S1E15 – Mental Health Hospital (part 1), with Ellie Page

W: Hi everybody, before we get started I just want to give you a heads up about what topics
we’ll be discussing in today’s show. These will focus on inpatient experiences in mental
health institutions including voluntary and involuntary admission, sectioning under the
Mental Health Act and some brief references to institutional abuse. There is also a reference
to suicidality. Please take care whilst listening and for signposting to support, visit our
website www.anyamedia.net/LivelyMinds

W: Hello my name is Will

E: And my name is Ellie.

W: You are listening to Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday.

E: The podcast that is less about how we deal with our mental health and more about how we understand it in the first place.

W: Over the next couple of episodes I will be chatting to Ellie about her experiences of both being admitted to and working, in mental health hospitals.

E: In the UK a mental health or psychiatric hospital or ward refers to an inpatient healthcare setting which specialises in the treatment of people who are considered to be experiencing a mental health crisis.

W: Mental hospitals or what were referred to as asylums until the early 1900s have always been and remain controversial. There is conflicting evidence surrounding the recovery benefits of inpatient admission and whilst of course practices will vary between institutions, for decades the sector has been marred with scandals about the abuse and neglect of those in its care.

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W: So Ellie, first of all, thank you so much for talking to us about this.

E: You’re very welcome.

W: It’s going to be a really fascinating conversation, I’ve got no doubt about that.

E: I hope so.

W: In preparing for this episode, I suggested that really I should just ask questions. I said to you when we last spoke that I’ve never set foot inside a mental hospital, but actually that’s not quite true. I did go and visit somebody once in a mental hospital, but er, I have such little experience of mental health institutions that I’m just really keen to hear about and learn from your experiences.

E: Yeah.

W: To begin with, could you just tell us what you think the purpose of a mental hospital
Is?

E: That’s a tricky one to answer because do I answer what I think the purpose of mental health hospitals as they are now are? or do I answer with what I think the purpose of something like a mental health hospital should be?

W: Ah, that’s a good, good point. Tell me what you think the purpose of them is as things stand
at the moment.

E: I think the way in which mental health hospitals are most commonly used at the moment is more to do with containment and as a holding space rather than for treatment and you know, that kind of recovery oriented approach. That’s not to say that, you know, there’s no recovery
or treatment kind of intention for many of the staff or hospitals but that they’re so underfunded, there are so few beds in the UK in mental health wards and in specialist hospitals. There’s so many people who feel that they would benefit from inpatient admission, but don’t get it because there aren’t enough beds. You know, it’s firefighting is basically what, what a lot of mental health hospitals are having to do at the moment, because there’s so few beds and so few resources and staff to offer, kind of continued therapeutic treatment. So the treatment that they can offer is in very, very acute scenarios and medication focused and that’s kind of how they’re used. That’s my perspective of how they’re sort of used in the UK at the moment.

W: And from the point of view of those people that are responsible for policy related to and indeed run mental hospitals, what do you think they would say the purpose of a mental hospital is from a the, the, sort of health system point of view?

E: I think they would say that it’s to provide longer term treatment to people who require more specialist mental health treatment quite acutely or perhaps quite urgently. But I do think that, you know, it is acknowledged that a stay in an NHS mental health ward, the treatment options available while you’re on that ward often do not include therapy. So I don’t think that the kind of
policymakers and hospital managers or whatever would say that there’s much kind of psychotherapeutic treatment but there, there is a lot of pharmaceutical treatment and figuring out what dosage of medication works best for people and often it’s, I think they would probably say as well it’s to get people out of an initial very acute period of crisis so that crisis could be what is often referred to as psychosis or quite extreme suicidal ideation things like that, also there’s, there are a few, emphasis being a few, much more specialist mental health hospitals on the NHS. So for example, again, very few, but you know, there’ll be particular hospitals around the country that have a particular unit that they’re known for for treating, for example, eating disorders, or addiction, or, you know, more specific mental health challenges, I suppose. So those would work differently and, and would have a more kind of, well, one would hope, slightly better range of more longer term treatment options kind of available.

