(In)Secure Mental Health Units

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I have shared about my entry into secure services previously but I thought it might be good to share a little more of my experience.  This experience is why I passionately believe that inpatient mental health services have to improve.

Secure services are unlike anything most people can image, it’s certainly not conducive to recovery and well-being.  To take away a persons liberty is one thing, but to then deny them basic human rights and treat them like a prisoner is another.

There is an assumption that secure units provide safety, safety for the patient who needs something more than a normal acute ward. I would say that isn’t necessarily a true reflection of the safety these units offer.

I transferred from an unlocked open acute ward, where people self harmed,  walked off the ward, took part in negative behaviours and often struggled with low staff levels and limited support. The secure unit for all its locks, security measures and perceived safety encountered many of these things, and while people couldn’t just walk off the ward the levels of aggression were higher.

There are many moments I recall, but some stand out in my mind more than others these blog is about one incident that impacted my view on such units greatly. At the secure unit one day the majority of people were particularly agitated. It had been a day of low staffing and the atmosphere was very tense. As the evening came so did the chaos, the staffing for the ward was just 3 staff and not all of them were qualified nurses.

I remember sitting and reading in the communal area I was still not allowed into my bedroom unobserved, that was a privilege I still had to earn.  Some of the women were allowed in their rooms and one by one they self harmed. This was serious stuff, incidents that needed medical  intervention, there were some who harmed due to being in a distressing mental state and others who just seemed to copy. I’d already realised that for some being on 1 to 1 observation gave them the attention they needed. I personally hated it so couldn’t fathom out why they’d harm to get put on close obs. but they did.

self harm

In the space of less than a few hours I sat as one after the other the self harm incidents mounted up, they brought in a extra staff member from the other wards but even that didn’t stem the tide. As I sat and listened to the staff frantically try and resuscitate one of the young vulnerable women who in desperation had tried to take her life I was willing her to live. Meanwhile patients were attending to other patients who had harmed, there wasn’t any free staff. People were verbally attacking each other and yet the staff who were simply under-resourced were trying to save a life. I remember some of the girls getting very angry with those harming, it was extremely tense and volatile.

That evening all bar 3 of the patients self harmed, and the ward was in utter chaos.  We didn’t have the staffing needed and the ward was anything but safe. Thankfully on that night no one lost their life but it was a shock to listen and see how staff reacted. The on call doctor visited and they brought in another healthcare assistant, I remember thinking how did this happen. I was told I was being sent to secure services as they could provide the safety others felt I needed I realised that was a false assumption. I also realised if I didn’t know already, that  I was not like most of the women/girls on the ward I wanted to get out of there and I wanted my life back.

That night somehow we were given our medication and sent to bed, I was taken off my 1 to 1 observations for that night, they couldn’t have done them there wasn’t enough staff.

That incident has stuck with me through the years, I think perhaps that’s due to the impact it had upon me. I had never wanted someone to live so much as that night, she was a young women the same age as my own daughter.

When I hear today of cases of vulnerable  people being sent to secure units in the name of therapy, or perhaps keeping them safe I think back to that time and wonder  if people realise how much self-harm, aggression and suicide takes place in secure services.

In my time at the unit I know of two deaths within the hospital, shortly after I left there was another these were someone’s daughters, and every week I was aware of more self harming incidents than in any acute ward I had ever been.  There were violent outbursts and attacks against fellow patients and staff, and  someone even  managed to abscond. Truth be known I think if the door of my acute ward had been locked I would have been just as safe there. The problem is we take the terminology and assume secure means exactly that, secure, safe, maybe even supportive; I can honestly say the secure units I experienced were anything but.

suicide wreath

I want to dedicate this blog to the young women from that night, as sadly she died in that unit 6 months later, at her inquest the unit was found to have failed her, low staffing levels was one of the failures identified.   I wonder how many more they failed.

DID Dispatches 2014


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