Content Notes: discussions of self-harm and suicide, detention under the MHA
In 2009, six weeks into my first term at university, I was sectioned. I was driven from my halls of residence by a mental health nurse, and admitted to an acute psychiatric ward in the nearby city. I was 18, 200 miles away from home, and terrified. Like many people, I had never seen inside a psychiatric ward, and this empty space in my imagination was filled with images from popular culture – some terrifying blend of One Flew Over the Cuckoos Nest and Girl, Interrupted. That night, I refused to lie down in my bed, propping myself up in the armchair in my room and trying to stay awake. The next day I refused to leave my room for breakfast and lunch. When the nurse knocked on my door that evening, I didn’t even acknowledge them.
‘You have a visitor‘
I followed the nurse through the corridor to a tiny box room where my flatmate Tom was awkwardly crouched on a low hospital chair, clutching giant bags of mini milky ways and mini mars bars. He beamed at me with his lovely stupid face.
I had only known Tom for six weeks, and whilst we were friends we weren’t terribly close at that point. He was one of twelve flatmates in our campus accommodation. We had similar tastes in music, but where Tom was open-hearted, had friends and involved himself in university life, I was struggling to cope, and collapsing in on myself to form a black hole I didn’t know how to get out of.
When Tom came to visit me, he showed me that I wasn’t forgotten, that there was some part of me that existed outside of all of this. It was a brave thing for an 18 year old to do for someone he’d only recently met.
Drawing from this experience, my experiences of hospital since, and my experiences training as a Peer Support Worker (someone who goes back into services to support other people) I’m going to talk a bit about the things that were helpful and important to me. It can be scary if someone we know – a friend, a flatmate, a family member, someone on our course at uni or college, someone we knew from back home – is having mental health challenges and is sectioned. A lot of this is because mental health services and wards feel like very closed off places, and not many people have experience of them. Unlike physical hospitals where you may visit a relative as a child or end up in A&E with a broken arm, psychiatric hospitals often remain a mystery. I’m so grateful to all of my friends who visited me in hospital, who never let me go. I feel beyond lucky to have had these people in my life, who braved unknown places and reached across awkward silences.
Being sectioned is a phrase that is used to mean being detained under one section, or part, of the mental health act. The mental health act is there to make it clear when doctors or other professionals have a responsibility to keep you safe, even if it means denying you some of your basic rights – like your liberty. Its a long formal document because it needs to be; taking away someone’s freedom shouldn’t happen lightly. There are lots of different sections but I’ll quickly cover the two most common – Section 2 and Section 3. Under Section 2 of the mental health act, a person can be admitted and held on a psychiatric ward for observation, diagnosis and some types of treatment for up to 28 days. Under Section 3, a person can be admitted and held on a psychiatric ward for treatment for up to six months, although this can be renewed. These ‘sections’ are only used if a person is considered to be a high risk, normally to themselves, and they are not willing to go into hospital voluntarily. There are lots of reasons why someone might be unwilling to go to hospital – its a scary and unknown thing, they have to give over a lot of their control, they might not trust doctors or nurses, or feel like what they are going through needs to be treated medically, or they might not be able to see how bad things are, or that there is hope for them to get better.
Being sectioned is not normally very dramatic. It takes two doctors and a mental health specific social worker. For me, the first time, it happened in my tiny student room and, given that the social worker was some kind of giant and that the university chaplain happened to be there at the same time, gave it a surreal, oddly comical, vibe. There were no strait jackets. Other times, I’ve been sectioned when I’ve already been in hospital – because I wanted to leave and they didn’t think I was safe to, or because doctors have less control over things like whether you take medication if you’re a voluntary patient.
All of the mystery around being sectioned, with the gaps filled by its dramatic portrayal in movies or TV, has real negative consequences. For a start, being worried about being seen as ‘mad’ and being ‘locked up’ can make people less likely to seek help earlier on when they are less likely to be admitted. It can also mean that people become even more isolated, not just because of their mental health challenges but because of their contact with mental health services. Part of the reason I’m writing this article is at the suggestion of my fiancee. Before she met me, she said, she’d never knowingly met anyone who’d been sectioned and assumed it only really happened if you were really dangerous or out of control. Sure, sectioning can be loud and dramatic, but it can also be quiet and sad. It made me feel small and scared and powerless. It made me feel profoundly different to my friends. It made me feel alone. This is why it is important to normalize mental health care and hospitals.
So, here are five things you can do to support your friend if they are in hospital:
Visit or Stay In Touch.