W: Yeah. Would you be fair to say that another purpose or at least purported purpose of mental hospitals would be to safeguard people who are at risk of being a threat to themselves or to others?

E: Yes, that’s kind of what I meant by containment. It’s sort of, I guess I’m looking, I’m thinking about it more from an emergency admission into a mental health hospital, which, you know, by definition it would become an emergency if someone was to be sectioned or something. But yeah, I should have specified also that the criteria there is best simplified as presents a considered threat to other people or themselves, and that definition does cause a bit of confusion, shall we say, or toing and throwing or hot potatoing between law enforcement and healthcare services and I’ve worked on a couple of wards where there’s been neither the criminal justice system nor the healthcare system can decide which of those two institutions should be dealing with one particular person which you know in terms of managing a ward and beds and things I guess makes it really difficult.

W: Let’s just clarify the difference between er, voluntary and involuntary admission. Can you take us through that?

E: Sure. So what we’re talking about with mental health wards and mental health hospitals, it’s probably good to clarify first for this conversation, is we’re not talking about a clinic where people receive outpatient services. So that might be, you know, an appointment with your psychiatrist or an appointment to have your bloods done, or to check your kind of current antipsychotic medication levels. We’re talking about inpatient wards, so where you’re admitted
as an inpatient to hospital to stay for a number of nights in a row etc. So … the concept of voluntary and involuntary with mental health hospitals is quite contentious shall we say, because
if someone says to you would you like to come in to be admitted to the mental health hospital
and you say “no not really” and then they say “well if you don’t want to come with us we can
enact a section” which refers to various sections of the Mental Health Act which are used to override someone’s liberty in order to detain, to take someone into hospital when their choice is that they don’t want to go. So is that, would you still call that a voluntary admission if you said “I
I don’t want to go, I don’t want to be treated as an inpatient in a mental health ward”, and they said, “well, you know, if you don’t come with us, we can go through an inactive section and basically do this all through the involuntary way”, which is kind of legally depriving you of your rights.” Well, not of your rights, sorry, legally depriving you of your choice as to what treatment you receive. So at that point, you can kind of think to yourself, “Well, can I be bothered to go through all that?” Probably not. I’ll just go in. That would go down as a voluntary admission. But I think there are so many power dynamics and things at play in these scenarios that the sort of voluntary bit is a bit notional, if that makes sense to me.

W: In its purest form, for want of a better word, voluntary admission is where somebody checks themselves into a mental hospital, right?

E: Er good luck trying to do that, I don’t know if you, I’ve never met anyone who has been trying
to get an inpatient admission but unfortunately it’s extremely difficult what with there being
no beds.

W: Yeah.

E: So, no one ever checks themself in. You can’t say I want to be treated here. You know, you need to be a whole sort of referral from biosocial work or a responsible clinician with the hospital.

