A little while ago an opportunity came up with Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) for someone to speak at a Positive and Safe Conference about their experiences of restrictive practices…
Now, considering I’ve been a mental health Blogger for almost nine years, I think it’s totally reasonable to assume that I’ve talked about my entire mental health journey by now. In all fairness, I think even I thought that was true; until this opportunity came up… So when I was chosen to give the speech and first met with the lovely Lauren (who you’ll be hearing from later in the post) from the Trust’s Positive and Safe Team, I almost immediately realised two things:
1. I have a lot of experience and a lot to say about the topic
2. I actually haven’t talked a whole lot about it all before
In acknowledging these two points, I had a decision to make: did I want to change that? Did I want to change the fact that I didn’t talk about these things?
Of course my answer was ‘yes’ and that’s why you’re reading this blog post… I mean, I guess a huge motivation behind my eventual decision circled back to the fact that – as a Blogger – I’ve already talked so much about my mental health journey; and that a lot of that has included arguably very personal issues such as the trauma and my self-harm and suicide attempts. So, why stop there?
And in asking myself this, I began to consider all of the benefits that could come from me talking about my experiences of restrictive practices:
ü Therapeutic to talk about things that have gone unsaid for so long
ü Being able to educate those who might misunderstand or be uneducated on the subject
ü Encouraging others to talk about this issue too
ü Opportunity to advise people on avoiding restrictive practices or managing them better
So, I guess I’ll start at the beginning; my first memory of a restrictive practice in psychiatric services came in probably the most dramatic and startling way of being sectioned under the 1983 Mental Health Act after my first suicide attempt.
Just ten days before the attempt – in 2009 – I had begun experiencing auditory hallucinations and out of fear, I didn’t tell anyone and so I had no help or support when I finally began to listen to the hallucinations telling me to kill myself. And that meant that I found myself being taken to A&E in an ambulance and then told that I had to wait four hours for blood tests. I remember feeling so suffocated in the room I had been put in and feeling as though the voices were getting louder and louder the longer I sat there, and so I left the hospital and walked toward the nearest town.
Because of the situation, the A&E staff called the Police and within half an hour, two Officers had come up to me on the high street and told me they’d be taking me back to the hospital. I tried to run, but I didn’t know the area and ended up running straight into a dead end(!) which allowed the Police to catch up to me and put me in their car. When we got to the hospital, I heard a Nurse tell them that they didn’t have anyone to sit with me to keep me there and one Officer told her “we’ve sectioned her anyway; so we’ll be staying with her.” I had no idea what that meant, and it seemed that neither did the Officer who was instructed to stay with me whilst the other went to get the paperwork for it.
I made two or three more attempts to run in between trips to the toilet, but I eventually – as is procedure when you’ve been detained under the Police section 136 of the Act – ended up being assessed by two Psychiatrists and a Social Worker. They decided to section me under section 2 of the Act and when they said the Police could now leave, I questioned how they thought they could make me stay and was told that the section now meant that the hospital staff could restrain me if I tried to leave.
Being sectioned for the first time, and having only just turned 18, months before the admission, to the CNTW psychiatric hospital, meant I was taken straight into adult services and was very easily the youngest person on the ward. It felt so incredibly intimidating and anxiety provoking, and out of fear that I’d be in there until I reached the age of the other women, I finally confided in a professional that I was experiencing hallucinations. This confession, seemed to reassure the staff that I was prepared to talk and accept help and support and they believed that didn’t have to mean I was sectioned so I was sent home.
My next experience of restrictive practices still involved me being sectioned under the Mental Health Act after a second suicide attempt, but this time; the professionals took it a whole lot further… Firstly, they had me sectioned in my Mum’s home and when I continued to refuse medical treatment, they ordered six Police Officers to come in and carry me out in handcuffs and Velcro leg restraints, to be transferred to the local medical hospital. At the hospital, one of the Psychiatrists called in four psychiatric staff to sit with me for the entire time it took for the antidote to be administered (a little over 24 hours).
The medical staff hadn’t even had the chance to move me from A&E to a ward before my first escape attempt(!) which ended with me being rugby tackled to the floor, restrained, and given a sedative injection for the first time. I think that if someone had bothered to try and tell me what was happening – and more importantly, what was going to happen – then maybe I wouldn’t have been so terrified when I felt a sharp stab in my bum and then my eye lids started to become so heavy. In fact, if I’d been told they were going to do that, maybe I’d have had motivation to stop struggling completely…?
After the medical treatment, I was taken back to the CNTW hospital I’d been in the first time, but this time I knew the ward doors were unlocked and I made consistent, persistent – and mostly successful – attempts to run away. A huge reason for my escapes was the trapped feeling that so naturally and understandably engulfs you and your life when you’re sectioned. I hated the notion that at a time when I already felt that I had very little control over my life because of the hallucinations and felt as though I were desperately trying to track down some level of control, professionals were exacerbating this by literally taking away my freedom.
After a few days of my escapades, the staff decided to transfer me to the Psychiatric Intensive Care Unit (PICU) on the other side of the hospital and all too suddenly I was aware of the existence of the restrictive practice – increased ‘observation levels.’ You may have heard of these, but if not, there are basically a number of different types of observations you can be on as a psychiatric inpatient. These can vary from having a member of staff check in on you once an hour, to having to be within eyesight of staff, to having to be within arms length of four members of staff at all times! Like most restrictive practices, it’s a complete loss of privacy and – particularly when you need the loo – a loss of dignity too!
