Forensic Psychiatric Care

Plastic fantastic

Sitting in the back of my kitchen cupboard lurks a cup, one that I haven’t used for a number of years now but still I can’t throw it away. This cup symbolises so much for me, it’s made of melamine, a heavy type of plastic and it is practically unbreakable, it’s decorated with pretty flowers and it would happily form part of a good picnic hamper. Yet this cup has never been used on any picnic, instead it was used behind a multitude of locked doors.

This was the cup I used during my time in forensic psychiatric care, in the secure unit were for over a year I was confined. It was specifically chosen by my children as it adhered to the strict regulations about the type of non breakable cup I was allowed. The regulations about such items were very strict and if your cup didn’t conform you simply wouldn’t be allowed to keep it. On finding it the other day I thought of my time in that place and how dehumanising the whole experience was, you see it’s hard to suddenly be labelled as too unwell or perceived as too dangerous to use normal everyday objects like a china cup.

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The reality of course I now know was that I was sent there because I was depressed and self harming, but the scale and level of my harming was not in anyway as extreme as some of those I met in these places. Yes I cut myself on an almost daily basis in the hope of making the internal pain I was enduring somehow physical or more visible in some way. It was my way of protecting me, because at the time I truly believed that if I didn’t harm myself others would and this way I could control the harm done to me. I did bang my head on occasions purely out of frustration at the way in which no one seemed to understand the horror of flashbacks, of memories and of how I felt. But in all my time of harming I have never used a cup, or a knife, or a fork or any number of other items that suddenly I wasn’t allowed in this place to self injure. Nor had I ever harmed another human being, so I wasn’t dangerous in any way, yet in secure forensic services everyone is labelled and treated the same.

I look at that plastic cup and I remember how the so called professionals treated us, how they made me feel so worthless, so pathetic and so very wrong. I left an open unlocked ward and in the time it took to drive 200 miles I was viewed as a whole different person. No longer a free citizen who just happened to be ill, but a forensic detainee who could be barked orders at, denied her possessions and forced to do things whether I wanted to or not.

The forensic unit didn’t treat me as if I was ill, I never felt like a patient who was regarded an equal, no I suddenly felt like a third class citizen who they regarded as bad. In truth I feel they saw all of the women in there as criminals, yes I know many of the women I lived with in that place had criminal histories that had resulted in them being sent there, but not me. Yet these people couldn’t treat us all as individuals we were collectively dealt with in punitive ways.

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Like the cup made of unbreakable plastic, I can recall the lukewarm drinks we were served, and the mealtime chaos of cutlery counts and at times being made to eat meat and vegetables with a spoon. I was thinking back the other day to my first meal in this place and being lined up in a queue to collect my food, spaced out from the person in front with staff all around. When they handed a plastic plate, a spoon and a serving of meat, vegetables and potatoes, I was perplexed. Only that morning as I left my open ward I had sat with a china bowl and had open access to knives, forks and spoons and yet now I sat on a long bench table, surrounded by staff and other patients holding a spoon thinking how do I eat with this? I remember saying I needed a knife and fork, and being told that I wasn’t allowed such items and to shut up, sit still and eat. Yes the staff really were that blunt. My drinks in those early days came in polystyrene cups and I was told I wasn’t allowed a plastic cup until I had approval from the team.

The Team became a familiar part of my life, they ran my life for me after all they were in control, in charge and me well I was just a nobody. I soon learnt that if you challenged them over anything it didn’t get well received, but try as I might I couldn’t not challenge some of the more ridiculous rules and procedures this institution operated. They’d count the cutlery every single meal time first it was counted out then back in at the end, if they mis-counted then we would all be made to wait and wait and wait, while they hunted for the missing object which in truth there never was. Of course I never once saw anyone harm with cutlery, but pens that were freely available were used by many to self injure, as were a plethora of other objects we had access to. I learnt a million and one more ways to self harm, I learnt the weak spots in the system and I witnessed many awful incidents in there too.

It soon became clear that you could tell when certain women were more anxious and you could certainly sense who was going to harm before they did. Yet it surprised me over and over again to find the staff didn’t sense this increased anxiety and risk within a person, the team over focused on physical security and so missed clear opportunities to help women. Physical security included stupid rules about cutlery and certain other object and it also included an over reliance on locks. It focused on staff dominance and patient compliance to rigid rules that made no sense and yet the system failed.

