But…
(Guest post by DeeDee Ramona)
With additional material provided by a friend who wished to remain anonymous. Please note that as I’ve also been asked to write a version for distribution in the USA, a lot of the language is targetted in that direction.
Introduction
Here’s a little guide I wrote to how to stay out of trouble during your stay on a a general adult acute psychiatric ward in the UK. Despite what you might think from the TV, such places are, in general, not particularly dangerous. There are factors that can, however, make your stay more difficult if you’re not careful how you approach the situation.
The problem is that you are, effectively, shut into a set of rooms smaller than the Big Brother house, with twice as many people, none of whom really want to be there and with whom you have nothing in common except mental illness. All of you have had your social skills drastically compromised by illness. Some of the other patients may live a very rough existence, due to past and present social exclusion and you will need to get on with them too.
Here are 10 tips to help you have a trouble-free admission.
1. Secure Your Possessions
You should not bring anything into a psychiatric ward that you would mind losing. Everything, including your socks, can and does get stolen. The staff will probably give you a key to a locked drawer in your bedspace in which you should place any valuables such as cellphone, money or cigarettes. Carry the key on your person. You will need clothing with secure pockets to keep this key safe. If no such drawer is provided, then you need to leave your high-value items with staff, or keep them on your person at all times.
Anything else – expect it to walk. Have a friend come in and collect your dirty laundry. If the hospital has a laundromat, make sure you keep your belongings in line of sight throughout the wash and dry cycle. If you can’t do this, or there isn’t a member of staff overseeing matters, don’t use it.
2. Smoking Area Drama
The vast majority of psychiatric patients smoke. I don’t know why (I don’t), but they do. You will find the corridors of the ward completely empty during the day as the 30 or so patients squeeze into one tiny balcony area or ventilated room to get on with the essential business of getting through 40 Marlboro Lights a day.
Stay out of the smoking area.
With everyone crammed in there, you get endless drama. A thinks B is looking at him funny, because A is paranoid. B gets really aggressive about this because he isn’t able to control his emotions well due to illness. C starts shouting at them both to can it, because he can’t hear the TV (there is no TV). D and E get stressed out by the noise and start screaming at everyone… (Seaneen Molloy refers to the above as the game of “Mentally Ill Dominoes”). Or there will be schoolboy and schoolgirl bitchery, as one patient decides he or she wants a clique, and passes comment on everyone else….
The smoking area is the source of 90% of all ward drama. If you have a falling out with someone in there, you have to cope with being in the presence of that person constantly, perhaps for a number of weeks, until you are discharged. They may decide to make their distaste at your existence abundantly clear on a daily basis, shouting at you whenever they see you so you find it impossible to go sit in any of the common areas without being yelled at. Avoiding the smoking room cuts the probability of having this happen to you right down.
If you don’t smoke and another patient invites you in, state that you can’t, because the large number of people in a small area makes you feel “anxious”. If you must smoke, go in there, stay really quiet, and if anyone says anything, mutter, “I’m not feeling well today, the walls are closing in on me” and then leave when you have finished your cigarette, citing that you feel paranoid. No-one will question this, regardless of diagnosis.
3. General Drama
Remember that no-one has any social skills due to illness. This means that a normal conversation, where you discuss a mildly controversial topic in a civil manner, can result in an adult woman in her 50s – who would never behave like this when well – screaming blue murder at you because she doesn’t agree with what you have to say, or alternatively bursting into floods of tears and complaining that you are being mean.
Therefore, be very careful about what you bring up in discussions with other patients and steer well clear of anything that could lead to disagreement or friction. The weather and your dog are good topics. The government and the state of your local football team are not. Avoiding talking about your children or asking others about theirs as many patients feel tremendously guilty that their illness takes them away from their families.
4. The “250mg of Chlorpromazine Walk” and “Can’t Sit Still” Excuse
If for any reason you are in one of the common areas and someone you don’t want to be near comes in, or drama starts, or someone looks like they are about to start some, wait about 15 seconds and then say something like, “dammit, I can’t sit still today, bloody medication”, get up and leave. No-one will question you.
You then wander off doing what I call “the 250mg of chlorpromazine walk”. This is where you imagine you’re full of anti-psychotics, and shuffle along slowly with a blank, slightly-confused expression on your face. You sort of blend in as part of the furniture and people tend not to notice you. I’m serious, it works a treat. It’s the ultimate get out of jail free as regards getting away from troublesome patient-related situations.
