22. Poor discharge planning- a lot of the time, readmissions are caused by poor discharge planning. As an inpatient, I’ve seen A LOT of people back on the ward after a few days-week, and I was once readmitted two days after discharge. Reasons for this can be that people aren’t ready to be discharged in the first place, they weren’t given leave to see how they’d cope at home, they didn’t have any support in place once discharged, they didn’t have the correct support in place once discharged, discharge was sudden or unplanned, medications prescribed or treatment plans weren’t sent to community services or their GP, family members weren’t notified, people being discharged without having a safe place to go. Top of my head I can think of two patients I met that were discharged, attempted suicide, and were back within days. I know someone that was discharged within two days because she didn’t agree to having ECT (the fact ECT was being offered surely suggesting just how vulnerable she was?). The time I was discharged and readmitted two days later, I spent another five days on the ward- and five days was all it took to get me feeling better. There was one woman who asked if she could have extended leave over a long weekend to make sure she felt well enough to go home. She was told no, that “another three days won’t make a difference”. She was readmitted a couple of weeks later. You see it all the time as a patient- doctors discharging people that shouldn’t be discharged because they’re still symptomatic, they have nowhere to go or the support they need in the community isn’t in place for them.
While not mental health specific statistics, a 2015 YouGiv poll found that 1 in 5 people discharged from hospital over the previous three years felt they didn’t have the social care support they needed on discharge. 1 in 8 felt unable to cope at home following discharge, and in 2012-2013, within 30 days of discharge, there were more than a million emergency readmissions- which no doubt could have been prevented or mitigated with proper discharge planning.
23. Stigma!- I cannot begin to explain how stigmatised I felt walking onto my local mental health ward for the first time. I’d grown up hearing ‘jokes’ about ‘the mental’, how “this would send you to [name of hospital]”, how “I’ll be ready for [name of hospital] after this”. We’d drive past the ward as kids and my friends would whisper and point and say “that’s where all the loonies go!” I felt ‘Proper Crazy’ then, walking onto the ward. I was embarrassed, ashamed. It broke my heart when my little sister came to visit and said “this doesn’t look like a hospital”, made me wince when I corrected my BFF when I told her I was in hospital and she asked “You in [name of general hospital]? Can we visit?” It was horrible having my extended relatives find out, I felt embarrassed when they came to visit. In later admissions, I tell my manager I’m in a “head hospital” when she asks what’s wrong, too mortified to say PSYCH WARD out loud. My work friends are desperate to come visit, I ignore their messages. When I’m back at work, I listen to more ‘mental hospital’ jokes, day in, day out, and force a polite smile. I found psychiatric hospitalisation incredibly stigmatising. I leaned, of course, that it can happen to anyone- even me, that psychiatric inpatients could be anyone you bump into on the street. But it’s like, you feel the stigma.
There were no punnet of grapes or bunches of flowers beside people’s beds. The cards people gave me said things like ‘a big hug’ or ‘you’re loved’- there were no Get Well cards on my bedside locker. And it was all pretty hush hush- not that I wanted everyone to know, but I was lying on the phone to my grandparents who weren’t told and when my auntie came to pick me up from the ward for leave, she’d told my cousin she was picking me up from work. So while I stigmatised myself, unknowingly, my family were doing it in little ways too.
24. Miscommunications and being ‘fucked over’ (told one thing one day…)- being a patient it’s often ‘your word against theirs’. I remember one Sunday planning with the ward sister what I was going to ask for during ward round the next day. We decided it would be sensible to ask for a few hours leave. She told me I’d be in hospital until I was well. The consultant was off the next day, so during the next ward round on the Thursday I assumed I’d be asking for the same things. Only the consultant told me I was being discharged that day. The nurse that was in with me insisted that the consultant had told me this during our last ward round and told me I “knew it was coming”, which he hadn’t and I didn’t. And there was the time when the consultant told me I wasn’t depressed and didn’t need antidepressants, a nurse shouting “he said WHAT” when I told her. Then the next week he put me back on antidepressants and had a go at me for spending the week in bed and telling me I was in hospital to fight “this depression” (the depression he’d told me the week before I didn’t have…)
And it’s little things too. Complaining about tossing and turning the night before for the doctor to say “but the report said you slept well”, being told “but you said X” and having it held against you (and knowing you didn’t, someone had taken what you actually said out of context), doctors forgetting to write you up for PRN they said they would, doctors taking you off PRN despite having needed it every day, doctors and nurses forgetting to write things in your care plan or make notes of requests so when go ask to go on leave or to do something the duty doctor has to be called over to reassess you for something that had already been approved, or a nurse forgetting to call you for meds, telling them this an hour or two later, then asking for leave the next day and being told “but you refused your meds last night”. When everything you do is charted and observed and written up, if there’s mistakes or miscommunications or things are misinterpreted, you as the patient are the one who gets fucked over
25. Feeling like you don’t belong- I’m not sure how common this is, and it’s not necessarily exclusive to hospitalisation, but sometimes, and particularly when I was in hospital, I felt ‘left behind/left out’, and like I didn’t belong anywhere. I felt like this a lot on leave. Walking down the street or popping into shops or restaurants- I felt like everyone that passed me would know I was on leave from a psychiatric ward. I felt like there was a big neon sign above my head telling everyone so. I guess the feeling of being isolated from your community and missing out on things and watching your friends or family getting on with life can be a little hard. In hospital I just felt like I didn’t belong anywhere- hospital wasn’t ‘my’ life, the nurses weren’t going to be there forever and I could’t stay there forever, but my ‘home’ life didn’t feel like mine either anymore