Been a while, but here’s Part III of the ‘De-glamourising inpatient’ series.
13. Alarms- anyone who’s been in hospital will know that alarms are a common feature of life on the ward- be it fire alarms, door alarms or rapid response alarms (when staff call for help to deal with an incident). Alarms going off is always unpleasant and, well, alarming. Day two of my first inpatient admission I was woken to the sound of alarms and a restraint going on in the corridor. At first I assumed it was a fire alarm and willed it to shutthefuckup, but after hearing screams and shouts from staff and patients I gathered it was something else going on and slid under my blanket, petrified. On my home ward, every night at 9pm the door alarms would go off as the doors to the ward locked, and thereafter any time someone tried to open them without a swipe. Every night, one patient would start screaming when the alarms went off. The fire alarm would go off occasionally, and on one occasion, we’d all just finished supper and started to settle down for the night when it did. Staff panicked, we were all herded up at gathered at the door, and when word came that it was a false alarm, staff made another pot of tea and round of toast to calm us all down. Rapid alarms are the most uncomfortable though- the second they go off, everyone comes running and shouting and it is chaos and we all shift uncomfortably in our chairs, knowing someone, somewhere, is having a shitty time. Loud, blaring, intrusive, stressful. It sounds minor, but for a lot of people, the sound of alarms on the ward can be hugely distressing.
14. Boredom- boredom on a psychiatric word can be crippling, particularly if the ward is under-resourced. On my local ward, there was Occupational Therapy on a few mornings and afternoons a week. Aside from that, there were a few art materials on the ward, some jigsaw puzzles, a handful of ancient books, a pair of straighteners and a box of nail varnishes for ‘beauty’ activities and the TV to keep busy. Most of the day is spent sitting around doing absolutely nothing or watching daytime TV. Hospital isn’t fun at the best of times, but when you’re in a shitty place mentally, the lack of anything to do can drive you mad(der) and give you too much spare time to think and dwell on things. Time just…crawls.
15. Under-resourced/understaffed- there’s been cuts right across the NHS and the mental health sector is no different. Cuts mean increased pressure on mental health beds, less money for resources, and increasing staff shortages- all of which can impact the quality of care received in an inpatient setting. Pressure on beds= push for discharge before patients are ‘ready’, fewer resources= no activities available or things to keep patients occupied (particularly during evenings and weekends), no therapeutic groups, no individual or specialist therapy; staff shortages= fewer staff available for 1-1 chats or 1-1 observations, staff spending more time doing paperwork than with patients, staff escorted activities (like walks, using the ward gym or pool table) can’t be facilitated, delay in things like dispensing medication, staff are stressed/overworked/don’t get breaks etc, which can further lead to a decline in quality of care or an increase in mistakes/accidental malpractice. I guess that there’s a bit of an assumption that hospital care= better care, which is inaccurate. As an outpatient, I’m engaged in a far wider range of services and treatments than I was in hospital, and being around staff 24/7 as an inpatient by no means meant you received more support- staff were often busy, and they had other patients to look after too. Obviously things will be a little different between private and specialist inpatient services, but generally speaking, there are huge pressures on acute mental health beds, and those pressures can affect the quality of care and in some cases, can result in negligent or even damaging treatment for patients.
16. IT’S NOT A QUICK FIX!- Oh. My. God. I just want to scream this from the rooftops- inpatient will not cure you! Again, speaking from an acute ward perspective, inpatient treatment is for the acute treatment of mental illness. It aims to get you up from rock bottom/reduce psychotic symptoms/stabilise your weight or vitals/bring you down from a manic episode/sort your sleep out etc etc. It will not magic you better from your mental illness, but it will (or should) alleviate the worst of your symptoms and get you to a level where you can function in the community and better engage with the help offered to you there. X days/weeks/months in hospital is not enough time to unravel sometimes a lifetime of distorted thinking patterns or damaging behaviours, The idea that hospital is exactly what you need to get better can be really harmful- it raises your hopes and removes from you YOUR role/responsibility in getting better. People get better without ever stepping foot on a ward, and there are people who’ve spent years on wards who haven’t gotten well. Inpatient treatment is not a prerequisite for a long, happy recovery.
17. It’s a false/artificial environment- same way hospital isn’t enough time to work through all the reasons why you are the way you are, it isn’t the right or fair place to do so anyway. Recovery from mental illness can sometimes take years, and keeping someone in hospital for that length of time can be damaging. Psychiatric wards are bubbles. You get shut off from the outside world, from your home routine, from friends and family and your life put on pause. A ward isn’t ‘real life’, so all the coping mechanisms or new skills you learn through treatment can’t be put into proper practise- learning and applying these skills in the community will give you the best chance at a successful recovery. Secondly, it’s easy to get sucked in to life on the ward and forget about the ‘real world’. Being in hospital can be quite suffocating- you’re living in close proximity with a bunch of new (unwell) people and are under constant watch by medical professionals. Pee on the toilet seat, no orange juice left in the morning, someone taking your washing out of the machine, the doctor changing your ward round day without telling you. Little, irrelevant things get blown up way out of proportion and towards the end of my last admission, I found myself getting far more worked up about petty things on the ward than I was about ‘real life’ things, like my degree. Shielding you from ‘real world’ responsibilities can be helpful for brief respite, but it’s not a viable long term solution.