Tag Archives: seclusion

Secrets from the modern day asylum

20 Aug
Actor Ray Winstone in episode 1 of ITV's new series Secrets from the Asylum

Actor Ray Winstone in episode 1 of ITV’s new series Secrets from the Asylum

 

This evening, episode 1 of ITV’s new family history series Secrets from the Asylum aired. It delves into the murky world of dreaded Victorian lunatic asylums through the eyes of celebrities who make emotional discoveries about relatives incarcerated in the distant past. With a doom-laden commentory and spooky music, viewers were invited to be shocked that people with senile dementia were condemned as lunatics, to gasp at disturbing treatments like chaining or hosing with cold water (“treatments which now seem crazy themselves”) and to shake their heads at “sickening attitudes towards the mentally ill”.

I’ve often said that one of life’s cruel ironies is that, whilst nowadays we condemn with obvious horror what was done in the name of mental health care in the past, we don’t recognise the horror of some of what is being done now, today, in modern psychiatric hospitals. What is going on now – behind locked doors, out of sight, to the country’s most vulnerable people, sometimes by the most brutal of “carers” – goes unremarked. I’ve said before that, in the future, we will look back at some of today’s practice of mental health care with horror, just as we now look back  in horror on the lunatic asylum. How long will it be before we do that? And why can’t the general public see it now?

Because it is happening now. This minute, as I write this piece, as you read it, horrors of commission and omission, of things done and not done, are taking place in the name of mental health care. And yet the damage they cause – the lack of job satisfaction of good staff, the lives half-lived through inadequate treatment and support and even the lives cut short – go largely unremarked. It’s a secret from the modern day asylum, because no one is looking.

Only this morning, government minister Norman Lamb announced he was establishing a new mental health task force to look at the state of children and young people’s mental health care. Some of the papers ran the story. There was an excellent feature on the morning news. But, by lunchtime, it seems it had all been forgotten. What – if not hundreds of sick children detained in police cells for want of treatment of hospital beds, of sick children bussed from hospital to hospital, hundreds of miles from their parents – what could make the wider public see the utter inhumanity of the way in which people with mental health problems are treated today? If even sick children won’t make the public – and hence politicians – sit up and reach into their back pockes for some serious money and some serious thought how those in need of help can best be supported, then what hope is there, really for things to improve in mental health services in this country?

So today, the day that Norman Lamb announced that children’s mental health services were “in the dark ages”, ITV launches a new two-part series, Secrets from the Asylum. We gawp at the outdated practices of the old lunatic asylums. We gasp at the people locked away without proper treatment. We shake our heads in judgment at the barbaric treatments in days gone by.

And yet, it wasn’t until very recently that there were any effective treatments for mental distress and mental illness. Those running the old Victorian asylums had, in a way, an excuse. They did the best they could. In the words of the title to episode 1 , those trying to help people with mental health problems in the past had the “best intentions”. Nowadays, we don’t have that excuse.

Nowadays, there are treatments, help and support that can make a real difference to people’s lives. And yet … they are not employed. And, worst still, sometimes – in fact, far too often – practices that we know – through logic, humanity and research studies – are actively harmful to people are employed instead.

Why is that? It’s hard to explain. In large part it will be down to the resources allocated to NHS mental health care: with few staff on wards and paperwork to complete, there isn’t enough time to spend building therapeutic alliances with patients. There isn’t enough time to show the care and compassion, kindness and support so vital to helping people in mental health crisis. With wards that are badly designed and ill-equipped (as was the one on which I was detained), staff will be struggling from the outset.

But, also, it seems that there is something to do with the training of mental health professionals that creates a barrier, preventing staff from recognising human suffering. On ward, it seemed to me that the priority of even well-meaning staff was ward management. “Order and control took precedence over care,” said the commetator in episode 1: it seems that nothing has changed.

I speak as someone who was so traumatised by my experience of inpatient psychiatric care that I came out with the gift of PTSD (post-traumatic stress injury). Tonight’s episode refers to people in the past – before the advent of Victorian asylums – being chained, caged and beaten: I have been “chained” by means of the chemical cosh, a cocktail of drugs intended to quell me; I have been “caged” by being held in seclusion; I have been “beaten” by staff who assaulted me (in the criminal sense) and many more who physically restrained me, six at a time, for forced treatment and by patients from whom the staff did not protect me. Based on my experience of modern day inpatient psychiatric care, it doesn’t seem to me that there’s any obvious reason for us to pick over the bones of history and gloat about how far we’ve come.

And how is it such practices are allowed to continue, without a public outcry? Several powerful reasons. One is that there is still an enormous stigma to mental health problems. There is a shame to having been treated in a psychiatric hospital. It’s not something people speak out about readily. Another reason is that psychiatric patients lack almost any credibility. In an NHS system which we know is hard for even staff to raise concerns about and which has, it seems, a culture of closing ranks and covering up, what hope for patients’ complaints to be dealt with? And of course these things go on behind closed doors, out of sight. No one sees apart from those incarcerated in the strange world of the psychiatric ward, whether they are staff or patients.