W: Yeah,

E: but I guess an involuntary, what we mean when we hear involuntary admission means
someone was resisting treatment and emergency mental health legislation was enacted in order
for said service, so social worker, police, to override their right to choose what healthcare
they do and don’t receive, which means they will be taken into a mental health hospital against their will, which can be through physical restraint or physical force even, now, especially after we’ve hearing more and more stories coming out of what’s been going on in lots hospitals, but that’s kind of what people mean by involuntary. Um, and at that point, there’s like a strict order of which sections can be imposed under which circumstances. Each section has different periods of time attached to it. So you can sort of be immediately sectioned for, I think it’s up to 72 hours, but then, you know, um, you have to be able to legally have access to like, an independent mental health advocate. It sort of goes on from there. So each section requires, you know more people to sign off the longer the period of time is that you’re under section, so under section three for example you can be you can be sort of held in the hospital under section three for up to six months, that has to be reviewed and renewed by your responsible clinician which would be your psychiatrist in the thing, and you always have the right to an independent mental health advocate who’s someone who, you can request one at any stage and they can come to try and help you understand the sectioning if you wanted to challenge it by going to a tribunal
to challenge the fact that you’re being held under section. Being held under section often means you cannot leave the hospital at all. It doesn’t always mean that, there are people and every case is different and so sometimes people might be in a long-term section but they, as part of their kind of entitlement that is given by the hospital, they’re allowed out to the shops twice a day or something like that. You know you almost have like licence agreements of what your section is when you’re under a, a proper section. So in theory, in the legislation, there are lots of safeguards built in, that if followed give, in theory, very much in theory, are there to kind of safeguard and protect your rights and your agency. However, in practice, many of those safeguards can’t be put into effect because if you’re in a completely understaffed hospital, someone’s made the decision to be held under section, you have a right to ask for a independent mental health advocate but, you, there might not even be any specialist mental health nurses on shift at that point if you were in an A&E. They might not have access to an independent mental health advocate, might not have a clue how to get one and so then that bit doesn’t happen for the first 24 hours. You know there’s, there’s so many logistical things like that that mean the things that someone is legally entitled to and that those are the things that are within the legislation that are meant to safeguard your rights don’t happen in practice either through poor practice on behalf of the hospital or through it’s not resourced properly and so those safeguards aren’t enabled, it’s not possible to enact those safeguards.

W: Let’s just quickly go to a break and then we’ll find out more when we come back.

E: If you’re listening to this show on a podcast app could you do us a favour? Could you pause the episode and see whether you can leave us a rating or a review on your app? It really helps
others to find the show.
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W: So, Ellie, could you tell us in your own words, sharing as much or as little as you would like, just tell us about your experience of being admitted to a mental hospital.

E: Sure, so I had had a job that I really loved working with young people. It was very challenging. There was a lot of safeguarding and just lots of things going on, it was a sort of stressful job, and for various reasons, I had to suddenly stop doing it. Part of the various reasons were that I already had chronic health problems, but at some point my legs suddenly stopped working in the way that I was expecting them to, i.e. allow me to run around a youth centre for 40 hours a week. And I just suddenly, basically was going through this very acute period of stress and then developed a number of really significant health problems. So I was in a wheelchair, I just had to stop my job, but I decided to start a Masters in Social Work at that point, which is actually when I was working in mental health, adult mental health hospitals actually that year. But during that year I also got even more poorly and developed, like, I think I killed off a small part of my brain through this acute period of stress, and I developed narcolepsy and atypical cataplexy, which I don’t know, maybe we’ll discuss in another episode. I was also on a lot of painkillers and I was still insistent on doing my, on getting through my social work placement even though I was in a wheelchair and could barely walk and yeah, it was generally just, I had so many new health problems just sort of bombarded at me.

So at the end of that year I was doing really well in, I did really well on my placement, I got 100 out of 100 on my mental health law exam. So it was all going well but the university basically were concerned that they wouldn’t be able to find me a final social work placement that would be accessible for me. Which now, if that had been said, I would, well, I’d be better equipped now to argue with that and kind of make sure that I wasn’t kind of being discriminated against or that we could work together to find an accessible placement. About that time I just was so unwell physically and also I think probably mentally at this point from the stress and things and just I was finding it really hard and I’m very active, not as in sports, I’m like the least active person in the world but I’m always out and about doing things and I’ve struggled a lot mentally to cope with you know suddenly just being in a house share but being stuck in my own room and not being able to do anything, so I kind of said that I’d take a year out and we’d reassess or something and then, turn of the new year, I don’t even know, I don’t think anything in particular sort of triggered a massive downward spiral but all of that just kind of culminated I think in
me being very sort of suicidal. I can’t quite remember at the time how a social worker ended up visiting me in my bedroom but I remember that’s what happened.

