Thursday, 24 October 2013

The Institutionalized Debate

A couple of times recently, people on Twitter have had discussions about inpatient settings becoming institutionalizing so I thought I best give my view on it considering I've now been an inpatient on the same ward for 15months.
Before I came to this hospital, my longest admission was for five months. It was right at the beginning of my ill mental health (it was the third admission and only two months after my first OD) and they were trying to rule out psychosis so I was sectioned for walking down a main road but because of my behaviour I was put onto a PICU (Psychiatric Intensive Care Unit). I was on the PICU for three months and on an open ward for two... I remember that on the PICU I was being put in seclusion (the closest thing to an actual padded room) so often and given IMs (intra-muscular injections) of Lorazepam (a sedative) so often that the muscles around my eyes relaxed and I needed glasses. It felt like it took ages to build any kind of leave up even to just go down the corridor to the Hospital cafĂ© with staff! But they let me go home on Christmas day and I was allowed into the nearest town centre. When they discharged me from my section I was asked to stay for another month voluntary but I only managed two weeks before wanting to go home. It was so strange to leave after such a long time in Hospital and with barely any contact or experience in the community and with the public! I think, a part of me missed Hospital and the safety and security it provided as well as the constant support and company from other patients and staff.
My many admissions after this one have never amounted to anything beyond a month so the thought of coming to the Hospital I'm in now and knowing that the typical length of stay (according to their website) is 12-18 months was quite daunting. When I actually got here though and I found out some of the girls had been here years and there was still no sight of their discharge, I panicked. I think it probably took me almost a year to actually accept that I'd be here for the long-haul because I tried to appeal my section so many times when I first got here, so I guess I always thought I had the chance of being discharged at a tribunal. Also, I'd had so many admissions that occurred as an attempt to break my pattern of overdosing and as soon as I've self-harmed or managed to go AWOL the admission's been ended as it was realised it wasn't making a sufficient difference. So, whenever I would self-harm or run off here I thought (and sometimes hoped) that would mean the Hospital staff would give up and send me home. But they never did. And on my last overdose last week, when I saw the lengths the staff went to to keep me alive and save me from myself, I guess I finally realised that they weren't ever going to give up; they're in it for the long-haul too! That thought, as strange and new as it is, is so completely comforting and special that I think that, and the length of my admission so far would make it understandable for me to become institutionalized here and not want to leave. But that hasn't happened.
Some people, if they saw my bedroom, might say I've made myself at home here but this Hospital will never be my home. Although, I've started to refer to it as home e.g. "let's get home now" that's only because it really is my temporary home, base, address... Whatever. And the fact my room is covered in my things and that my walls are full of cards is more about making it a nice place for me to be rather than settling in. Also, when the staff have told you (as they have me) that you have at least another year in the Hospital... The best thing you can do is accept it and make is as easy as possible on yourself.
I've spent 15 months watching girls getting close to discharge and jeopardising it by self-harming or running away and I get it... Some of them have been here for so long that they only know there's a different life because they get home leave... And the majority are leaving to go into their own flat and even if it is supported accommodation it's a massive difference to go from living with up to 18 other people and having up to eight staff nearby to going a whole day without being able to talk to someone. As well, some of the girls recognise that the only reason they haven't self-harmed has been because they haven't had the opportunity to in Hospital...
At the moment, my discharge is so far away that I don't even want to begin to worry about how I'll cope when I get discharged; I have a lot more in the meantime to be panicking about that it makes no sense to worry about something so far off! But, I am encouraged by the fact this Hospital is pretty decent on arranging after-care with community services and ensuring you're in the right accommodation for your needs.
Finally, I think there's a difference to wanting to be in Hospital and needing to be in Hospital. As long as you want to be back in the community then there's no risk of becoming institutionalized, no matter how long your admission.