It isn’t just me who thinks that some of what goes on on inpatient psychiatric wards is wrong. Here are a couple of examples from this week:

  • Here is a conversation that took place a couple of days ago when a psychiatrist, a psychiatric nurse and I discussed our experiences of physical restraint and bullying on mental health wards. The strong impression is that what I experienced is the norm, rather than the exception, which is heartbreaking.
  • Here is a post by Skye, the Secret Schizophrenic, about an upsetting incident that happened to her on ward recently. It illustrates how what happens on wards now can confound humanity and logic.
  • Here are some tweets on the hashtag #secretsfromtheasylum comparing modern day practices with those in Victorian asylums and questioning whether it really all is in the past.

I do know people who have had excellent experiences of psychiatric inpatient care that has transformed their lives for the better. It gives me hope. It should be the norm. Especially now that we there are effective treatments available to help people recover from  or manage mental health problems.

What is the hook? What is it that makes people want to watch programmes like Secrets from the Asylum but not care about the way mental health patients of today are neglected and mistreated? And how can some aspect of that be harnessed to our benefit, so that the lessons of the past are learned? Those are questions I wish I had the answer to but don’t.

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Background – recent experiences of psychiatric hospitals:

 

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Restraint – 10 ways it harms psychiatric patients

19 Jun
Greer Garson, Lauarence Olivier, Maureen O'Sullivan & Bruce Lester in Pride and Prejudice

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

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:

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

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The saucy side of restraint, plus art:

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Treated like an animal

24 Mar

Project Nim 2

Today I shared some of my experiences of forced medication, restraint and seclusion from my recent (2011) stay on a psychiatric ward. Hopefully it will be my only stay on a psychiatric ward, because, as you’ll see from these tweets (see the links below), it wasn’t a healing experience. In fact, I’m undergoing treatment for post-traumatic stress disorder as a result of my hospital stay.

The photo above is taken from the documentary, Project Nim, that prompted me to start tweeting this morning. Nim Chimpsky was a chimpanzee taught to sign then sold for medical research. When I watch documentaries with captive animals, it reminds me how ward staff treated me like a creature to be observed, not a person. That’s what happened this morning.

I was tweeting a flood of consciousness, as the images came to my mind. I was sharing what was, for me, a very powerful experience. Holding those images in my mind, tweeting about them, wasn’t easy. I’d never tweeted in that much detail before. I felt sick when I sent these tweets. Bringing back these memories brought back some of the trauma. I was shaking. I was crying. It took me over an hour to send the first tweets.

I wasn’t engaging in a light hearted conversation, garnering opinions, having a chit chat. I wasn’t looking for banter and interaction. I just kept tweeting through the tears.

When I’d finished, I went back and checked the responses of others. I’ve included those in the Storify story as the voices of so many tweeps both mirror and challenge some of my experiences. There isn’t much interaction, because I was too upset.

At the end of the Storify story are comments from two tweeps who say they are psychiatric nurses (I don’t know them). Their comments, sadly, demonstrate one of the reasons my stay on psychiatric ward was so horrible: lack of empathy, lack of understanding and lack of compassion from ward staff. It was a reminder that, for some psychiatric staff, people’s emotional distress is just a day job.

I know there are more compassionate psychiatric staff out there, because I have seen excellent psychiatric care in practice. I’ve just not received it myself.

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*** UPDATE *** [23 October 2018] Tweets now saved on Wakelet > Treated like an animal

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What advice would you give someone recently discharged from psychiatric hospital?

31 Jan

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What advice would you give to a patient who’s recently been discharged from psychiatric hospital? What would you have wanted to know when you first came out? I was asked these questions yesterday evening by someone I’d known for a long time, someone who’d visited me on ward 2 years ago and thought I might be able to help someone who’d come to them in despair.

The woman had recently been discharged from a mental health ward in the hospital where I’d been detained.  She was angry. Her world had falled apart. Her marriage had fallen apart. She was appalled by her treatment on ward. She wanted the hospital to hear what she had to say about her care, to know it was wrong. She wanted to meet with people who would know, through shared experience, what she had been through. Would I meet with her face to face to offer advice and support.

When I got home I sent this series of tweets which sets out my reaction to the question. I’ve also added in the responses of other tweeps, and there’s some good advice in there so take a look. Read the tweets to see my gut reaction at the time, or read on for a slightly edited version (tidied up from yesterday’s stream of consciousness), including my 10 tips.

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Open quotes“Will you meet a woman who’s just been discharged from psychiatric hospital?” I was asked. “She’s so traumatised by the experience.  Her  world has fallen apart. She doesn’t know where to turn. She feels so angry about the experience.” More details were given about her difficult circumstances and how she wanted to make a complaint to the hospital but didn’t know how to do so or where to turn. “Can you meet her?”

