while yet. Because being on a medication with a sedating effect is like being a hostage in your own body. There are restrictions you’ve just got to accept.

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At bedtime

I wrote the following sitting at the kitchen table from 9pm last night:

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When you take medication at night which has a sedating effect, it can mean you’re at your most alert … right around bedtime. Bummer.

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So, with my alert brain, I’m getting organised and have just made a little list of things I really need to do tomorrow morning. Some things I can’t do now because it’s outside office hours (such as calling the water board). Others I don’t want to start just before bedtime because they might be stimulating. I’d like my mind to be nice and relaxed when I hit the sack, for a restful sleep. Getting sufficient sleep is important to everyone and even more so when you’re managing a mental health condition. So I put my little list aside for now, and start my bedtime routine.

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But then I remember the morning drug hangover and how that means it’s unlikely I’ll be able to get anything much done in the morning. Bummer. It’s hard to know how to fit everyday life round the sedating effects of the psychiatric medication I’m taking.

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•  .My tweets on this topic
• I came across this video of Kerry Katona from ITV’s This Morning in 2008 when she says her speech is slurred due to having taken 150mg clopromazine (thorazine or largactyl – as in the Largactyl Shuffle). She’s tripping over her tongue in the same way I do in the mornings, but she’s all there in terms of her responses.

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What’s it really like to live with mental illness? Stephen Fry, bipolar and suicide

Banner from Stephen Fry’s website

Yesterday, Stephen Fry – actor, comedian and writer, national treasure and president of mental health charity Mind who has a diagnosis of bipolar disorder – spoke about his 2012 suicide attempt. Today, the press reported the suicide attempt of Michael Jackson’s daughter Paris and speculation about a diagnosis of bipolar disorder. The day’s press has been full of reports of these stories, together with supposedly contextual information on bipolar and suicide. Sadly, coverage I’ve seen so far has been unhelpful to those managing mental health problems and those wishing to know more about them.

As I tweeted earlier:

“I think if you’d just been diagnosed with bipolar & read that piece, you could think your life was over. There’s nothing to give you hope.”

This is the piece on Stephen Fry & bipolar disorder that got me started. Written by BBC health and science reporter James Gallagher and tweeted by the Royal College of Psychiatrists, at first glance it appears informative and well written: it quotes a scientific study, includes quotes from Fry himself as well as a mental health professional and a mental health charity, and includes links to sources of further information. So far so good.

However, look closer and the piece is a load of clichés linked together into a web of misleading hogwash. What are the problems with the article? Here’s a quick whizz through:

• Speculation: “There are suggestions that at least a quarter and maybe even half of patients make at least one attempt.” Suggestions? You’d want to be really sure before delivering such a miserable prognosis to the legions of people in the UK who experience bipolar disorder.
• The black and white characterisation of bipolar disorder as consisting of mania and depression, when it is far more nuanced.
• The description of mania as being “extreme happiness and creativity”. Which really sounds like something we’d all enjoy!
• References to “hypermania”, which has become the grey squirrel to hypomania’s red squirrel across today’s media coverage, the former existing only in journalists’ spellcheckers. I call it Hypermania Cluster Disorder; or “I’m too lazy to check the spelling for this pop science piece I’ve been told to write”.
• Bald statements such as “There is no cure for bipolar disorder” deliver a bleak prognosis without recognising that, for instance, many people experience differing diagnoses throughout their lives. If someone’s diagnosis changes, are they cured, did they never have the disorder in the first place or does it reflect differences in clinical judgment?
• Linking bipolar disorder to drink and illicit drugs, which some people objected to on Twitter today since they’d never taken either.
• Only passing reference to the fact that, for many people, bipolar isn’t a second by second living hell but an episodic experience – a relapsing and remitting condition, in the jargon.

On the one hand, it’s good to see pieces in the media about serious issues like bipolar disorder and suicide: for too long, mental illness has been a secret shame kept hidden in the shadows. Yet, on the other, it’s not good to have misleading cliches & miserable hope-destroying myths doing the rounds.

A diagnosis of serious mental illness shouldn’t be a death sentence. Yet pop pieces like this make it sound like it is. Millions of people are getting on with their lives, passing by in the streets, buying their lunch, sitting on buses, managing conditions. The reality of living with a mental health condition isn’t reflected in articles like these.

As Mental Health North East (support for the north east mental health voluntary sector) tweeted:

“Was half expecting the article to contain a photo of Stephen Fry clutching his head on current BBC form #headclutcher“

This story again raises for me a question I often ask: who speaks for mental illness? Who speaks for those of us managing mental health problems? Who speaks out with information in the face of a breaking story where the media’s emphasis is on speed rather than accuracy, on getting your story out there rather than educating and informing? Today’s stories, whilst on the surface being about the dramatic event of a suicide attempt are, underneath it all, really about what sometimes happens in the day to day realities of living with and managing a mental health problem. Where have we heard that story reported today?

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Below I’ve linked to people’s first hand experiences of managing bipolar disorder as well as sources of information, together with commentary and news reporting of today’s stories (if you don’t know where to start, try the commentaries and first hand experiences).