5. The Violent or Threatening Because of Illness (VTI)
There will always be at least one other patient who is threatening, violent towards staff or overtly lecherous towards other patients because they are ill. The lecherous while manic thing is so common that many wards have a women-only section as otherwise the ladies would have to hide in the dorms all day from one hypersexual male after another.
Avoid this person. Yes, you may feel sorry for them, but they are NOT your problem. The staff are there to assist them with their recovery. You, look after yourself. If they come and sit down beside you, do the ‘can’t sit still’ excuse followed by the 250mg of chlorpromazine walk (see above). It is not judgemental or narrow-minded of you to prioritise your personal safety and recovery in this way. If you see the VTI behaving erratically or in a threatening manner, tell the nursing staff and let them handle it. Just stay well away from them and concentrate on your own recovery.
6. The Nasty Piece of Work (NPW)
There is always one. This is someone who is, outside the hospital, a social predator who spends their time scaring and intimidating others, getting involved in low-level crime, or frankly they are a violent offender who also have a severe mental illness. They tend not to control their condition very well and so end up spending quite a lot of time in hospital. They are used to the environment and have lots of practice. Therefore, they are in a position to exploit people they see as vulnerable and will go after anyone they see as a threat to their position as king/queen of the ward.
The NPW will likely immediately try and see if you can be intimidated into handing over cigarettes, or, if you don’t smoke, money. They will either approach you while walking around the ward, or, if they are feeling more aggressive or confident, come directly to your bedspace with their demands.
It is ESSENTIAL that you do not give in, regardless of how much this person may scare you. Otherwise you mark yourself as an easy victim for the duration of your stay and this person will not back off. Just flatly state, sorry, I’m not giving you anything. No matter what kind of tantrum the person throws, or how much they scream in your face, just stand there and keep repeating yourself. They are unlikely to resort to violence as this will get them in hot water with nursing staff. Once they have backed off, report them to staff immediately. With luck the staff will come running anyway if things get in any way loud, and your problem has gone away – the NPW now knows you are not to be picked on and so they will interest themselves in someone else.
Don’t be tempted to become the “ward police” and report the NPW whenever they step out of line. If you do that, they may see you as a threat to their dominance of the ward and could react violently. Mind your own business if they are not directly affecting you.
7. The Phantom Staff
Regrettably, there are still some acute wards where the staff do not have a presence on the ward at all, preferring to lurk in the nurses’ office, emerging only to administer medication or if a violent incident has occurred. This is going to be a real problem if you have been targeted by the NPW – they are free to threaten you with violence and you have no backup, and they know this. It’s a situation that is totally untenable and no hospital should inflict it on you – but there are still cases where this does happen, so it needs to be mentioned here.
You may be thinking about smacking them one, hard (the NPW, not the nursing staff). They may richly deserve this, but, remember, your goal is not to teach this person a lesson, it is to get to the nurses’ office and pound on the door. This way, the NPW they realise that the outcome of any threat made to you will be hassle from the staff whose darts game has now been interrupted.
There is an additional problem you need to think about if you do decide to engage in violence to deal with someone like this – that of what goes on your file after the previously non-existent staff erupt from the nurses’ office, find 2 patients “fighting” and give both of you haloperidol jabs to calm you down. The merest mention of “tendency to violent outbursts” in your file could change the tone of your treatment forever from working with you to find the best solution to containing the potentially violent offender at all costs. You don’t want your doctor to be scared of you.
I would suggest you study carefully what Marc MacYoung has to say about bullies and how to deal with them on his excellent site No Nonsense Self Defense. Take a very detailed look at this page, and indeed at the rest of his site, before you decide what you would do in that situation. Mr. MacYoung has a LOT of experience in the field of self-defense in the USA and is highly knowledgeable (Note for Mental Nurse readers: yes I’ve met him and yes he really is that good).
8. Drugs and Alcohol
It is commonplace for “friends” of patients to bring illegal drugs or alcohol in to them. It was so frequent at my local hospital that there are now stern notices at the entrance threatening anyone so doing with immediate arrest.
If you suspect someone has brought in booze or drugs, my advice would be DON’T report them to staff. Mind your own business. Do not become a “snitch” on what is a criminal undertaking or you could be letting yourself in for serious violence. The staff are not stupid, they will find out and handle it themselves – they see this every single day.
