Do you remember your first time?

16 Nov
My bedspace after one incidence of forced treatment by six people.

My bedspace after one incidence of forced treatment when I was restrained and injected on my bed by six people.

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Open quotes

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Patient: When you’re unwell you need care. And what I got was punishment. So when I was unwell I was extremely stressed and I was anxious. And I was taken by the police from my bedroom, unlawfully as it turned out, erm, from my bedroom into hospital where I was assaulted by patients and staff and I was held down and drugged repeatedly. And nobody came and spoke to me and said this is what’s happening, this is the diagnosis you have, we think you’re experiencing this and this drug will help you. Nobody came and spoke to me. And instead what they did was I would just be on my bed, reading a book, or not reading a book, couldn’t read, I would be on my bed, doing something, minding my own business, and I would turn around and there’d be a team of six people with rubber gloves who would hold me down [Starts to cry], pull my trousers down and drug me. They didn’t tell me what the drug was, they didn’t tell me what the effects were, they didn’t tell me what to expect, they didn’t tell me how long it would last, they didn’t tell me what it was for. Nothing. And they would finish and they would climb off my bed and they would walk away. And I wouldn’t know when they would come back. And they did that, erm, over and over and over and over again over a period of several days. I don’t know what they were giving me and I only found out after I left and saw my medical notes some of the drugs they were giving me. Sometimes they’d make a mistake and they’d give me drugs twice. Even though I went to the counter to get my drugs, take them voluntarily, they would still hold me down and give me other drugs. [In a strong voice, stops crying] So in that context I don’t think medication was helpful. The approach was unhelpful. What that approach does is it makes people afraid to ask for help.

Interviewer: It’s incredibly brutal. Can I go and get you a tissue?

Patient: No, no, I come prepared. I always have tissues with me.

Interviewer: Are you okay to …

Patient: Yeah, yeah, I’m fine.

Interviewer: And that was your first experience of medication as well?

Patient: Exactly. I don’t, I don’t take … Well, before this experience, I didn’t take anything. I didn’t take aspirin, I didn’t take paracetamol. I didn’t even drink coffee. You know, I didn’t take any drugs. I had a fear of drugs. I had a fear of needles. I have low blood pressure so if you give me a needle I’ll faint. So if you want to give me a needle I need to be lying down, I need to be calm and then … Whatever. So, Close quoteser. So I’m, you know … Now I know a lot about drugs. [laughs] I know a lot about drugs. Erm, before that, no, that was my, that was my first experience of drugs.

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Do you remember your first time? I do. I remember the first time I was treated by force. I remember it very well. The account above is an unedited segment from the transcript of my February 2012 interview with a researcher. In it, I briefly describe my first time being treated by force. That interview was also the first time I’d been able to speak to anyone in detail about what had actually been done to me in hospital. I knew it would be difficult and emotional, but I forced myself to take that first step in speaking out as part of a research project. It was six months after I’d been discharged from an acute inpatient psychiatric ward but, even so, I was floored for a week by the emotion of the interview.

Then, the following month, I found myself tweeting in bursts, over the course of several hours, about my experience of being treated by force. That was the first time I’d conjured up those images in detail and written them down for others to read. As I tweeted, I shook, cried, felt sick – but kept going. I couldn’t turn it into a full blog post but instead wrote a short one (Treated like an animal) linking to the collated tweets. I hadn’t read them back till just now: I couldn’t. That blog post and collated tweets have since been read thousands of times.

Three months later, in June, mental health charity Mind launched a campaign to end use of face-down restraint on psychiatric wards and that prompted me to write about forced medication again (Restraint – 10 ways it harms psychiatric patients). That post was read even more times than the first, though the toll in writing it was, thankfully, less on me. That was because, this time, I wasn’t conjuring up images of what it was like to be forcibly medicated in order to convey a picture to the public: it was a more considered overview of the topic. Almost a year after discharge, it seemed I’d begun to attain some distance from what was done to me.

Then, in November of that same year, the interview transcript arrived and a mental health charity asked me to write a piece for them about my experience of forced medication for their campaign. I forced myself, again and again, to sit down and bring to mind, in great detail, what it was like, so the reader could envisage themselves there, in the moment, being on the receiving end themselves. It took a heavy toll on me emotionally. Trying to edit it was toughest. Trying to take my raw recollections and shape them into something suitable for a mainstream audience without being overwhelmed by the intensity of the recollections. In the end, I couldn’t submit the written work. (It’s languished on my computer for 2 years, and I’ve only just looked at it. And I’ve only just glanced through the research interview transcript.) What that reinforced for me was that speaking or writing about forced treatment is a part of a healing process for me and something I cannot conjure up to order: it has to naturally arise from me when the time is right. I have a diagnosis of post-traumatic stress disorder as a result of what was done to me in hospital, and that’s just what I’ve got to work with.