The idea of visiting hospital can be scary. If you find out what ward your friend is on, you can call to ask about visiting, or look up the visiting hours online. These will often be in the early evening (between dinner and evening meds) on weekdays and for most of the afternoon (between lunch and dinner) on weekends. You can also ask them if there is a good time to visit – for the first few weeks of being in hospital I found it hard to see people for more than an hour, and generally preferred if they were there early. In hospital, everyone is on different levels of observations and leave. Sometimes you have to have a nurse or HCA within arms reach of you at all times (yes, including when you pee), sometimes a nurse or HCA has to be watching you, and generally everyone on the ward is checked every hour. Some people are able to go off the ward on their own, for a few hours or overnight (if they are close to being discharged), some people have to go with another person (like a friend or a family member), some people are only allowed out with a nurse and some people aren’t allowed out at all. I really appreciated when my friends were willing and able to take me out – we would often walk to see the snowdrops in the grounds. But, its important that you feel comfortable with this – its better to be honest and upfront about what you’re worrying about. I appreciated the trust of my friends when they took me out, and I also appreciated when they articulated their limits.
Depending on what kind of ward your friend is on, you may sit in the communal space on the ward like the dining room or outside in the ward garden, you may sit in a private visiting room on the ward, or, if its a secure unit, you may meet them half way in a room that’s separate. It can sometimes be a bit chaotic or stressful, but it can also make for some funny stories. One time my friend Evelyn came to visit in lounge wear (pajamas) that she’d spilled curry on before she left the house. I left to go back through the doors to the ward, and Evelyn went to find someone to let her out. A HCA, who was an agency worker, looked her up and down and took her to the nurse in charge to make sure she didn’t actually belong on the ward and was trying to abscond.
It’s OK to acknowledge the ways that hospital is scary. Psychiatric wards are there for people when they are very distressed, so sometimes there is shouting, screaming, crying. Sometimes people are restrained by nurses, sometimes I was restrained by nurses. There are procedures and processes and rooms that are off-limits. Especially when wards are understaffed, filled with agency staff no one knows or something has disrupted the routine, the ward can feel very unsettled. You don’t have to pretend like nothing is happening. Once a (terrible) hospital manager insisted on sitting us all down to read a children’s book by David Walliams, ignoring the alarms, and that either end of the corridor the sparse staff were trying to restrain two of our peers who were very distressed. It was absurd and disrespectful.
At the same time, remember this is where your friend lives at the moment, and once you leave these are the people they live with. When people make judgements, make fun of, or try and ‘other’ my peers in hospital, I feel incredibly uncomfortable. Once, a customer at the cafe I worked at overheard a conversation I was having about hospital and told me it was so good I worked ‘with those people’. I had to pull her up, and tell her ‘I am those people’. Even if we don’t have a friend in hospital, we can all think about the way we talk about things, the memes we share, the things we find funny, and how they may create a distance between us and those with mental health challenges and lived experience of psychiatric hospital.
Sometimes you can’t visit. Increasingly, people are sent to hospitals a long distance away from where they live because of cuts to mental health beds. Or you may have a hectic work schedule or other caring commitments. If you can’t visit it’s still important to stay in touch. Sometimes it felt like people didn’t know what to say, or didn’t want to send me trivial stuff. But it was important to me that someone, somewhere, remembered me as a whole person, and saw that there was more to me than this. In hospital you can sometimes feel reduced to your mental health challenges. Just being tagged in a post made me feel like I still existed, like I wasn’t forgotten, like other people had hope for me, had hope that things could be different. A facebook message, a text, a phone call, sending your love through a mutual friend. It’s all small things to hold onto.
I spent a lot of my time in hospital ranting about needing to get out. Instead of trying to persuade me to feel differently, which is what all the doctors, nurses, and HCAs were already doing, my friends sat with me through those feelings. Everyone has the right to appeal their section if they feel it was wrong and they should be allowed to leave. Sometimes focusing on this appeal process was helpful for me, and sometimes it wasn’t, but the important thing was it was something I was in control of. It can be really hard watching someone you care about struggle with mental health challenges. But remember, they are in a place where everyone has ideas about what is best for them, and nobody is necessarily listening to or prioritizing what they think they need. It may be that they are having strange or unusual experiences, or hearing voices, that are dismissed as ‘symptoms’. Listening without judgement, and validating their experiences is a great way to stay connected to them, and let them know that you accept them as they are.