Just stay out of the common areas, especially the smoking area, for the rest of the evening, as drink and drugs on top of a major psychosis and heavy medication can turn some otherwise OK patients into violent assholes.
9. Loudly saying “I don’t belong in here”
This goes down about as well as in the Shawshank Redemption. You may feel that you’ve just landed in a ward full of hard-core mentalists who have all been hearing voices since birth and have been fully “in the system” for most of their adult lives whereas you have been depressed for precisely 6 months – and this is possible. If you were on a kidney unit you’d meet all the people who have had dialysis 3 times a week since they were 6 years old even if all you needed was 2 days of treatment. Nonetheless, although these people are sicker than you, you are all mentally ill and that is why you are a patient on that ward.
Patients are very sensitive to any suggestion that someone is “too good” for them or that the severity of their illness makes them a lesser person than you and will interpret anything that remotely suggests this as such. Many have suffered years of discrimination and ill-treatment from their families and communities. So no matter how scary you think everyone else is, do not express this view in conversation with other patients, or to staff where other patients can hear, even if you don’t mean it like that. It will not make you ANY friends and will probably create drama.
10. Relationship Troubles
This is not the time to start any sort of romantic attachment with another patient. If you really think this person is the one for you, they will still be that 2 months after discharge. It’s best to wait. It’s known to be bad for your recovery, which is why your doctor will not be happy with you about it, plus you risk breaking up on the ward and this will cause further drama.
11. Relax!
It is extremely unlikely that you will be threatened with violent assault while a patient on an acute ward anywhere in the UK. It is more likely that you will have a falling out with another patient that will make your life more unpleasant, or that the behaviour of other, very ill patients might result in drama.
The tips presented here should reduce the likelihood of these problems occurring. I hope you’ve found this guide to be useful. The most likely problem you will encounter is other patients eating your grapes when you’re not looking!
Howard Martin – I hope you don’t mind my nicking your copyright notice as I need one:
Copyright 2009 DeeDee Ramona (Z knows my real name for this purpose).
All rights reserved – for publication only as part of the Mental Nurse website. No editing or copying by whatever means or for whatever purpose without express consent.
ps Why yes, I am up posting to MN at 2am. I’m not manic at all, of course not…
Brilliantly fantastic, love it. And all so bloody true.
This is awesome. Nell, Mental Nurse, and I had tossed around the idea of a Survival Guide to mental health care a while ago. It’s been on hold, but I still want to do it. If we do it, I think this should be a part of it. But it is definitely your decision. I’ll try to remember to ask you about including this specifically when/if we gear up for this.
Not finished it yet but number 4 is brilliant.
Excellent post, though as a member of staff I don’t think I can do the 250mg Chlorpromazine walk as an avoidance technique.
(And before anyone asks, no I don’t do the lock-yourself-in-the-office thing either, though unfortunately I have come across nurses who do.)
Glad you decided to post it here
shuffle along slowly with a blank, slightly-confused expression on your face
This is me every early shift…
Pre or post-administration of the caffeine IV?
Caffeine just makes me shake, which isn’t good when trying to do a depot…Sugar is my stimulant of choice
In the US, smoking areas are a thing of the past which increases misery and agitation but decreases interpersonal conflict. Great post! One other rule-no screaming or yelling because it draws staff in hordes to contain possible incidents.
This is really a good post DeeDee, I haven’t been in an acute ward for ages but my previous mentorship link tutor was researching why people actually got better in an acute ward despite the chaos and obvious need for a survival strategy.
BTW – useless bit of info – mental health service users are twice as likely to smoke than the general population, but if a comparison is made using social class, it comes out as roughly equal. I suppose this is because a high proportion of mental health service users are unemployed, consequently all are identified as being within the lower social class scale.
thanks. I hadn’t thought of it like that – that the high incidence of smoking was linked to social class… being a middle class girlie, most of my friends don’t smoke at all.
Reading my post again it sounds like I was attempting to make a correlation between mental health service users and a particular social class, what I was, in fact, trying to say, was that there is a correlation between unemployment and official attribution of social class. This is regardless of background, culture, professional/academic qualifications and other status. ie reductionist. Sorry if this sounded offensive in any way, I was not inferring that any service user on this site is a particular social class.
