What are Ellie’s hopes for the future of mental health hospitals in the UK?
In the third and final part of this three part mini-series, Will chats to Ellie about her experiences of running creative workshops and events within mental health hospitals, how this differed from her time as an inpatient, and what her hopes are for the future of mental health hospitals.
Please note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find our more about the show and get signposting to support on our website 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: This is the third and final of three episodes in which I am chatting to Ellie about her experiences of both being admitted to and working in mental health hospitals.
E: In our last episode we discussed my experiences of being an inpatient on a mental health ward.
W: If you haven’t heard that episode, or indeed the one before that, then we recommend you go back and listen to those before this one. In this episode we will be finding out more about Ellie’s experiences of working on mental health wards, both before and after her admission as a patient, as well as some of her wider mental health advocacy work as well.
W: Welcome back, Ellie.
W: So we are still recording in person because we recorded this episode and the last episode in the same session. So it’s nice to be able to see you IRL – in real life – if you’re not like up with the lingo. And it just feels more relaxed, isn’t it, doing it in real life rather than doing it on virtual. But you know, we live 150 miles away from each other. So its, there’s not much we can do about that I guess on the whole but anyway yes, so I mean to start off with let’s just place your experience of working in mental health hospitals, let’s place that in context with your admission because you, you were working in mental health hospitals before you were admitted but you also worked in them and with people who experience inpatient mental health care settings afterwards as well.
E: Yes, that’s correct.
W: Give us an overview of, of, of what your experiences were before and after, and what your ongoing experiences are.
E: Well, I wasn’t particularly new to mental health hospitals before I started working in them because obviously I’d already had mental health difficulties, even if I hadn’t been sort of an inpatient on a mental health ward. But also I had lots of friends growing up who … not lots growing up, but a couple growing up who, you know, have had like mental health hospital inpatient stays that have lasted, you know, years at a time kind of thing. So, I wasn’t completely unfamiliar with how hospitals work, although they all do work quite differently in prac, terms of practical stuff like security in the keys and whether or not there’s an airlock door and whether there’s a separate smoking courtyard to the outside and stuff like that. So I always find them quite different whenever I go to a different one. But yeah, so as I think I’ve said before, I was a youth worker and I really, really loved it but then, I had a lot of problems and I was helping someone else who was being sectioned at the time actually. There was a lot going on, I developed lots of like, more physical problems and I had to stop doing it but I’m not very good at not doing things, so yeah I decided to do a social work Masters and my intention at the time was that I wanted be a children and family social worker, but my first placement was at a charity, like an arts charity, that works with adults who have experienced, I can’t remember how it was phrased, like, moderate to severe mental health difficulties. And so part of that role was running a weekly art group on a mental health ward. So that was the first context in which I regularly went and kind of like properly worked in a mental health hospital. Before that, I had been regularly visiting a couple of hospitals, generally for kind of like advocacy stuff for friends and things like that. So not in a sort of professional setting.
Urm, so yeah, I used to run an arts group once a week on a ward and I loved it. We’re very lucky on that ward, there was a brilliant member of staff whose job I think had just been created for them because they were so good. But their, their role was specifically like inclusion and recovery or something, which in practice means all of the things that help people to become less sort of institutionalised for want of a better word, after a long stay inside a hospital. So like cooking, creative stuff, skills stuff, I guess a bit like an occupational therapist type way. So I used to do it with him. So he’d always be the member of staff in the session with me and then I’d run the session. And yeah, I really loved it. I was lucky at that hospital because they weren’t too strict about what materials I could and couldn’t bring in. And that’s something that changes depending on different wards. And I’m sure at that ward, it will change depending on their current risk assessment of the ward at the time. But generally I was allowed to bring in things like paintbrushes and glue and pens and pencils and things like that. And yeah, I found it really fun like actually planning the activity, and also I just really, you know, I got to know people there because I did my placements so long, it was like 10 months or something. So I really did get to know quite a lot of the people who were, who were on the ward and we always got on. And yeah, I just, I really, really enjoyed it actually. And I thought I wouldn’t, actually I was nervous before I first went because I’d had such a hard time with this person who was close to me being sectioned and me trying to sort of help out and sort things out that I was really like, oh God, this going to be too much and it is a lot but but yeah I really enjoyed it, there was no, no one was forced to do this activity it wasn’t like we were in a separate room and you know some staff had like dragged someone over to try and force them to do art stuff with me so anyone who came and sat at the table wanted either to take part or just to chat, so I think that you know, that made it quite pleasant no one was, people might have been being forced to be there in the hospital but they weren’t forced to come and chat to me. But yeah, I did that every week. I really enjoyed it.