A forensic unit has a higher level of self harm incidents and serious incidents endangering life than other types of psychiatric facility. It’s not just about the clientele they serve it’s about the complex nature of people who need help, and yet are failed by the system. It would have been so easy for me to have got sucked into the cycle of punitive rules, punishments and de-humanising that took place, it would have driven me to self harm even more if I had let it. I had to fight not to succumb to this place, to not end up like many who had spent years existing in these units. Who no longer felt human or had any worth, they felt better off harming and dead than existing in this horror in which they lived. Many didn’t have visitors or leave and they were rarely empowered, encouraged or given opportunities to believe they had a future.

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I was fortunate, I had a family outside, I had children who cared and friends who stayed in touch, most of all I had years of experience surviving similar controlling environments. My abusive childhood was all about control, punitive random punishments and dehumanisation, dissociating allowed me to survive that time. Dissociating again allowed me to survive this period of my life too and parts of me would ensure I never spiralled into being a continuous long stay forensic patient.
The truth is I can’t throw away that cup now because it will forever be a permanent reminder of the fact we survived the horror of our time in forensic care.

 

copyright DID Dispatches 2015

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Out of the darkest of times comes hope – the hardest blog to write.

One more year on and it still hurts to remember this awful day when my life changed forever, I will never forget the nightmare MentalHealth Professionals inflicted upon me and my family by moving me to privately run Secure services far away from home.

DIDdispatches Blog

Today has been a significant day, 6 years ago I was driven by my local NHS trust 200 plus miles from home to a privately run secure service. I had been on my first ever section 3 for less than 2 months and was in an open acute ward; no lock on the door and a fair degree of freedom.

The professionals decided I needed trauma therapy and to get that therapy, they needed to separate me from my children and relocate me to the south west coast of the UK. Suddenly for the very first time I felt like a third class citizen, I was deprived of all my clothes bar the ones I was wearing, all my possessions except my teddy were taken away and locked in a room to be searched. I had to eat with a spoon, drink from a plastic cup and worst of all…

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Hospital Restraint procedures – a survivors perspective

Trigger warning : some people may find the contents of this post distressing.

Yesterday during a meeting I was asked questions about my time in hospital, one question though was really tough and related to my being restrained. It’s so hard for me to describe in detail my experiences of constant observations and restraint procedures, these are the most difficult of experiences that I have ever encountered in hospital and they stir emotions and feelings deep within.

Being manhandled by other human beings who weald control and hold all the power is impossible to forget, in fact it’s hard to not feel the panic that I felt at the time of those events all over again. Watching others being restraint was scary enough but then when it happens to you it seems so unreal and yet so terrifying. I know that at times I dissociated during these episodes such was the triggering element they contained. I thought it might be helpful to write about the impact of those days so others might understand what it’s like.

It’s hard to choose which incidents to write about but I have chosen two incidents as they reflect I think the many other such times I was forcibly restrained by the so called caring profession.

Having been returned to the unlocked acute ward following an attempt to leave the unit I was manhandled by the police officers from their vehicle to the ward. Nursing staff took over the responsibility of me and a posse of nursing staff grabbed hold of me, in an agitated state I was placed in the locked high dependency area of that ward. I hadn’t threatened anyone indeed I hadn’t done more than choose to leave the hospital environment which had been my home for some weeks. Once behind closed doors the staff laid me on the black solid seating face down and then let go, I immediately began to pace up and down and I did keep telling them I wanted to leave. 2 rather burly nursing staff began the task of looking after and observing me and one kept barking orders at me to sit down and stop pacing. A senior nurse came back into the room holding a medication pot and told me to take these as he moved the meds pot towards me. I refused saying I wanted to leave and I didn’t want their medication it would only dope me up. He told me there wasn’t a choice but at this time I wasn’t sectioned and so I felt he couldn’t make me take anything, how wrong was I. After a few minutes he left still holding the meds I had refused, and I continued pacing.