During this second admission, I finally reported the abuse I had experienced two years previously and whilst this should be seen as the ‘right’ thing to do, it isn’t that ‘simple.’ It’s not straightforward enough to have any benefits outweigh overwhelmingly enormous consequences… And, one of those consequences was that finally talking about what had happened to me brought all those terrible memories to the front of my mind. Which meant that when I was being restrained after the report, it was like going through a time warp and suddenly being back in that office, being pinned to the desk, and being hurt over and over again. I mean it was so intense that it was almost as though every member of staff were wearing a mask of the face of my abuser. I might as well have been going through the entire thing all over again – that’s how triggering the restraints were…
With the staff restraining me in those ways, gave me the misguided – but understandable – thought process that they actually didn’t care much about what I had gone through. This felt contradictory considering the encouragement, and sometimes downright pressure, they had put on me to be open and to talk about why I was self-harming and why I felt suicidal! And I didn’t have much tolerance or patience for contradiction and people claiming to be one thing when actually, they were completely different! Which meant that I had no real inclination or motivation to cooperate and engage with them and the medication they prescribed. I mean, why would I do as they asked if they wouldn’t allow me the same courtesy/respect?
My third admission to a CNTW hospital was the one which led me to experience – on many occasions – a seclusion room. Again, I was put on a PICU, but a different CNTW site, and in all honesty, I can’t remember the very first time I was put in the room, but I definitely still remember what it was like…
It was kind of everything you’d assume in hearing the words – which I find ironic because all of the horror stories and rumours I’d heard about inpatient psychiatric wards turned out to be far-fetched! I guess it was surprising to realise that the ultimate, stereotyped feature of mental health services was exactly what you’d have guessed. Although, I will add that I know the appearance and function of seclusion rooms does differ between hospitals, healthcare providers, and counties.
So, the one I was regularly dragged into, was quite a large room with slightly padded walls and flooring and had one plastic, uncomfortable mattress on the floor. If you needed the toilet, you had to knock on the single door to the room which had a small glass panel in the top for staff to look through every so often. After a few instances in there, I had the realisation that I could use the mattress to cover that glass panel so whenever I heard them dragging the mattress out of the room, I knew they were about to put me in there! And to put into perspective how often I was given a sedative injection and put in seclusion, the hospital had to call an Optician onto the ward because all the muscles around my eyes had relaxed so much I couldn’t see clearly!
After that third admission, I spent the following three years in and out of hospitals and had no real different experiences of restrictive practices until 2012 when, after a suicide left me on life support for a few days, I was admitted to a psychiatric hospital owned by a private healthcare company. Since this post is in collaboration with CNTW, I thought it not appropriate to talk about specific instances that have no reflection on the Trust. So instead, I thought I’d make it a bit more general and talk about the things which seemed to come into play during my experiences of restrictive practices there.
The first issue, was around the us versus them culture that became more and more obvious and real over the two and a half years I was in the hospital. Whilst I believe that this is a difficulty throughout any stage of mental health services, I think it is exacerbated in situations of restrictive practice because they becomes more about a power struggle and a battle for control. And I think that, in hospital, this was especially prominent where the practices involved could be perceived as a sort of ‘punishment.’
When I managed to go AWOL from the private hospital, I made a suicide attempt and once the Police had found me, I ended up on life support for a few days. When I woke from the coma, I was taken back to the psychiatric hospital, but rather than being led to the ward I’d been on for over a year, I was taken to the PICU on the floor above. I remember being so terrified because I’d only ever heard bad things about it… and screams from its patients and staff which tore through the whole hospital!
Kind of fortunately, I was tired and nauseous from the coma and anaesthetic, that I didn’t venture out of the empty bedroom I was given with a member of staff keeping me thin eyesight at all times – even when I felt so desperate for a shower, I didn’t care that I was going to be watched! So it meant that I didn’t really witness and wasn’t involved in any of the dramas on there. However, I was still so grateful when the staff agreed I could go back down to the other ward because I knew I’d have some of the other inpatients around me, who – after over one year there – had become family. But back on that ward, the staff decided to put me in a ‘stripped bedroom’ which meant that the only items and furniture in it were bolted to the floor or the wall.
Initially, I saw this ‘consequence’ as kind of sly because in my mind, the only object that should be removed from me were things that I could use to hurt myself; so why was giving me a totally empty room fair? With the staff either unwilling or unable to explain their decision to do that, I was left to imagine their reasons myself, and one thing I thought of was that they were trying to punish me because I had made them look kind of stupid. I’d convinced them all that I was better and they’d believed it and trusted me in giving me unescorted leave from hospital. And I’d managed to plan my escape, make it, succeed at it… I mean, I wasn’t stupid – I appreciated that chances were, staff would be questioned on how they fell for my pretence. And that might make them feel kind of inadequate and embarrassed. So, to re-assert their power and control, I was punished with a stripped bedroom!
Finally, in my talks with Lauren from CNTW, she told me about the improvements that the Trust have made, and the one I thought the highest of was that they now deliver de-briefs for everyone involved in a restraint. I liked this procedure because during my numerous admissions, I’ve witnessed a lot of upsetting scenarios of other inpatients being restrained, and whilst I’ve found them difficult to see, I can recognise that for some people to witness that, it might go so far as to be traumatising and triggering of memories of their own difficult experiences. So, ensuring that everyone involved in the incident is properly and appropriately supported in its aftermath, could be very essential to someone’s mental health.