It was another four months before I wrote about forced treatment again, in March this year (Forced medication: resistance is futile). I was able to write my first proper blog post describing one aspect of it. Compared to 12 months earlier, I noticed that tweeting about the topic (almost all my blog posts arise from tweets!) had been less overwhelmingly painful and that I’d been able to go back afterwards and edit the tweets into a blog post. It seemed as if I was naturally and instinctively keeping a distance from something that had injured me to the core, gradually circling round it and every now and then being able to touch on the subject. It seemed that, each time, after several months had passed, I was able to return to the subject with a little less terror.

So here I am, 8 months later, over 3 years since I was discharged from hospital, writing about forced treatment again. Circling the subject again, adding a little more depth, noticing that I can now approach it with a little less pain, with fewer flashbacks and  physical responses.

And what is new this time I’m writing about forced medication? It’s not a topic I’ve seen discussed much on social media or in the mainstream media. But then, it’s not something I’ve been able (emotionally) to investigate. However, I have been aware (very much at arm’s length) of campaigns to reduce the use of physical and chemical restraint and seclusion related to what’s called “challenging behaviour”. These include Mind’s campaign to end the use of face-down restraint and Mersey Care NHS Trust’s No Force First pilot to create coercion-free psychiatric inpatient wards. I’m also aware of research on conflict and containment in inpatient psychiatric settings which highlights that it’s staff, not patients, who influence how much of each there is likely to be. There may well be research and discussion on forced medication that’s passed me by, and please do let me know if you come across any.

For me, forced medication is very much a separate topic to use of force in situations of danger (to the patient themselves or others) or conflict (such as verbal abuse or violence). Forced medication is about a psychiatrist deciding on a course of treament (medication) and leaving ward staff to get on with administering that. It seems to me there are no controls over use of forced medication, other than the good will of staff and we already know that, when one group of people is given power over another, it may not always be a benevolent dictatorship. Even with the best of intentions, shortcuts can be taken – and using force to medicate someone is the ultimate shortcut – and staff can become aclimatised to routine use of force.

Here, then, are my recommendations for reducing the use of forced medication and thereby the harm it causes:

  1. Collation of national statistics on use of forced treatment – Make it compulsory to record each use of forced medication and to report it nationally. That way, national statistics and a picture of best practice can emerge as the basis for comparisons and for developing evidenced-based interventions. That will necessitate development of standard definitions of forced treatment, particularly since my medical notes record “No restraint employed” in relation to the first incident of forced medication. So, for instance, I would include (but in different categories), where use of force is mentioned to a patient in order to coerce them to take medication “voluntarily”; where the medication “hit squad” attends and stands near a patient to encourage them to take the medication “voluntarily”; and what was done to me (ie the full 6-person take-down). Make use of forced treatment a notifiable process (like a notifiable disease): it’s such an invasive process – state-sanctioned assault on someone at their most vulerable – that there cannot be a justification for treating it in such a slapdash way.
  2. Earning the right to use forced treatment – Make use of forced medication a right which must be earned, each and every time, by exhausting every alternative option beforehand. It may suit some ward staff to go straight for forced medication as a short-cut for ward management purposes. However, patients are people who exist beyond the locked ward and will do so once they are discharged, and forced treatment can have damaging effects in the medium and long term. Forced treatment can cast a long shadow. It should never be a first resort. The Code of Practice to the Mental Health Act sets out strict conditions for use of physical restraint but forced medication is nodded through under the guise of general principles. Clearly that approach is not working, meaning that detailed guidance on the prerequisites for the use of forced medication, in the same way as they are for restraint, are necessary.
  3. Debrief patients after each use of forced treatment – I’ve seen on documentaries (such as ITV’s recent series Broadmoor) that, when a patient is physically restrained and forcibly medicated, afterwards staff meet to discuss and debrief. All the while, the patient – who’s just been subjected to what, at the very least, could be described as a highly intense experience – is left in their bedroom or bed space alone to try to work through their responses. I recall time and again being left face down, underwear and trousers askew, in sheets covered in bootprints on a bed pushed out from the wall, empty antiseptic wipe packets on the floor. I’d be left shocked, terrorised, humiliated, confused, frightened, to clear up my bedspace, somehow get hold of clean sheets and somehow work out how to, well, be on the ward again. Patients need a debrief just as much as staff. Or perhaps more. After all, they are the vulnerable ones, there to be healed, not brutalised. Witness a patient’s pain. Be there to comfort them. Help them work their way through the experience.

I shouldn’t be left, over 3 years after discharge from hospital, still being triggered into flashbacks by obvious reminders like the photograph above or the word “restraint”, let alone such seemingly innocent stimuli as the flicker of fluorescent lights, the hum of air conditioning or traffic cops chasing a motorist on TV. Treatment is supposed to help patients. No patient should ever leave the ward more harmed than when they went in, too scared to ask for help in future and only referring to “that place” in hushed tones. Good psychiatric inpatient wards exist all over the country. Hopefully these three proposals are a helpful addition to dialogue around ridding the psychiatric system of forced medication by learning from those who use it least.

