Thursday, 26 November 2015

The Stigma Within Mental Health Patients

Stigma of mental health is a well-known, well-publicized problem. However, the focus is normally on the general public, police and medical staff having little knowledge or education in mental health and as a result, have out-dated opinions and unhelpful behaviours. There is rarely any focus on stigma within the network of psychiatric service users and patients. I'm going to take the lid off of this can of worms in this post...

I was hospitalized a number of times before the admission that led to this blog but never into a setting where there'd been a sense of community and family. This, was for three reasons; there weren't those type of wards, I wasn't admitted for long enough to build any relationships and there was no interaction with the wards beyond your own.
This all changed in my last hospitalization. Firstly, it was a specialized personality disorder unit so the patients all had some similarities; areas to bond on and behaviours and attitudes to dispute. It was also a long-term unit so during my admission there were around 5 girls who were on the ward from the beginning to the end of my admission (two and a half years). This also enabled relationships to be built. We were also in a smaller hospital with only different four wards and there were often trips out or activities with patients from each ward. After a while, the courtyard was also changed so that those who went out could interact with patients from the other wards.
And this is where the first stigmatization came in. Within our hospital there was our unit, a unit for 'challenging behaviour,' a men's unit, and a PICU (Psychiatric Intensive Care Unit): who we had the most confrontations with. Patients on a PICU, are often the most poorly or unsafe and so, any interactions with them often resulted in something upsetting and triggering being said to a girl from our ward. This would result in self-harm, distress, the need for extra medication... And it caused tension with other patients who felt the need to argue with those staff who were responsible for mixing the wards and for not supervising them properly in order to avoid such incidents. Over time, there was also physical assaults from PICU patients to those girls on our PD (Personality Disorder) ward and this all led to our PD patients having a pre-conceived idea of any patients on the PICU, which meant generalizing all those on that ward.
Within our ward, there was also stigma attached to aspects that resulted in patients feeling inequal to one another. One factor in this, was your level of observations (varies from arm's length to hourly) which meant that often those on a high level of observation, were avoided. Not particularly in a cruel way, just at fear of being upset or triggered by the person's poorly state of mind and often violent outbursts. If you were to pass someone's room and see a member of staff sat outside the room, it was always assumed that the patient had needed to be restrained or had self-harmed to have gotten themselves on such a level of observation.
Another aspect on the ward which sparked stigma was how much leave a patient had. The Psychiatrist of each patient who was detained under the Mental Health Act had to prescribe leave for that patient. This included detailing how long the leave was for, where the patient was permitted to, and whether they must be escorted by staff, which included how many staff were to go with the patient. If a patient had unescorted leave (without staff) then they were regarded as much further along in the recovery process. The amount and kind of leave a patient had caused a divide on the ward between those who had unlimited unescorted leave and those who couldn't even go into the hospital grounds without a member of staff.
Even medication became a ward divide. For some, it seemed to actually be a competition with one patient stating how many milligrams of a medication they were on and another stating how much more they are prescribed. For those who had experienced varied medication throughout their mental health illness, they often deem some drugs to be insignificant to their own. For example, Lorazepam (a mild sedative) was deemed less significant to Zopiclone (a sleeping tablet). There was also some level of competition between patients and what they had done in their past. For example, one patient would recount a time when they jumped from a building and, as though as to go 'one better', another patient will recount a time when they self-harmed to such a degree that they needed surgery.
It's a sad state of affairs when there's stigma and inequality within mental health patients and their units/hospitals. Especially when really, they should be working as a team (so to speak) to unite in battling the public's stigma on all those with mental ill health.