Life in a Psychiatric Ward - Bipolar Disorder
I have been admitted to an acute psychiatric ward nine times in two years, which meant I was hospitalised for most of this period of time. This was between 2013 and 2015.
My first admission to hospital was in October 2013. During my first admission, I was manic and I was very elated, therefore, I was not afraid of being admitted to hospital. Like every hospitalisation I have had, I was assessed by a psychiatrist on admission. During assessments, I was always asked very personal questions, which, depending on my mental state, were either very easy to answer or very difficult to answer. By this I mean, if I was elated I would be excited about answering the questions but often went off topic, if I was psychotic I would struggle to speak to answer any of the questions, or if I was depressed I would often be crying too much to answer coherently.
During the first 24 hours of all my hospital admissions I had all my private property removed including my phone, laptop and anything that posed a danger to myself. At first assessment, the psychiatrist would decide if 24-hour observation was necessary for reasons such as suicidality, psychosis and so on. When under 24-hour observation a nurse would constantly be with the patient.
I have been under constant observation on many occasions for suicidality, psychosis and manic aggression. During observation, I would not be able to use the bathroom by myself, I would not be allowed to shower by myself and at night a nurse would be at the bedroom door the whole night assessing me. With a mental illness, I have often suffered with paranoia in the sense that I believed people were watching me or talking about me. Under observation I was literally being watched all the time. This made it extremely difficult to sleep at night. I believe it would be difficult for anyone to sleep at night while being watched, let alone someone with paranoia and sleep problems. I will note here that sleep deprivation causes a lot of problems for someone suffering with a mental illness. You lose a lot of your dignity when under constant supervision, however, in many instances it was entirely necessary.
I have been in hospital over birthdays, public holidays and Christmas. I was not even allowed pass on Christmas day to have dinner with my family. On Christmas day one year, there was an exception made which meant that my children could visit on Christmas day to open their presents under the tree on the main ward. I much appreciated this decision by the head psychiatrist.
During my first admission to hospital it was a long time before my inpatient psychiatrist allowed me to have accompanied pass out of the ward. I was terrified to leave as I had been in the ward so long without leaving. I called this the Shawshank redemption complex. It was as if I had already became slightly institutionalised at this point even though this was during my first hospitalisation.
Institutionalisation involves harmful effects such apathy and loss of independence arising from spending a long time in an institution such as a psychiatric ward. This has been the case for me as I feel institutionalised in certain aspects, and this was particularly bad in the past. I lost all my self-confidence, ability to do daily tasks for myself such as cleaning and cooking, even though this was addressed in occupational therapy, and I still to this day suffer with social anxiety, which, I believe, in part, stems from being institutionalised. I am also not used to being alone so am unable to sleep when alone as I become afraid, as, when in hospital, I was never alone. I was so used to spending most of my time in hospital in a bay with the curtain closed or in my own room (which was normally the case due to the severity of my episodes of bipolar disorder) that even today my bedroom is my safe place. I find it difficult even today to leave the house. However, in terms of carrying out basic tasks such as cooking and cleaning, have improved drastically over the last two years or so. I do not resent having been institutionalised as I really was so unwell that all my hospitalisations, voluntary or not, were completely necessary for not only my safety, but also the safety of others.
In most cases I got on well with most patients, and still to this day I have friends that I met in hospital, who I am in regular contact with.
I witnessed a lot of incidents regarding other patients during my multiple hospitalisations. I witnessed patients being thrown to the floor to be restrained (which has also happened to me), I witnessed patients coming back after ECT in a wheelchair completely out of it, I witnessed patients being dragged by nurses to their rooms, I witnessed patients smuggling cannabis onto the ward after day pass, I witnessed patients being locked in their room screaming for help as there was a lack of nursing staff to deal with their needs. I have had severe depression in hospital in which I was screaming and crying in unbearable pain, but I have also heard the screams of others in the same situation which is heart breaking. I have seen nurses and patients being attacked by other patients. I met a lot of people who had been through a lot of trauma just like myself. My friend in the ward had attended accident and emergency trying to seek help as she suffered with borderline personality disorder. She was told that they could not help her so she ran to the roof of the hospital and jumped off the roof breaking her back. She had been an all-Ireland runner which she will never be able to do again. Some hospitals still do not take mental health seriously which is demonstrated in this case. An example in my own case would be when I overdosed and had kidney failure. When I was physically well again I was discharged from hospital with no admittance to the psychiatric ward on this occasion. However, I was hospitalised several days later for another suicide attempt.
On one occasion, I escaped from hospital during a period when I had been sectioned and had no day pass whatsoever. I was extremely agitated so I wanted to leave the hospital. However, the doctors would not allow this due to my mental state. I was extremely underweight so I knew that I could fit out of the small gap when my window was opened. While the nurse had gone to the clinical room to get me some medication to calm me down, I seen my opportunity, so I went out the window determined to walk fifteen miles to get home. However, I was stopped by the police who brought me straight back to the ward. When I got back my bedroom window had been locked and I was still extremely agitated so I pulled the blinds off that covered the window and kept kicking the window to try open it again. Then my room was flooded by nurses. I was pulled to the floor and restrained and given an injection in my bum. Still to this day I do not know what they injected me with. The injection did not work, as they hoped it would sedate me, however, it did work after about eight hours. I was put under observation while I was running around my room screaming and pulling my hair out of my head in severe agitated mania.
Whether I was under observation or not, I would be seen daily by my named nurse to access my mental state, and assessed weekly by the multi-disciplinary team including a psychiatrist, junior psychiatrist, care coordinator, named nurse, social worker and an occupational therapist. I always found these meetings to be quite daunting as I did not like being in a room with so many people staring at me due to paranoia and anxiety, and this team had control over what would happen to me in terms of release, medication and observation. Each day became quite monotonous: I would cue up for medication four times a day, breakfast, lunch and dinner were always at the same time and attendance of occupational therapy was the norm. Weight, food and fluid intake were also monitored each day.
Occupational therapy became a break from the monotony of routine and being locked up. In occupational therapy, the activities were usually art based and cooking for rehabilitation. I am a very creative person, so when I was in the right state of mind I really enjoyed it. When I was very depressed I would not attend occupational therapy, however while manic I was never out of it and I would continue doing multiple tasks at once even when occupational therapy was over. Furthermore, once a week a therapy dog would come into the ward. I really enjoyed this and it would lift my mood especially when I was extremely depressed.
I would like to mention that, in a sense, there is not really any such thing as a voluntary admission. You can voluntarily admit yourself to hospital, however, you cannot voluntarily discharge yourself from hospital. It is the psychiatrist’s decision whether you can leave the ward or not. In many cases the admission itself may be voluntary, but it is a choice made in the sense that, if you do not go to hospital voluntarily, you will be sectioned. This has happened to me on many occasions, and in these instances, I always agreed to go in voluntarily unless I was extremely manic.
All in all, I have, although institutionalised, benefited from my hospitalisations. When you are in a psychiatric ward you are assessed all the time. This lead to me receiving the correct diagnosis and care that I really needed. I am extremely grateful to my mental health team both inpatient and outpatient, as without their care, I would not be living today.
(c) Maria O’Hare