I know I'm writing a lot about life in psych wards at the minute but it's a topic that's close to my heart right now. Probably because I'm in a psych ward myself at the moment! But I'm remembering my first time in a psych ward a lot recently. I remember how scared I was, how confused I felt by the rules and how bewildered my loved ones were at me being in a psych ward. So I thought I'd write a blog post to try and help those who are in a psych ward, followed by a short bit to try and help those who have a loved one in.
Bear in mind that I'm a Brit and writing about British psych wards. I know psych wards are different across the world so my advice may not work for people overseas.
What Patients Should Do
The first thing to be aware of is that psych wards are NOT like the ones you see in horror films. Other patients are NOT going to beat you up or murder you in your sleep. On the contrary, a lot of patients are the kindest people you could ever meet and many will try and help you as much as they can. I know it is scary to be put on a psych ward, but there is rarely ever anything to fear from other patients. For more about what other patients are like, read this blog post I wrote on the subject.
Remember, there’s no shame to being in a psych ward. I know stigma around mental health is rife and things like ‘mental patient’ or a ‘loony’ can spring to mind in a bad way during the first few hours and days. But ignore these thoughts. You’re not a mental patient, a loony, or a nutter, you’re just going through a rough time and need a bit more help than can be given at home. Whatever you do, don’t stigmatise yourself! If there’s ever anything that you don’t understand or feel scared by, ask a nurse or fellow patient. Psych wards are daunting at first, very much so, but if there’s something you need to know or are scared by, tell someone who can put your mind at rest.
When you are first brought in, your bags will be checked. There's no way around this; it has to be done. I've never been frisked on arrival, but I have heard of it happening to some people. I think frisking is very rare though. Often it's just a case of them asking if you've anything in your pockets and sometimes they ask you to empty your pockets. If nurses deem an item or items in your bag to be unsafe, they will confiscate them and put them in storage. You should still be able to use the item(s) if you ask for them, but they would have to be returned.
The things that are confiscated can seem weird. The weirdest thing I've had confiscated was a pair of flip-flops. I still can't work out why they were confiscated, seeing as they let me keep my proper shoes. I've also had mouthwash confiscated (because of the alcohol content), keys, mobile phones, chargers, cords from dressing gowns and cords from the hoods in my hoodies. I've also heard of people having things like shoelaces confiscated too. So while it may seem strict, there is a reason why they're confiscated. You may not want to harm yourself with the items they're taking away, but another patient might.
So what should you bring in? Clothes, lots of clothes. Bring as much underwear as you have, along with warm and cool clothing. Even if you're brought in during the winter months, bring some summery clothes. Psych wards are notorious for being excessively hot during the day, and there have been times where I've seen windows open, even though it was snowing outside! Bring some warm clothing too, even if you're brought in during the summer months. Even though psych wards can be boiling hot in the day, they can also be freezing cold during the night.
Also, bring all your toiletries, but be aware that some might be confiscated. They should give them to you when you ask for them, but some may wish to watch you while you are using them if you are deemed to be at high risk of harming yourself. Things like hairdryers and razors are often kept in storage and only brought out when you specifically ask for them. And don't forget to ask for them back when you are discharged. Last time I was in, I left my razor behind because I forgot to ask for it back! It can also be worth asking for hospital towels rather than bringing your own ones in. It means you can just throw dirty towels in the laundry basket rather than having to go through the hassle of washing them.
Don't forget to bring your mobile phone's charger with you, along with your mobile phone. Depending on the unit, you may have to have your phone charged in a locked office rather than being able to keep it while it's being charged. Recently, there have been units banning the use of mobile phones that have cameras. If your mobile phone has a camera on it, you may not be allowed to use it at all. It can be worth digging out an old mobile phone that doesn't have a camera on it so that you can keep your phone. Some other units allow you to keep your phone for about half an hour at a time and then request it back after you are finished with it. This is extremely frustrating but there is a workaround. If you ask for your phone at a busy time and then keep it out of sight of the nurses, they can forget to ask for it back. It doesn't always work, but when I was in a unit that wanted mobiles back, it worked the majority of the time.
Make sure you have some money too, and have some of it in change. Money may also be confiscated and kept in a safe but make sure you do have some with you anyway, in case you need it for a pay phone or if there's a hospital shop that you can buy little bits from. The only other things to bring in are any home comforts that you can realistically bring in. Things like a blanket, fluffy slippers, photos, chocolate, or other non-alcoholic food and drinks. Alcohol is never allowed in psych wards but sometimes a patient will sneak out to the pub when they’re out and return drunk. Returning to a psych ward drunk really isn’t a good idea.
If you don’t have anyone who can bring stuff in for you, ask the staff for toiletries and pyjamas. The staff have toiletries like soap and shampoo that they can give you. The pyjamas they give are often hideous, but if you only have the clothes you were brought in with you, stay in pyjamas until you are allowed to go home to get more clothes or are discharged. It means that you have a clean outfit for when you leave the ward.
Whether you're on a section or not, you have the right to an advocate free of charge. The advocate is independent of the hospital and will speak up for you if you don't feel able to speak up yourself. It can be worth asking to speak to an advocate when you are first brought in so you can talk with them and see if you would like their help. Be aware though, some hospitals don't tell you about your right to an advocate so you may have to go and ask them rather than wait for them to ask you.
The attitudes of nurses and other staff in the ward vary greatly. Sometimes you get lovely staff that will bend over backwards to help you and let you bend the rules a little. Other times the staff are horrible and do as little work as they can get away with. I’m fortunate that the unit I’m currently in has lovely staff but I have been in a unit with horrible staff too. It’s hit and miss throughout the country but generally, if you want to talk to someone, ask them and they’ll have a chat with you.
