A random comment recently about mental health professionals and my views towards them has led me to think about my reaction towards those mental health professionals I have come into contact with over the years. When I first accessed mental health services as a young adolescent I viewed the staff I met as an out-patient as being somewhat important and aloof, but today after years in the system my attitudes have changed.
As an adult I have accessed both in-patient and out patient services, crisis intervention and assertive outreach alongside psychology services. My views are based upon my encounters with the professionals I have met along the way and whilst some have been friendly and accessible, others have utilised authority and control. It is this control that I think has led to my changing views, I no longer see medical professionals as just aloof but often depending on the individual as uncaring, unhelpful, interfering, misunderstanding, judging and most all controlling. I know I am sadly not alone in my views and that causes me some concern, when after all the reality is that these very same people are deemed to be there to help someone like me with mental health issues.
Why has my attitude changed so much, from being the compliant patient to the person who probably now is seen as a bit of a pain in the backside, as I will exercise my rights to raise concerns, expect a certain level of service and insist on being treated as an equal. Yes that’s right an EQUAL.
I think the reason is quite simple, the power imbalances I have encountered along my journey have led me to no longer be so willing to just roll over and take being treated like a third class citizen, one without rights, views or opinions.
It is only within Mental Health that you will encounter healthcare professionals with the power to take away another human being’s liberty, to decide what they do, when they do it, how they do or even where they reside. The Mental Health Act gives this group of health staff more powers than most and it means that people like me can be treated with force, against their will and in a manner that at times is down right degrading.
During my first admission I was an informal patient, and yet deeply distressed I left the ward, my intent was to commit harm to myself, I realise that the healthcare staff had a duty to look after me, but did that have to involve chasing after me in a vehicle across the hospital grounds and onto a neighbouring hospital site as if I were a fox being hunted. Did they really have to restrain me with force, when I would have accepted that I needed to return back to the ward. Did I really need to be forced to take medication against my wishes and then placed on a Section 4, put on 1-1 obs, and treated in a totally degrading manner. I was watched going to the bathroom, the staff who sat observing me; many of whom were random strangers to me, didn’t engage nor did they make any attempt to understand why I had wanted to leave or the pain I was feeling.
Over time and a number of admissions these experiences got even worse and I have endured being held in a locked room, never mind a locked ward. I have faced being injected with medication, held face down and restrained so forcibly that I was left with bruises. I have had every ounce of dignity stripped away as the power imbalance that exists has allowed them to deny me not only my freedom but the right to make even simple decisions. I am left feeling as if at times during my encounters with healthcare staff all rights to humane treatment were taken away.
When I was a sectioned patient and placed on my one and only Section 2, I was placed in a high dependency unit for short periods on more than one occasion, I was often nursed by male staff more like bouncers, who seemed to be deployed from the male ward to deal with the so called ‘problem’ female. I wasn’t allowed the right to even a hot cup of tea, no only a tepid one , yet I have no record of being aggressive towards any staff so cannot to this day comprehend why. I wasn’t going to throw it at them that’s for sure. I wasn’t allowed access to many of my things, I was held in a small area of confinement and treated as if I was just a trouble maker, again there wasn’t any kind of what I would call treatment, no one seemed to do anything except ply me with medication.
When I was held on a Section 3 the power imbalance allowed these same staff the right to determine where I would reside, and the type of unit that would be. They sent me miles from home to a private facility which last year failed its care quality commission inspection, there the treatment got even worse and I wasn’t allowed the right to even walk alongside the very people who were tasked with my care. My therapy sessions were through a series of locked doors and I couldn’t leave a session even if I wanted too. They could control whether I was allowed in my room unaccompanied, what times of the day I could access my bed, they forcible restrained me, refused me access to fluids and phone calls home. They had control over my possessions, even my toiletries and they determined whether I could use a bathroom with any ounce of dignity at all. They tried as best they could to prevent me from studying in the unit, because it meant that a tutor from the Open University would have to visit once in a while. It took a lot of pressure to be allowed to study, which is something that is still regarded as a basic right afforded to many prisoners, just it seems not mental health patients. They also observed all of my family visits, searched every object I was given and denied me access to many things my family brought me. these weren’t harmful objects just simple things like objects of clothing, flowers, and a radio to name just a few.
The power imbalance is huge for patients especially those on the wards, for more than 60% of my time as an inpatient I have been informal. I have only had one rather long hospital stay as a Section 2 and than 3 patient, but even as an informal patient my rights were stripped bare, the staff controlled the times we could have hot drinks, what time we went to bed, what times the TV was on, our meal times, our visiting times. I have been in locked wards as an informal patient, and still denied the right to leave without any justifiable reason or the legal support of a section to detain me.
The power imbalance wielded by psychiatrists and mental health staff against me has left me no longer the compliant unquestioning patient I was on my first admission. I now have higher expectations of the staff even those in the community, I don’t try and cause issues indeed I want to work with these professionals.
But my experiences of the power imbalance within psychiatry has left me scarred, it has also left me suffering trauma from some of the encounters, as someone who has suffered childhood trauma the impact of being held against my will in hospital whether sectioned or informal was terrifying, especially when during that time there were periods when I was forcible restrained, medicated and more.
Whilst I understand that staff need to have some degree of responsibility and authority when dealing with patients, how they communicate this and explain this difference can magnify or minimise the impact of this imbalance of power. Perhaps if staff were able to step back and think for one moment how their actions would feel to them if they were in the patients position, then maybe there wouldn’t be quite so much oppression or wielding of power. Maybe its time for there to be a reassessment of the power imbalance.
Copyright DID Dispatches 2014