I’m very conscious every time on the podcast we say like, oh, and working in mental health hospitals, because I, you know I do creative project work. It’s not the same as what my friend will experience who is in the kind of 7 p.m. till 10 a.m. every day, you know, managing a ward, it’s not, I don’t work full-time in a mental health hospital, which is a very different experience. And some of the older nurses used to like, take the piss out of me. They’d be like, “Well, it’s all right for you. You just come in here for like two hours a week and you have paint brushes and then bugger off at the end of it.”
W: Compared to the experiences you described in the last two episodes, I’m getting the feeling of a much nicer environment in this particular setting than in the setting that you were in when you were admitted. Is that because you think there was some fundamental differences between this setting the setting that you, where you were admitted as an inpatient, or do you think it was just more that you’re having a different experience, different perspective which gave you that
more pleasant experience, you keep saying that you loved it?
E: Being there by choice for two hours for two or three hours a week is very different to being held there against my will for two weeks so and I wasn’t you know, obviously it’s completely different, I’m sure most people there were not having a great time but I think what, do you mean in the question like what makes the difference to what kind of experience someone might have on a ward? Well I think, I actually think about this quite a lot, about the setup because it was that old like prison structure at the one I was at, that doesn’t make any sense to me as a kind of way of building a safe ward – like five dead end corridors. While I was there I was thinking about this other hospital that I’d worked at quite a lot and I was thinking would I prefer to have been in that other hospital? The bit where I ran the art group was sort of the shared area. There was like sofas, sort of a kettle, I don’t I don’t know if there was a vending machine or something, there was a TV, there was a little courtyard with a locked door that was just used for timed smoking breaks for patients, and then there was sort of the big table in the corner where I, where we did the art sessions. But that whole sort of shared space was like physically quite small, so it felt very chaotic a lot because, just depending on how many people had decided to come and hang out in the shared space at that point plus staff, like there was just more bodies than there was room for so it just seemed really busy however, like I said, at the place I was at that there wasn’t really a shared area, I think there was the canteen bit but I mean that was literally like the canteen and then some hard tables and chairs and I don’t, I don’t know if we had access to that all the time, I don’t really know.
W: it makes you wonder doesn’t it like to what extent the architecture of a place the setting and and how it’s designed how the place is designed it must have a huge impact
E: That would be a good episode to do because there’s a lot of research on that. Just as there is in terms of like, prison architecture and yeah it’s quite a big topic. It is really interesting. I mean it felt very small and claustrophobic but I never saw people’s, patients like bedrooms because that’s not, that was in a different part.
E: So I don’t really know is the answer. I would have found that shared space quite stressful but I wouldn’t have had to have gone in it. Maybe people’s rooms in that ward were nicer than the room that I had because I didn’t really want to speak, I wasn’t there to socialise when I was a patient. I didn’t really want to speak. Yeah basically I don’t know if they had better rooms then, yeah I probably would have rather have been there. Also crucially the staff, like that, you know the the member of staff, that I mentioned earlier who you know, was able to do that kind of quality of life and talk to people and you know, you could see that regardless of how successful or not you think it might have been there were lots of things going on, there were lots of efforts being made to provide some form of holistic treatment to patients that wasn’t just medication focused. So that is good. And I think I would have actually, I would have found it much harder to work in a ward where, you know, I didn’t feel so good about the member of staff I was working with and the provision, that that would be a lot harder.
W: So that’s, this experience was before you were admitted, wasn’t it?
E: Yes, it was. So this was, I probably stopped working there in like, October, and then I was admitted the following early January.
W: Oh right, so it was quite a short gap.
E: Yeah, it was actually quite a short gap.
E: I don’t think it’s related, but, yeah, I mean, I don’t think that me working in one particularly led to me ending up being, ending up in one on the other side.
W: Thank you to everybody who has been sending in their thoughts and questions for Ellie to respond to. We are going to record that as a bonus episode, but we’re not quite sure when we’re going to do that because we’ve got quite busy schedules at the moment. But what that means is that there’s still time for you to send in your thoughts and questions if you have any regarding Ellie’s experiences in mental health hospitals. Our email is firstname.lastname@example.org at and you can find us on Twitter or X @livelyminespod. Back to the show.
W: And since your inpatient experience, what’s…
E: Since then, I’ve done some work for, like I ran a sort of festive Christmas party at a high security hospital, which is a very different experience because yeah, a maximum security hospital is also where people might be sent to fill out a, you know, what otherwise would be a custodial prison sentence. So that was a very, very different experience. The security is far more intense and more, yeah, more like if you were to go and be running a project in prison, but then even more intense in terms of like what objects you can use and things as well. And even more so because also it is, it’s still a mental health hospital, primarily. It was very organized, so not chaotic at all. And the facilities were incredible.
W: What do you mean? The facilities were incredible?