With regards to medication, the vast majority of people on psych wards are put onto medication. Whether it's an antidepressant, an antipsychotic, mood stabiliser or any other medication. If you are not on a section, you have the right to refuse medication, but bear in mind that if you keep refusing them and your psychiatrist is not happy with your progress, they will consider putting you on a section so that you will take the meds they want you to take. And always be aware of the threat of injections if you are on a section. If you refuse medication too much, they can and often will inject you. It’s happened to me in each of my stays. Forced injections are traumatic, even when done in the best possible way, so avoid them as much as you can.
If you are on a section, you cannot leave the ward unless you have leave. The leave is called Section 17 leave and a psychiatrist will use it to say how much you are allowed, who you have to go with and where you are allowed to go. Often, during the first week or two, the only leave you’ll get is an hour around the hospital grounds escorted by a member of the nursing staff. Sometimes they put family and/or friends on the Section 17 leave form so your loved ones can take you out instead of a member of staff. When they are more trusting of you, they can give you ‘unescorted leave’ where you can go out by yourself. Whatever you do though, don’t run away. Running away can result in a spell in the locked ward after a trip back to the hospital in a police car. Plus, it makes the staff trust you less, reduces the amount of authorised leave you will get and ultimately, can result in you staying in hospital even longer.
If you don't already have a psychiatrist and care coordinator, you should be assigned one. A care coordinator is normally a CPN (Community Psychiatric Nurse) but it can also be a social worker, support worker or anyone else. The care coordinator will help you more in the community but sometimes they come in to see you while you are still in hospital. The role of the care coordinator is simply to make sure you are doing OK. They will just have a chat with you about how things are going and to see if there's anything they can do to help you.
You should have a weekly or fortnightly ward round where you will see your psychiatrist and be able to tell them how you are doing. It will be a time for you to discuss what leave you can have (if on a section), your medication and other issues you may have. It can be useful to write down the things you want to say to your psychiatrist and take it in with you. Sometimes, ward rounds can feel daunting and memories can go blank. Having notes with you of what you want to say and ask can be a real help.
If you are on a section, you can appeal against it. You have the right to free legal aid and representation so ask for a solicitor when you are brought in. The solicitor will explain more about the appeal process - the different types of appeal etc and good ones will give you a realistic idea of your chances of success. I have a good one who gives it to me straight. I would rather he told me that I didn’t have ‘a cat in hell’s chance of success’ rather than sugarcoating my chances and giving me false hope. It may be upsetting knowing that you’re going to lose but it can at least stop you going through the stress of an appeal that’s doomed to fail.
Every hospital is different but often patients have to go to bed at midnight. This can be annoying if, like me, you’re a bad sleeper. Some units do have staff that will let you stay up a bit later, but not always. Normally here, they turn the television off at midnight to ‘promote good sleep hygiene’ but they usually allow me to stay in the day area until I’m ready to go to bed.
The bottom line is, behave yourself. It can feel like you’re in school or prison, but try and make the best of a bad situation. If the ward is quiet, catch up on some sleep or reading. If the ward is noisy, invest in a pair of earplugs. You need to jump through hoops a lot of the time, but the more you comply, the faster you get out. Don’t run away, take the meds they are giving you, eat and drink properly or as much as you can and don’t withdraw into your bedroom/bed area for days at a time. I know doing all this can be difficult and I’ve already tried running away, refused meds, stopped eating and drinking and withdrawn into my bedroom for days at a time. I’m far from perfect so I understand that it can be difficult to obey all the rules all the time. Don’t beat yourself up though if you break the rules. It happens!
What Friends and Relatives Should Do
The biggest thing for friends and relatives to do is to listen to what their loved one is saying and remind them that you love them. If your loved one doesn’t want visitors, don’t push them into seeing you. They will see you when they are ready. Also, make sure you get the direct phone number for the ward so that you can ring the staff to see how your loved one is doing. Often the staff will go and tell your loved one that you are on the phone to see if they will speak to you. If they don’t want to talk to you, don’t take offense. There can be a million and one reasons why your loved one may not want to talk to you but a common reason can be shame. A lot of people feel unnecessary shame about being in a psych ward so don’t feel like you are a bad person if they don’t want to speak to you. If you don’t want your loved one to know that you’ve phoned, make sure you tell the member of staff you speak to of this.
Your loved one may wish for you to do their laundry for them, even if there is a working laundry room in the ward. If staff allow you to do your loved one’s laundry, it’s a good idea for you to do it. It reduces the pressure on your loved one, plus I know it can make you feel like you are doing something useful for your loved one. My parents do my laundry for me and it’s a win-win situation. I get extremely stressed at using launderettes and my parents have something that they are able to help me with. I think (and hope) they feel good for doing it because it’s a real help to me.
At the end of the day, play it by ear. If your loved one doesn’t want visitors, let them know that you are ready to see them when they are. If your loved one wants something doing, do it for them (if it’s safe and legal to do so) and just let them know that they are loved. A little bit of love in a psych ward goes a long way. And there are also times where laughter really is the best medicine. You know your loved one, appeal to their sense of humour and make them laugh. A good laugh improves mental health no end.
There will probably be more things I will add to this in the future so any paragraphs with EDIT: in front of them are paragraphs added later. Also, if there’s anything you think needs adding to this post, let me know in the comments or on Twitter.