I think it is pretty much impossible to really understand what it feels like to be denied your liberty – no matter how ‘benevolent’ the reason – if you’ve not been there. It left me feeling truly powerless – hopeless, angry and frustrated. It was important that instead of trying to justify my being in hospital, my friends sat with me through it. It didn’t matter if it was the best place for me, it still hurt and I needed them to see that. I needed to feel they were standing by my side. Sometimes this is about just being present with your friend in that moment; instead of thinking about everything that led up to them being in hospital focus on validating what they are feeling now. Validation isn’t the same as agreeing – its about acceptance, about not trying to persuade them otherwise, about saying ‘I hear what you are saying, I see you, what you are feel is real’.
Look after yourself
It can be really hard having someone you care about go into hospital. Sometimes it can be a relief that they are being looked after, sometimes it can be terrifying if you feel they’re not being looked after well enough. Sometimes it can be very tiring to have the same conversation over and over again, or listen to their unusual beliefs. Sometimes it can bring up things around our own experiences with mental health challenges. Its important to remember to access your own support, and to look after yourself. Be realistic about what you can do and practice self-awareness and self-care. If you’re going to visit someone in hospital, try and anticipate how this might make you feel – sad, angry, upset, stressed, triggered, vulnerable, ashamed, relieved, embarrassed, exhausted. Think about how you will look after yourself afterwards. Think about visiting with a mutual friend. It can be hard when someone we know feels like a different person, expresses beliefs or has experiences that seem strange and unlike them. Again, it can help to stay in the present, to try and meet your friend where they are now and to hold hope for them – that things can be different, and that their life isn’t this hospital. Don’t carry this all on your shoulders – it was really reassuring to me when my friend’s reached out to each other for support because it meant I could see the ways they were looking after each other too.
You can also acknowledge the different ways your friend can support you too – good relationships are reciprocal. This doesn’t mean they have to give back in kind; they may not be able to offer the same sort of emotional or practical support you are giving them. But celebrate and value the ways that they can reciprocate in that moment (I used to like to do drawings for my friends who visited, or listen to them talk about some drama at work) or the ways they have throughout the course of your relationship. If you start to feel like you are keeping a tally, take a step back and think about whether you are taking on too much responsibility and whether there is a way of regaining balance.
Often, I’d end up in hospital with only the clothes I was wearing. I relied on my mum and my friends to bring me things that I needed – clothes, slippers (I often wasn’t allowed my shoes as they had laces), toiletries, books, cigarettes. Before you visit ask your friend if there’s anything they need. If there isn’t, you could bring them something you know they like, something to do, or just a nice card. It is worth checking with a nurse when you arrive that it’s OK to give them something – some wards have particular rules about what is/isn’t allowed (this is especially true on secure units or if your friend is really struggling with self-harm, disordered eating or suicidal feelings). You definitely can’t bring sharp objects, glass, alcohol or drugs onto the ward. It can be hard to say no to something if your friend asks for it, but remember you are risking the safety and well being of everyone on the ward by doing so. Avoid large plastic bottles or plastic bags as well. Some wards don’t allow people to have their own cigarette lighters. Things I really appreciated were: books, notebooks, pens, DVDs (my friend Amy lent me the whole Planet Earth), cigarettes, cosy slippers, postcards and photos, and, sometimes, food and sweets.
Don’t Disappear after Discharge
You don’t go into hospital ill and come out well. Sometimes you are discharged before you feel ready, sometimes you feel ready but then the world comes flying at you and you’re not so sure. Coming out of hospital into a world of laundry, important letters, away from a familiar structure, can feel overwhelming. Checking in with your friend, understanding they may still need some support, offering practical and realistic help is all important. Think about your discomfort, and don’t allow the time they spent in hospital to become the big unmentionable.
Fear, stigma, shame; they all feed on silence. They fill the gaps in our knowledge, the absent places in our maps. Psychiatric hospitals are closed off buildings, uncomfortable pauses, glossed over or unmentioned. When you’ve been in one as a service user, they can be hard to talk about. One of the reasons the service user and survivor community is so strong, and the relationships you form in hospital often so powerful, is because it can be hard to describe or explain that experience, that place. One of the things I find most difficult is that my fiancee didn’t know me when I was unwell, she’s never been on a psychiatric ward, never seen one. I can’t just take her to a ward and say ‘this was my room’. I can’t return to these spaces: you live there, but you have no ownership of the place. I no longer have access to them either. Talking about them helps open them up. The more I share my stories, the more people who visited me in hospital who aren’t afraid to say ‘I’m visiting my friend who’s in a psychiatric hospital’ or ‘I’ve visited a psychiatric hospital before, it wasn’t so bad’, the more portrayals that deal with the complexity of mental health, the more we see being sectioned as something that happens, often quietly, to our neighbors, to our friends, to ourselves, the more we can challenge the fear and challenge the stigma.