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• My twitter conversation on this topic (Storify); and here’s part 2 (my later discussion with Irish psychiatrist Dr Niall Crumlish)
• BBC news – Stephen Fry: Suicide risk in bipolar disorder – the original story that got me started
• Stephen Fry’s website

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Commentary following the reporting of Stephen Fry’s 2012 suicide attempt:

• Black Dog Tribe – Stephen Fry reveals he attempted suicide in 2012 (6th June)
• British Comedy Guide – Stephen Fry reveals attempted suicide (5th June) – where the story was originally reported
• Charlotte Walker (twitter: @bipolarblogger) – Count no blessings: how a suicidal mind works (5th June)
• Mind – Stephen Fry’s story shows we still need to talk – by Tracey Pallet (Twitter: @EhOhSaysYes) (6th June)
• Samaritans – Comment piece: the attempted suicides of Stephen Fry and Paris Jackson (6th June)
• Time to Change – What Stephen Fry’s conversation about suicide means to me – by Mrs Shea Wong (Twitter: @MrsSheaWong) (6th June)
• Secret Diary of a Manic Depressive blog by Seenean Molloy-Vaughan – Stephen Fry, suicide and the cycle (6th June)

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First hand experiences of bipolar disorder:

• The Fementalists blog – Ask a woman with bipolar part 1 & part 2 – 4 women talk about what it’s like to live with bipolar disorder
• Fighting for Euthymia blog by Helen Moreton (Twitter: @gingersquirrel) – Crying at Work (14th April)
• Purple Persuasion blog by Charlotte Walker (Twitter: @bipolarblogger) (winner of the Mood Disorder category in the 2012 World of Mentalists Awards)  has lots of pieces on the day to day realities of managing bipolar disorder – some recent examples are The Court of Protection, motherhood and mental health, Bipolar highs: a runaway train & Pride and pragmatism
• Secret Diary of a Manic Depressive blog by Seaneen Molloy-Vaughan, has lots of pieces on the day to day realities of managing bipolar disorder – some recent examples are When you find the changing seasons affect you without reason, Saw GP today & I Smoked All of England’s Cigarettes: Mental Illness and Smoking
• Shea Wong‘s blogs on bipolar disorder for Time to Change

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Sources of information on bipolar disorder:

• Bipolar UK charity
• Mind charity – information on bipolar disorder
• Rethink Mental Illness – information on bipolar disorder
• Royal College of Psychiatrists – information on bipolar disorder
• Sane charity – information on bipolar disorder
• Time to Change – Bipolar disorder: blogs and personal stories (first hand experience by bloggers with bipolar disorder)

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Some information on suicide:

• Mind charity – how to cope with suicidal feelings
• Samaritans‘ guide to journalists on reporting suicide

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News coverage of Stephen Fry’s 2012 suicide attempt:

• BBC news – Stephen Fry reveals he attempted suicide in 2012 (5th June)
• BBC news – Stephen Fry discusses his 2012 suicide attempt (3 min video) (6th June)
• Huffington Post – Does fame make you more suicidal? – Dr Raj Persuad & Dr Peter Brggen (6th June)
• Guardian newspaper – Stephen Fry: recent attempted suicide a ‘close-run thing’ (6th June)
• Independent newspaper – ‘I am the victim of my own moods’: Stephen Fry reveals suicide attempt in 2012 and that TV producer saved his life & Stephen Fry suicide bid took place soon after confronting protesters while filming ‘gay cure’ documentary in America (both 6th June)
• MSN news – Bipolar disorder: the secret life of a manic depressive – by Seaneen Molloy-Vaughan (6th June)
• Telegraph newspaper – Stephen Fry: I attempted to kill myself in 2012 (6th June)

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Confiscating patient phones on psychiatric wards

My photograph of an Olympic Park telephone box, July 2012

Some thoughts on the confiscation of patients’ phones on psychiatric wards, prompted by the fact someone found my blog yesterday by searching the term, “If you are in a psychiatric ward do they confiscate cell phones or computers”.

I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.

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• Storify story of my twitter conversations on this topic, including patients & mental health staff
• An earlier blog post – Psychiatric wards and social media

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Some meandering thoughts on scientific studies

Elizabeth Garrett Anderson, Britain’s first female doctor, by John Singer Sargent

Some thoughts on the nature of scientific studies – what gets studied, how studies are designed, how interventions are implemented – in response to the  publication of a blog looking at a study that showed Joint Crisis Plans were ineffective.

(I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.)

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• My tweets & those of others bringing their perspectives, including researchers in the field. – Scientific studies
• Mental Elf blog – Joint Crisis Plans to prevent compulsory admissions: a good idea stymied by poor execution? (3rd June) (contains links to the 2013 study as well as its predecessors in 1999 and 2004)
• Dr Sarah Knowles‘ post (prompted by a twitter conversation on this topic – see the Storify story above) – What does ‘implementation’ mean in research? Or, finding out why good ideas can be badly executed. (5th June)

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