I’d started to lose touch slightly with kind of, my reality of what was going on around me. So basically I thought I was turning invisible, which the subconscious interpretation of that is obviously not, not too difficult to read between the lines there.

[laughter]

But I, you know, but at points I genuinely was sort of looking at my hand and thinking, oh, it’s like actually disappearing in front of me, I’m actually becoming invisible. So I think I must have, I don’t know, phoned a GP at some point, because I’d taken an overdose, but then I didn’t want to go to hospital and decided to just stay at home and then the next day, I think someone phoned me back and I was like, yeah, I’m having a really bad time, I think I’m turning invisible. And then a social worker came around and sat and talked to me in my room for a bit and she basically said you know I think you would benefit from an inpatient admission, what do you think about that?

And that completely, basically the way I’ve experienced when things that others might refer to as psychosis or the way that I’d experienced it then, it was always like I had two brains one of them is convinced I was becoming invisible and about to evaporate into thin air and just be a particle floating around in the air and that was it. The other part of my brain was like, aware who I was, the reality of the situation and what I needed to do and the point at which she suggested that and it seemed to be a reality that I was potentially going to go into a mental health hospital, I was just completely in equilibrium between the two and kind of froze and I think I was just sort of nodding but I think I said I don’t know if I want that, but also I was, I was just quite shocked really. She said, “Well, if you don’t want to come in, we might have to look into making you come in.” So I was like, right. But to me at that headspace at that point, that wasn’t very clear what that meant or what I was meant to do next. I remember then she was like, “I’m gonna go away and make some phone calls. I think there are two beds that I know of.” Meaning mental health beds in hospitals available for me were I to go in today. She was like, “Why don’t you have a think about it? And I’m gonna call you in an hour.” Also, there was no one with me, by the way. I was in an empty house. So all of this is, I think, you know, not ideal, but whatever. So she left and I remember that I was so frozen, I literally couldn’t move from the position that she’d left me, which was just sort of sat upright on the end of my bed. And I could barely get myself to move to pick up my phone, to phone her and say, “Yes, I’ll go into the hospital.” And I was just completely paralyzed like that for about an hour because I knew that whatever the first movement I made was, like moving my hand to, to reach for my phone, that movement was going to lead to me being in a mental health hospital as a patient. So anyway, I did phone her and she was like right okay, pack your bags, get a taxi to the main hospital in central Manchester where there’s like a mental health sort of unit, but it’s also sort of like a bit of a hub, like people go there for outpatient appointments so I was basically to go there with my stuff, but effectively as a waiting room, and then from there they would get me a taxi to the hospital that I was going to go and stay at. But I’d also been doing a lot of random sort of ad hoc work with a number of vulnerable people, adults, sort of around Manchester and there’s one person that, I had a particularly, that I found particularly difficult and you know there’d been a lot of criminal activity going on and basically I’d got it into my head, I was really worried that I was going to be put on the same ward as this person. So I’d made that really clear to the social worker. I was like, I know this person is on a ward at the moment. I cannot be put on a ward with them as a patient. Like that cannot happen. I will go, however mad you think I am now, that would make me significantly more mad and probably wouldn’t be good for the other person either. So she was, you know, like, yeah, took, took this person’s name. She said, well, you’re going to a women only ward. So there’s no chance that this ,because it was a male the other person, she was like there’s no chance that this person will be on your ward because you’re going to a nice small quiet women only ward and I was like oh, and that actually, I mean obviously the part of my brain that thought I was invisible was still there, but that actually, I remember made me feel a lot better about the idea that it was quite a small ward and that it was only female patients on it so anyway, I was just sat in this waiting room I’m not really sure what I thought was going and I was still completely thought I was like turning invisible so, but yeah again, I was on my own just in a waiting room with my stuff and still didn’t really know what was going on and someone came out and said oh we’ve got your taxi here we’re gonna take you to the hospital, I was like is anyone coming with me and they said no and I said which hospital is it and then they told me the name of the hospital and I was like okay, so I got in the cab get driven to a hospital no one’s come with me so I had to just get out and take myself to reception. And, you know, I have PTSD, and I was not in a good way and not that connected to reality at this point, increasingly so since getting into this taxi and being sat in this waiting room, like I’ve just even more and more just did not understand what was happening to me and how I’d gone from doing so well, like, in my career and academically to standing in an empty admissions reception for a mental health hospital. So I got there, I didn’t know what to say to the receptionist. I was sort of stammering over my words because I just had no idea what I was supposed to say. So I think I was just going like, “uh, Ellie Page for this?” She had no record that I was arriving. No idea which ward I was meant to be on. Basically no idea who I am or what was going on, was asking me, barking questions at me, as though I was someone who wasn’t currently like mildly psychotic, er, in inverted commas. And I was just like, for someone who’s literally being admitted because they think they’re turning invisible and are going to disappear off the planet without a trace and then you turn up at reception and they’re like, “Sorry, who are you? We have no record of you.”