That Marc MacYoung site really is good. Thanks for pointing to it! I love his skewering of martial arts hype and violence fanboying – “This is SOOOOO dangerous that your dick will grow three inches from just walking in the door.” Heh.
I like this a lot. Unfortunately it is worryingly accurate!
I would like to copy this and give it to all the patients we see with the crisis team as part of the “welcome” pack we are planning to give to all new referrals.
Wow, I’m flattered! However, I’m not happy to let you do that as-is as I have plans to get this up on a friend’s website under my own name which would conflict with this. Once it’s up, under my own name, I can give you a link to it (Z will pass it on to you) and you will be free to download and distribute in that format.
Yegods that reads like something legal.
Basically, it’s going up under my real name on another site, so, I’d like you to wait til it’s up there, and then you can print it out with the appropriate author’s name. This is because I want to start writing more articles of various types, and so prefer to have all my work under my real name. Does that make sense?
don’t forget to let us have that link when it is ready.
I’d like you to exercise some caution before making this more widespread, DDR.
In spite of your disclaimer at the start (about danger) many of your comments will, I feel, serve to reinforce many people’s negative stereotypes.
In my fairly extensive experience as a patient, there isn’t much more likelihood of there being “always one” violent/predatorytroublemaking/thieving person around than in any other effectively random allocation of human beings. There’s something about communal living that just brings out some people’s natural tendency to be arseholes, independent of mental health status, and I’ve seen as much of that in boarding schools, youth hostels, oil-rig accommodation blocks and groups of mental health staff as in any psych ward.
I’ve also seen, in psych ward smoking rooms, a number of heart-warming examples of patient-to-patient personal support that would eclipse an awful lot of the “professional support” offered by staff.
Though advising people to be careful about who they associate with is never a bad thing, I think the overall tone of your piece strays towards throwing out the baby with the bathwater.
Thanks. The piece is written from a self-protection viewpoint. Perhaps I need to add a paragraph explaining that the problems are frequently germane to other forms of communal living, as you term it, and also to the mix of social milieu that you get.
My experience as a patient, though, has been that you DO have increased risk of violence due to people kicking off than you do in a student halls – that’s just the way of acute admissions, and you DO have on every ward quite a few people from very rough lifestyles who need to be treated with caution. So I do think a guide like this is handy to have.
Just realised my initials (DDR) are those of the old German Democratic (cough) Republic. Not….. quite the impression I had in mind….
I’m afaraid I have to agree with Jan, which is why I have hesitated to comment before. It seems to me to be a guide for middle class women, which does not acknowledge that they can be just as predatory as men, particularly when manic (although they are advised to avoid romance). Otherwise it could be summed up as keep your head down and mind your own business in case you upset any patients who are lower down on the social scale and more disturbed than you.
I have been a patient myself and a carer too, as well as an advocate and a “user representative”. A lot of people I know have found more support from their fellow patients, in and out of the smoking rooms (which don’t exist anymore on acute wards in the UK either) than they have received from the nurses, who don’t have enough time to talk to them much, even if they want to.
Some of the advice seems a little outdated. The new acute wards in my neck of the woods have single rooms with ensuite facilities, so people have more than a bedspace and much more privacy too. The average stay on an acute ward is less than a month and a lot of people are only there for a few days, so there isn’t much time for anyone to become topdog (or bitch) like in Cell Block H.
Doing the chlorpromazine shuffle isn’t a very good idea either, because it’s not as common as it used to be now that most people are on the new medications which have less obvious side effects. You don’t have to make excuses to avoid someone or pretend to be something you’re not, you can just walk away normally without comment, which is much more dignified and just as effective.
So if you are unfortunate enough to find yourself on an acute ward, try and treat the other patients as you would like to be treated yourself, with respect and courtesy and compassion. And share your grapes!
Because after all, there but for fortune. . . “Insanity, like sex and death,
Is one of the great levellers. We are all flawed, who can draw breath,
All fragile, damaged, fellow travellers, all human and all vulnerable,
And all unique, and equal born, and all, to some, intolerable!”
@Nell. Can you attribute the pearler of a quotation at the end of your comment please?
@Jan. I’m so glad you liked the quotation, because I wrote it myself a few years ago, when I was “performing as a poet” under my real name, which is Alex Murray. Please feel free to use it if and whenever you feel like it.
Thanks Nell, much appreciated.