“No,” I said. “No, I can’t meet her. I’m still too traumatised myself to take on someone else’s pain. I have to take care of myself first.” Her experience in late 2012 seems similar to mine in 2011. So nothing has changed. The hospital hasn’t changed, despite a programme of improvements to the physical environment. The culture hasn’t changed. Same leaders. Same nurses. Same bullying, abuse and poor care. I don’t want to relive it with someone else who’s suffered in similar ways to me, nearly two years later.

“Did you know,” I said, “that I was discharged requiring treatment for harm inflicted on ward? For mental trauma and a physical injury? That I’m being treated for PTSD from the ward experience? And I’m being treated by a physiotherapist for a restraint injury?” The trauma of being held in seclusion, forcibly treated, repeatedly restrained, yanked around by my arm by a bully nurse, has left scars that still need help to heal. I’m still vulnerable.

“Did you know,” I said, “that, when I raised a sample complaint with the hospital, I was disbelieved and blamed?” Which felt like being assaulted a second time. Making a complaint made me feel worse, not better. Much, much worse. I don’t want to go through that process again with someone else.

“Did you know,” I said, “that I have to measure carefully how I use my brain? To flex & strengthen the mental muscles but be careful to not stress or weaken them. Did you know,” I said, “that, although I tweeted all day about the Mental Health Act report, I’m not going to read it?” It would be too harrowing for me to read about others’ difficult experiences on ward. To read about forced treatment, restraint, seclusion, lack of care as being far too common an experience on ward. I look like I’m coping, but that’s because I’m practised at measuring out my energy so I can hold it together in public when I need to.

So no. No I won’t meet them. No I won’t offer support or comfort. Right now, for me, I want to meet happy people. To smile and laugh. To rest my brain. To enjoy life. To put clear blue water between me and the hospital experience. Having caring responsibilities before contributed to me landing up in hospital before. I can’t take on someone new to care for.
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“But,” I said, “I can give you some advice to pass on. Some things I would have wanted to know when I was discharged. That will still be some help.” Here are the tips I passed on:
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  1. It’s good to have someone on your side. If you’re within 8 weeks of discharge, the ward IMHA should be able to help you make a complaint or get your voice heard. They know the ropes. Even if the ward IMHA can’t help you, your local branch of a mental health charity like Mind, Rethink or Sane may have advocates who can help you be heard.
  2. PALS can also help you if you feel you’ve received poor care on ward.
  3. If you feel like you want to be heard, that’s different from making a complaint. Hospitals will have a procedure to help you be heard, outside of a formal complaints procedure, and that may be a better option for you.
  4. If you’re thinking about making a complaint, what end result do you want to achieve? What do you want to get out of it? Do you want “justice” and, if so, what would that look like to you? Do you want to get an apology? Do you want financial compensation? Do you want a review of procedures? It’s helpful to have an outcome in mind before starting the complaints process, to ensure it’s worthwhile going through it.
  5. If you want to make a complaint, are you up to it at this time? As the saying goes, you cannot break concrete with a feather. Organisations can become defensive in the face of complaints. They can fight back. Is that something you want to deal with now? Weigh up the costs to you of doing so.
  6. If you want to make a complaint, can you achieve the end result you desire by some other means? For instance, you can report poor care or abuse – anonymously or using your name – though the Care Quality Commission. They can send an inspector to the hospital or ward to check on care. That might lead to improved care for others in future.
  7. If what you want is to know that you’re not alone, that there are others who share your difficult experiences, then one place to start is yesterday’s Care Quality Commission annual report on the care of patients under the Mental Health Act (voluntary and sectioned patients, and those under CTOs).
  8. Don’t focus exclusively on the negatives of your hospital experience but make sure you also do positive things. For instance, find out what support services are available in the area which play to your strengths or develop new ones – eg art, creativity, music.
  9. People you’ve met on ward can be a valuable support. They were there with you. They know what it was like. They’ll know what you mean when you talk about what happened. But also mix with people who nurture your sense of funClose quotes and make you smile.
  10. Consider returning to the ward and thanking the staff who helped you, then walking away. Doing this helped one of my ward buddies to draw a line under the experience and move on.

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These are my tips, off the cuff last night. But what advice would you give to someone who’s just been discharged from a psychiatric ward? What would you have wanted to know? Please comment below.

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  •  Storify story of tweets I sent together with responses of others – some great advice in there from other tweeps, so take a look
  • Some tips from Wardipedia (the resource for inpatient psychiatric staff) of things to think about when planning for discharge, but a useful to do list post-discharge too
  • Link to the Care Quality Commission‘s website where you can report poor care or abuse
  • The CQC’s most recent report into the care of patients under the Mental Health Act – voluntary and sectioned patients (and those under CTOs)

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