26. Institutionalisation- this one is HUGE. It was within my first two weeks on the ward that I learned just how easy it is/would be to become institutionalised. Often, when hospitalised for mental illness, patients have little or no structure in the ‘outside world’, living a life completely consumed or controlled by their illnesses. In hospital, routine is somewhat forced upon you- fixed meal times, med times, activity times, smoke times, bedtimes, getting up times. It’s very easy to fall comfortable with that routine, and very easy to fall out of it once discharged and you no longer have people encouraging you to stick to it. There’s a risk that by hospitalising people, thereby ‘focusing’ on their mental illness, it more easily becomes their identity and in some cases, can make their illness worse- two things that make it harder to ‘reintegrate’ back into society once discharged. A further issue is that hospitalisation removes a person’s independence for a period of time, takes away their responsibility for managing their illness in the community and can decrease a person’s social or life skills- as their life is now confined to a hospital ward. Skills learned to manage their illness are taught within a restricted environment, and it can be harder to apply these in the ‘real world’ where it is less safe and people are exposed to different triggers. For some people, hospital can be a place where they receive care and support that they never had at home, and so adjusting to discharge can be further complicated by a poor support network at home.
All of these things can lead to a reliance on the hospital system. One nurse told me during my last admission that she doesn’t think anyone should be kept locked up on an acute ward for weeks or months at a time. Another said that it hits a point where it becomes unhelpful, and that people reach a certain stage in recovery where leave from the ward and beginning to link back in with ‘real life’ proves far more beneficial for a patients recovery- something I experienced myself in my final two weeks there during my last admission. (Of course, it’s a little different for specialised or rehabilitation units, where there is more of a focus on regaining independence.)
27. Becoming a revolving door patient- this can be linked to institutionalisation, but I’ve found that since first being admitted to hospital, outpatient services far more readily turn to hospital admission to get me through a crisis or for stabilisation. Before being admitted, I’d be asked if I’d ever been in hospital, and when the answer was no, they’d look into alternative solutions. After having been admitted, my CPN, psychiatrists, duty officers and out of hours teams were all far more willing to readmit me, often saying “the girls on the ward know you/you got on well there the last time.”
Back on the ward, I see the same faces time and time again. During my last admission, one patient was admitted, discharged and readmitted four separate times. During my second admission, there were four of us who had spent summer on the ward together a few months previous- all of us had been readmitted. And I can still remember what the patients told me on my first day of my first admission: “don’t make this your life wee girl”, suggesting that that is easy done. In Ireland, 70% of all inpatient admissions are readmissions. Which is a lil scary! Heaps of people are never readmitted, but for some- for a host of different reasons, revolving door syndrome can become a reality
28. Other lil things- there’s a couple more things I thought were worth noting. Favouritism can be a real issue- I was always aware that the nurses had little nicknames for me or made me cups of tea in the middle of the night or let me watch TV past lights out and worried about how that might make others feel (once or twice other patients did mention it). One time there was a patient that the ward sister was fond of, and even when said patient blocked one of toilets on the ward, we all got a telling off for raising the issue and told to “remember where we were” while the patient got off scot free and carried on what she was doing. (Which is fair enough, but later, she blocked ALL the toilets and we had to use the staff toilets the rest of the night, at which point night staff stepped in and told her she was behaving inappropriately).
Circumstantial admissions meant that sometimes people weren’t necessarily in the right place for them- for whatever reason. There was one patient that was in the bed next to me (that was in for something circumstantial) and would make endless phone calls to her friends/family telling them that “the people here are just…you know…” as if she was surprised to find sick people in a hospital.
Acute wards aren’t recovery orientated, so treatments tend to be medication, stabilisation, discharge, so the idea people have that hospital will give you the tools to start recovery isn’t always the case!
And hospitalisation is very isolating– obviously you’re away from friends or family. During my last admission there were two out of area patients, one that had no visitors the entire time she was there, and another who was there a week before her mum was able to make the 3hr round trip to see her. Sometimes even when F&F can visit, you don’t want them to- either because you feel too low or don’t want them to see you in this state/this place. And again, it’s little things too- not being able to nip to the shop or leave the ward, or just simply looking out at the cars driving by or staff members coming or going and feeling really, really, trapped
29. It can make things worse- because of all the reasons listed in this series of posts! Hospital admission is drastic, invasive, disruptive, degrading, humiliating, traumatic, isolating…it can be hugely beneficial, of course, and I’ve always taken something positive from each admission and there were occasions where it was 100% necessary. I do sometimes wish though that I’d never been admitted, helpful and all as it’s been. Inpatient treatment is HARD and it’s intense and it’s so, so, so important to get the balance right, because if you’re not there long enough, it can set you back more when you get out, and if you’re there too long, it can very quickly become unhelpful and counterproductive
So there we are- 29 reasons why inpatient treatment is, ummm, pretty miserable.