 

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web links 5

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Related web links:

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My previous posts on forced treatment (each containing links):

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On restraint, conflict and containment:

 

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10 Responses to “Do you remember your first time?”

  1. artnexa 17 November 2014 at 4:46 am #

    [Probably should have a trigger warning here for you]

    Hey there, it was really interesting for me reading your post because I also know what this sort of thing is like. My “first time” was at 15 in a psych hospital I was in for two months. I remember that place so vividly, even though most of my past is something of a hazy fog.

    They didn’t quite do what they did to you, to me – with me it was scaring us into taking *something* (no idea what) if we were “acting up”, and if we failed to comply then we were denied the privilege of going outside, smoking cigarettes, dessert (the food was absolutely awful so this was a big deal), visitors, your money taken away, being denied going home on weekends (if applicable) or a mixture of all of the above.

    At mandatory group therapy if we had not been complying then we’d be “marked down” (you had to get an A, B or C to get the ability to have any of the above things anyway, but C was the start of where they stripped you of stuff), so if you had been doing things that mentally ill people tend to do, that quickly meant that you had yet another week where the world was filtered through bars on the windows.

    There are not many people who know what this sort of thing is like. There was some forced stuff, but that was mostly locking people in rooms for hours at a time (with no explanation, tied down to a bed sometimes, no toilet in that room) or, as I found out later, falsifying your notes so it looked like you were 100% A-OK – even if you had done something drastic that needed medical attention.

    It’s awful because I have a deep distrust of doctors now, which leads into further complications. It does not help that so many of them seem to repeat the patterns that lead me to distrust them in the first place.

    I hope you don’t mind me sharing. People tend to not believe me or they think I am exaggerating things. This seemed like a rare opportunity to share.

  2. The Manic Years 17 November 2014 at 9:58 am #

    I just had to share this because, even thought I have only been subject to outpatient and Urgent care needs (Bipolar 2), the fear of asking for help when my life is at risk is embedded in me through other patients experiences.

    I just want to express how grateful I am for sharing your traumatic experiences, your words truly project the pain from your memories – I cannot even begin to imagine how hard this was to write. Thank you.

    Megan x

  3. The Millers Tale 17 November 2014 at 5:31 pm #

    I am sorry. I am sorry that happened to you. Thank you for writing about it. This should be in the front of every psychiatric textbook. No psychiatrist and RMO should ever be allowed to sanction restraint and abdicate his own responsibility by being physically not present when it happens. And yes yes yes to a national collation of stats with an external body (made up of service users, non stat orgs, service users pressure groups alongside stat services) convened to adjudicate on whether something marked as ‘not’ restraint is, actually, forced restraint.

  4. savemefrombpd 20 November 2014 at 8:46 am #

    This is a very powerful piece of writing where you express ever so well what you went through. This post should be spread all over the place in my opinion.

    I’ve been restrained before but just by holding my arms and pushing me in to a chair and held on to. No injections though. They just gave me an Benzo orally. And I was put in the ‘de-escalation’ room which just has a padded bed type thing in and nothing else. It was pretty crazy. I got up on the windowsill and tried to get out of the window but of course the windows were designed so you couldn’t even get your head through them.

    I’ve seen others being restrained face down on concrete before when I was in hospital. The patient seemed calm and non-threatening before it happened. I heard him talking to a nurse and he said that he was hearing voices but it didn’t sound like the force they ended up using was really necessary. He had 8 nurses holding him down and he wasn’t even fighting them. And then they came with the needle and gave him a med. I saw it all happen and the patient was screaming ‘just get off of me’. I’m not saying therefore that was OK, but seeing that he was outside on a concrete floor, I can’t say that the staff did a good job in restraining him as they could have done.

    It was awful seeing it all unfold and I can only imagine what it feels like. If it makes me feel so distressed to talk about someone else being restrained face down etc then I can only imagine how it was for you. Truly awful…

  5. Kate Livingstone 24 February 2015 at 10:45 pm #

    I dont know what to write here that can convey how horrific your experiences have been within a so called place (hospital) that should be there so that very vulnerable unwell patients can get better. Sadder is that unless you have been a patient you probably will not fully believe that this goes on today, yesterday and probably tomorrow. I have witnessed it but felt powerless to do or say anything, selfishly, in case it happened to me. But now my 15yr old daughter is the patient I would not not say anything. She has spent much of the last 2yrs in a young persons unit where on the whole she is treated with respect. She was restrained when she was really unwell but it was with a N/G tube to feed her when she would have died without it. Now that her medication is working her delusional thinking is now sometimes clearer and she does not blame anyone for the restraining and knows that the ‘Compulsory Treatment Order’ was put in place for her to get better. But what was done to you in the name of treatment is the utterly shocking terrifying realty of what is wrong about our mental health service. But pick up a newspaper, magazine or watch an ad on tv about all the medical blunders that happen and there are outrage and sympathy and even lawyers who will champion your rights for you. I have never read any about bad mental health treatment, why? Stigma? I wish you well for the future.

Trackbacks/Pingbacks

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