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What happened next startled and frightened me, it happened at such a speed I had no control and no indication it was coming. Suddenly a number of staff appeared in this small area and pounced, I was forced to the floor and held face down. It felt like I couldn’t breathe, hands seemed to be everywhere and they were hurting me. Not being able to breathe is absolutely terrifying, no matter how hard you try it’s impossible to move your head to catch a breath and I honestly thought I would die. I felt someone pulling down my clothing and then as I fought and fought and they grabbed and pulled and hurt I felt a stabbing pain. Whatever they gave me I’m not sure, but I know they injected me with some kind of drug and it’s aim I guess was to calm me down. I had been agitated before this happened but now I felt even more agitation and I had been triggered too. I am a victim of abuse and being hurt in this manner by staff some of whom I didn’t know was too much to bare for parts of me. A whole cacophony of emotions raced through me and thoughts of are they going to rape me filled my head. I had no control, no rights, no one listened to my cries for help or to stop, they just carried on doing what they did whilst talking to each other. They continued to hold me on the ground for sometime though they turned my face to the side their hands still held me as if in a vice. After a while they lifted me up to my feet my arms still held tight, they manoeuvred me to the seating bench and laid me down. Barking orders about staying still and behaving they released their grip on me, laying there I felt drugged and confused. Most of all I was terrified, my arms felt heavy and sore, my legs were hurting and my head too, my trousers were still not fully pulled up and yet I dare not move to do this.

These were nursing staff who were meant to be looking after me, instead they bullied and terrified me. I no longer trusted them or had any faith in their abilities I had been degraded and treated and manhandled like a piece of meat. In a police station this would be classed as overly forceful in a locked hospital room it’s called acceptable and necessary, police stations have camera to record conduct of officers – hospitals don’t.

If staff had allowed me to talk, to express why I was agitated, to understand my feelings,  the reasons behind those feelings and behaviours then they wouldn’t have needed to restrain me.  If they’d been more observant they’d have seen my distress earlier in the day and supported me more appropriately so I wouldn’t have left the ward in the first place.

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On one of my nights in secure services I became upset, I was on constant observations and a male staff member sat a few feet from my bed. I didn’t want to be on constant observation, I couldn’t understand why this was needed I hadn’t harmed or shown any signs I might do so. Having a male sat in my room so close to my bed was terrifying in it’s own right, I stated I was unhappy and I said I wanted him to leave. The situation escalated as he became frustrated and moved his chair nearer to me and I became more and more distressed. In sheer frustration I began banging my head against the wall, other staff including some males appeared demanding to know what was going on. I tried to be calm to say I wanted to stop being watched, to say I didn’t feel safe with a male, but my rational pleas for understanding fell in deaf ears. Once again I began hitting my head but by now there were a number of staff and 1 of me, they pounced and grabbed me. Holding my head forward from the wall and pushing it down towards my chest, others held my arms and others my legs. I screamed and pleaded with them as they hurt and yet they didn’t care, I recall one of them shouting at me as if barking orders. Stop fighting, stop screaming, stop…..stop…

A doctor arrived yet another male and began asking me questions, by now I wasn’t struggling I was compliant. Still held down I talked to this doctor and cried buckets, I felt so afraid I hated this place and I hated me. The doctor said I was going to take extra meds one way or another and I knew by now what that meant, I swallowed the pills or they’d forcible inject them into me. I guess I was learning because I agreed in fact I think I begged to be allowed to swallow his pills, I promised I wouldn’t mess about and I’d behave. That night I lay in bed with staff either side of my bed, my arms had to be visible as did my neck. I lay in this quiet room vulnerable and scared and terrified yet again I’d be hurt and no one but no one would know.

If staff had helped me to understand their observation policy, taken account of and respected my fears about a man so close to my bed I wouldn’t have got frustrated and hurt in the first place. It could have been prevented but the staff approach wasn’t to prevent such incidents but to forcible deal with them.

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These two experiences demonstrate the full horrors of being restrained by nursing staff on a mental health ward, at no time had I ever attacked or hurt staff and at no time have I ever been charged with any criminal offences. Yet I feel being restrained was a punishment and a gross abuse of power. I do understand that if a patient is unable to be calmed down or reasoned with in a safe manner the staff need to have a solution, but it shouldn’t be restraint in this way. It’s often used too quickly, too often and inappropriately. Things need to change, because right now patients are being held down, forcible medicated and hurt all under the guise of providing care.

I know on both of these occurrences there were other things that could have been done to help me, namely asking me how I felt, why I felt that way and listening to my fears, concerns and taking them seriously. Instead staff chose the heavy handed option I don’t understand why.

As I have said I was restrained on a number of occasions and I don’t believe it ever got any easier, the harsh reality is that fear grips you each and every time whether that be the first or the tenth occurrence. For anyone restraint procedures are terrifying but I truly believe for those who have suffered trauma or have complex dissociative disorders it is even harder to endure.

copyright DID Dispatches 2014