E: Just incredible. For the number of beds, which wasn’t very many, the actual, you know, the buildings that were available, the facilities at this place were just brilliant. There was so much stuff. There was like a giant hall for like events and stuff like that. There was an allotment. There was, I think there might have even been like pet rabbits or something. There was like a big sports hall. I think there was a swimming pool. It was absolutely brilliant. And yeah.
W: Because when you said high security hospital, I was thinking, yeah, I was thinking you’re going to say it was going to be, it was a lot worse.
E: No, I was really, really impressed. And also that’s me sitting there saying, Oh, it’s brilliant. I’m sure like there’ll be people who have had horrific experiences. So this is literally just from my perspective of going in for the day. And specifically because so much of the work or my involvement in mental health stuff is like campaigning about the fact that it’s under-resourced and so then it was really amazing to see what could be built. You know, it’s an NHS hospital and it just sort of, the setup and everything was just right. Yeah, I mean, it is a very different experience because just as I sort of would relax into whatever it was we were doing, you know, something would happen that would then make it suddenly very clear to me that I was in a very different type of hospital to the ones I was used to either visiting, staying in or working on.
So like you have to eat your, when you’re buying something from the tuck shop, if you’re a patient staying at this hospital, you have to like eat it in front of like, while you’re at the counter and hand the rubbish back to go in the bin. And you know, every single pen lid, pen, everything was accounted for, how everyone left the room in single file checked to make sure they’d not taken a pencil, you know, just things like that would suddenly to me be like, oh gosh, I’m in a very different hospital to the ones I’m used to. But then everyone, you know, people responded as though it’s totally normal and the other facilities were amazing. And yeah, I still overall, I enjoy it. I have enjoyed it. I haven’t worked on a ward for a while, but I would, you know, I’d love to get back and do art groups again. It was great. I did really enjoy it.
W: I’m really struck at how much more positive your experience of working on these, in these places seems to be compared to being an inpatient on these places.
E: Yeah, but we’re not interviewing someone who is a patient in one of those places who would
potentially be like, “Well, this once happened and this happened,” and they might have had
W: Of course, of couse. So I guess my question is, you talked about you’ve also visited many mental health hospitals to see people who are inpatients there. Have you ever kind of, from the side of a visitor rather than an inpatient, sort of, of seen a taste again of your own experiences when you were in a patient?
E: Yeah, the first hospital I went to go and visit, I don’t even think it exists anymore, actually, but the first mental health hospital was absolutely horrific. And we were young, you know, this friend was only late teens, it was on like an adult ward, it was filthy, nothing worked, the staff were horrible, it was just really unsafe. It was really awful. That was like my first experience of what a mental health hospital could actually be like. And I was like really shocked. A lot of that actually was spent trying to get my friend moved to a more appropriate hospital, which took years, but but we did manage to do it. But I’ve also visited someone on a hospital that was, you know, I’m not entirely sure the ins and outs of how it works, but some, some NHS mental health, like purpose-built mental health hospitals are also private ones, or private ones also have NHS beds in them.
E: I remember visiting someone who stayed at one of those and I remember thinking, “Gah, this is actually more what hospitals should be like,” partly because it was located quite rurally and it was peaceful and I think a lot of the time one of the things that a lot of people need and don’t get is respite.
E: You know that is it a lot of the time, that’s what I needed. I was just overworked, losing the plot, I just, you know, I just sort of completely lost it. You know, I needed to be somewhere, I just needed to rest, that’s what people often need is rest. And this place was much more restful and I remember thinking, oh, this is, this is really good and, you know, especially for sort of an NHS hospital, it seems to have the appropriate stuff to patient ratio. All the right posters about knowing your rights were up, you know, all over. There was a nice garden. There was another ward on there that was specific for a certain type of mental health difficulty. And they had their own like, kind of peace garden that everyone had built. It was really beautiful, kind of rec area with like a pool table. And you know, it just, to me, that’s more what, if you’re gonna have the model this type of mental health hospital that’s more what it should be like
W: so what do you .. ..
E: But I do remember also thinking hang on a minute if I was paying whatever the private fee was for that like, I don’t know five grand a week, I was looking around like really I mean it’s not that good,
E: I’d expect something much nicer if I was paying that much –
W: What do you think are examples of good practice in mental health hospitals?
E: appropriate staff to patient ratio and that’s literally a problem with there not being enough they just aren’t enough mental health nurses and staff at the different levels that you need. You know it’s not like managers sit down, I’m very awar, you know it’s not like managers sort of sit down and go “oh should we just like hardly have anyone on on Thursday?” “yeah” like that’s not what happens. It’s actually, the hospital that I used to work that I first worked in, there was a board outside that said this is a, and then the number of beds, I can’t remember say it was like 17, I don’t know what it, it wasn’t 17 but say it was like this is a 17-bed ward optimum target levels of staff, this is outside the ward so anyone in the hospital walking past just can see it target levels of staff and it would be like you know x amount of this level of staff x amount of this level and x amount of healthcare assistant and then every single day the manager would put, it was a whiteboard they put the number of actual staff that they’ve got compared to that optimum number and not once did I ever see the correct number
W: and it feels as well like, the environment is really important.