[laughter]

So I was literally like, “Ah, it’s happening!” And I remember just holding my… I was just clutching this like dressing gown and I was just like “oh my god I knew it I’m actually leaving the planet by just fading away”, so that was all worse and then I was completely shut down and I didn’t know how to answer any of her questions because then I was really freaking out. Anyway eventually she was like yeah yeah we’ve got a bed for you go upstairs. I said can I just check it’s the women only ward she was like “no you’re on a 36 bed mixed ward”, I was like, so my voluntary admission was on the basis that I was going to, you know, a small 12-bed women-only ward and now I’ve ended up here with the door locked behind me in front of a 36-bed mixed ward, which I then was obviously worried that this person was going to be a patient in the ward but, I’d, someone managed to tell me quite early on that they weren’t and yeah, everyone was… it’s sometimes, it’s hard to remember what happens in there. I remember that bit very clearly. The rest of it is a bit of a blur. Everyone has a named nurse who they can sort of ask to speak to or who would be the person to accompany you to any appointments you have with a psychiatrist while you’re in there. I met my nurse, she was nice, and I was taken to this room which was like absolutely disgusting. I asked if there were any pillows because there wasn’t a pillow on the little camp bed and she was like “I don’t think so, I’ll try and find you one” and sort of wandered off and that was it. That was it.

[laughter]

I was just then in the…

W: And so began your experience of a stay on a mental health ward.

E: Casa Del Mental Health Ward, yeah.

W: The what sorry?

E: Casa Del Mental Health Ward, yeah.

W: Is that the name of the ward?

E: No, Casa Del is like the name of loads of like holiday tourist package plowsers. Like houses.

W: For a moment there I was back in the realm of we’re gonna have to to get a right to reply in here somehow.

E: No.

W: We’re going to contact Casa Del Hospital.

[laughter]

W: So what we’re going to do is we’re going to pause there and next time we will continue
to hear about Ellie’s experiences as an inpatient at a mental health hospital, as well as your
experiences working with mental health hospitals. Because of course, before your admission to
a mental hospital, you had worked in mental health hospitals.

E: Yeah.

W: And since your admission, also worked with people who are admitted to mental hospital. So I think it’d be really fascinating in the next episode to also get your reflections on that too. So thank you so much, Ellie, for sharing your story with us. We look forward to hearing the rest of
the story next time.

E: Yeah, thank you.

E: Thank you so much, everyone, for listening. And please do tune in again in two weeks for another episode of Lively Minds, the mental health podcast.

W: Please note that this show does not constitute medical advice, and is not a replacement for
seeking professional help. You can find signposting to support on our website, anyamedia.net/LivelyMinds.

E: Make sure you keep up to date with our shows by subscribing wherever you get your podcast.

W: Take care and bye for now.

E: Bye bye.

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