E: yeah, yeah, the environment of the one I was in was just bizarre like I don’t, you know, I really don’t understand, I don’t, I do not understand why that’s used as a mental health hospital. People should be in an environment, if they’re going through something like a stay in a mental health hospital, they should be in an environment that can enable them to feel, that does what it can, to enable them to feel safe and if on the on the most basic level, you know, cushions, like people, daylight, staff who bother to smile or say hello to you. And if, I think it has just gone really wrong if you’re not even providing that most basic level of, in terms of it just as a building environment.
W: The other way that I know that you’ve worked at mental health hospitals is through your advocacy work for people who are in patients. Could you take us through that.
E: Yeah, I mean, I’m probably not going to talk in very much detail about that because
W: Yeah, because of confidentiality.
E: Yeah, and a lot of it, like, I’m not paid to do that. That’s ad hoc community activists.
W: That makes sense.
E: It’s like ad hoc stuff that has happened either with people I know or people I have worked with through like a local mental health group or something and they end up in a situation and then…
W: So, I guess to be clear, you weren’t one of the statutory advocates…
E: No, I wasn’t an independent mental health advocate.
W: That you referred to in the first episode.
E: No, no, no, no. So Mixture, it’s kind of like trying to make sure… A lot of people get very confused by what is actually going on for their situation when they’re in a hospital. So literally in terms of like, am I under section? If I’m under section, what section am I on? Am I allowed to go out for the day to visit my family? Do I have a named nurse? A lot of it is trying to clarify what exactly is happening and what the plan is, because it’s, it’s not always communicated to the patient in a way that they’re able to digest it slowly rather than, you know, they might have been told randomly like, “Oh, this is your nurse and, er, yeah, we’ll see you tomorrow for breakfast.” And also, again, like I said, when people go in, people are often very, really not very well. So as people start to sort of feel better, feel a bit more like themselves, they often don’t really remember what exactly is going on. So a lot of it is like clarifying that. Basically just being there as someone who understands the system, is on their side and cares about them. That’s kind of been my advocacy role. And a bit of communicating between them and the staff and clarifying plans and you know, if they’ve not been happy with something, I’d try and follow it up for them, that sort of thing.
W: And I guess your your lived experience of both being impatient yourself and also working on wards is really useful in those situations.
E: Yeah, definitely. To be honest, I think some of the social work training has actually been the most useful, plus a lot of the sort of community mental health activist groups that I’ve been involved with in Manchester, learnt a lot from them. But yeah, knowing the system as a patient and also as a sort of, from a staff perspective, which I guess the social work perspective is as well. Yeah, it definitely is a useful perspective and I think that what I hope it means that… Well, I’ve never gone in to help someone who hasn’t asked specifically, you know?
E: Not sort of like trying to impose my kind of shining armour situation.
W: Pushing your face against the window. I’m here!
E: Don’t worry, I’ll save you. Yeah, no, it’s never been like that. It’s always been someone’s asked and I don’t know whether the fact that they know I’ve got lived experience as well as professional experiences is why they would ask for me to help but I think it probably is.
W: To finish off with, I want to ask you what do you hope for the future of the mental health hospital?
E: Hmmmmm. A complete rehaul in how we, how the NHS is set up to treat mental health. We’ve come into this system that has taken away funding from community-based and recovery-oriented mental health care which has been proven time and a time again to work and what money was in those is now being put back into centralising mental health care at certain hospitals and therefore focusing on a clinical thing but this is often without the creation, even within that model which I disagree with, without even the creation of extra beds, so the bed problem’s not solved. There’s no community support, there’s like no social workers at the moment, the waiting list for people who haven’t been assigned a specific social worker is so long. So for me, the things that a mental health hospital could be, rest bite, inpatient therapeutic treatment, care, there are lots of, and maybe we’ll talk about this in a separate episode because it does seem like quite a, you know, bonkers concept, but there’s lots of places called Soteria Houses which are sort of around the world, which are medication-free mental health hospitals, all the staff have lived experience, you know there’s a lot of contention around some of the safety issues with that, but that model, there’s also some incredible studies about the success of those hospitals particularly in Norway and Finland and I would like us to work more towards a system that can allow for that.
W: Thank you so much Ellie for joining us. That’s the final part of our three-part mini series.
E: I bet no one wants to hear my voice ever again now.
E: Three times in a row
W: Nonsense. Nonsense.
E: 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 sign posting to support on our website at anyamedia.net/livelyminds.
E: Make sure you keep up to date with our shows by subscribing wherever you get your podcasts.
W: Take care and bye for now.
E: Bye bye.