There are many sections of the Mental Health Act that a person can be detained under. This may be my first admission to hospital, but since being here I have been held under the following sections : 5(2) (twice), 2 and 3. About a month before I was admitted, I was also detained under a 136; although this didn't lead to a hospital admission.
All these numbers!
What do they mean? And, more importantly, how does it feel?
In short, a section 5(2) is detention for a maximum of 72 hours. It can only be used to detain a patient who is already in hospital. It's a bit of an emergency measure- a useful tool for a doctor to prevent a patient from leaving the ward if they are deemed to be an immediate risk to themself or others.
A section 2 is detention in hospital for a period of up to 28 days. Importantly, this section is for assessment, which means (amongst other things) that a person cannot be compelled to accept medication unless there are extreme circumstances.
Section 3 is the 'biggie'.
Technically, being detained under section 3 means that you're detained indefinitely. The initial period lasts for up to 6 months, but it can be renewed for a further 6 months, and then yearly after that. Another thing about a s3 is that it is for treatment. This means that you can be compelled to take medication (at least for the first 3 months) even if you don't consent. Everyone has the right to appeal against their detention, but only about 13% of appeals actually result in the section being lifted.
Obviously, a person is detained as a result of suffering from a mental illness or disorder that requires treatment that can only be accessed in hospital. In short, the doctors have to show that you're so unwell that the only way to prevent harm to yourself or others is to restrict your freedom and autonomy. If there is a viable option that is less restrictive, then that has to be chosen instead of detention. It Is also necessary that three suitably qualified mental health professionals agree that detention is necessary, and that appropriate treatment is available.
THis is a quick (and hopefully correct) rough guide to sectioning.
How does it feel?
For me- and everyone is different- when I was held under section 3, I was relieved. Looking back, it seems to be a strange emotion to have when you've just had your liberty, autonomy and freedom of choice removed.
But I was out of control. I simply wasn't capable, at that time, of being autonomous. The depression that I was experiencing was unremitting and severe. I didn't sleep, I couldn't concentrate, I could see no hope. And yet I didn't want to be in hospital. I wanted to be discharged, or to discharge myself, so that I could go quietly on my way, curl up in a ball, and die. Death seemed to be my only option. When life is unviable, death is the consequence. My continuing existence felt unviable. So dying felt like an entirely logical and rational next step. I even asked the consultant if he wanted me to sign a disclaimer so he wouldn't get into trouble at any inquest into my death.
Retrospectively, I can see that I was really quite ill, and because I refused to accept that I needed to be in hospital, the only option was to put me on a section. Being put on the s3 probably saved my life.
So I felt relief. I was no longer allowed to go out. Smoking was every two hours, escorted by staff. I felt safe, and 'contained'. Because of the slightly unusual circumstances of my admission, it also meant that the borough that the hospital is in took over financial responsibility for me. Previously, responsibility was with a different local authority, and a real lack of co operation between the two
areas was not helping me to feel secure or safe. The unhelpful, and yet very real, threat of being transferred to another hospital without any notice was removed by being put on a s3.
This gave me some desperately needed security. I suddenly felt like I had some breathing space. A place to rest and recover. A place where I could just stop. I knew I would be looked after. I knew that it was other people who held responsibility for my day to day life. And that was a huge relief. I was depressed, and I wanted to die. I planned to die. I intended to die. I didn't wash for weeks on end, ditto changing clothes. I slept on the floor and could barely understand simple instructions. It's a horrible place to be. It's bleak and lonely. It feels never ending. Existing, not living.
The irritations of being sectioned come when you feel a bit better. When I wanted to go out, and couldn't. Christmas, new year. When you don't feel suicidal, but you're still not allowed to pop to the shops and get fags. When you miss friends, family and freedom. When you don't want to be continually observed anymore. When you realise that you've got no choice. These are things that I only became aware of as I began to get better. Essentially, when you're well enough to start participating in life again, but you have to go 5 steps more slowly than you'd like. This is when ou notice the irritations and constraints of being detained.
I suppose when you're first sectioned, you're a child. Unable to make good decisions. Unable to keep yourself safe. It must be said that this 'unable' must be the direct result of an illness or disorder. So the professionals do it for you. They protect your life, and/ or the lives of others. You're told when to eat, smoke, sleep, take medication, have visitors. And in my case, when to wash, change and tidy up. When you're ill enough to be put on a s3, your mind, and your life, is in utter chaos. You have ceased to be able to make it better by yourself.
As you start to get well, you become more like a teenager. Wanting more freedom, but oh so carefully. Mistakes might happen. And they might be serious. At this point, you start to get 'leave'. This is a chance to show that you are well enough to be unsupervised in the community. You're on the mend. Still unwell- but not an immediate danger to yourself or society. From what I've seen, and experienced, this is where the bargaining starts. People 'chomp at the bit' for more say in their lives. People order take-away food instead of eating at regimented times, they smoke out of the window. A few go AWOL. Ward rounds become more demanding. You start to recognise people who are more ill that you are. For a lot of people, it seems that relationships and sex come back as desired for things. There is a world outside of mental illness.
In other words, by this point, you're ready for discharge. Now all you've got to do is convince the doctors!! (which might just send you a 'bit wonky' all over again!!)So, being sectioned isn't the end of the world. It's a temporary 'holding position'. It's a chance for people to get well, especially when they don't think they want it, or need it.
Saturday 16 March 2013
Friday 15 March 2013
This week on the ward, part 1
Some weeks are ok. And by that, I mean that they are relatively settled. Patients are getting on well with each other, and with staff. There are no alarms, no restraint. And patients who are particularly Ill are in the minority. All of this means that there is a relaxed atmosphere on the ward.
Other weeks are different.
Very different.
This is one of those different weeks.
It's difficult to pinpoint what and when the change happened.
But on sunday night, a group of about 5 patients decided to get wasted on cocaine and vodka. There wasn't much hiding it going on. By the time the night staff came on duty, the atmosphere was volatile, to say the least. Everyone was milling around the nurses station, patients were high, drunk and aggressive. Shouting at staff, refusing to move, and demanding to be allowed to go outside and smoke, despite knowing that the doors are locked for everyone at 9pm.
I must say that this really irritates me.
The reason why is that the drug taking and drinking is not as a result of being ill. Neither was the shouting at staff. Nor was what came later. And because the staff know damn well that this behaviour is not mental health related, they get stroppy. Rightly so.
I'm no saint. Good god, I'm no saint. I've been out, got drunk and been abusive. And I faced serious consequences. That is exactly how it should be. Bad, or illegal, behaviour- despite the fact that we are in hospital- is STILL bad, or illegal, behaviour. If you're going to do it, don't whine about the consequences. And don't, BUT DONT, blame staff.
Some staff are good. Some are, quite frankly, shit. Some are pretty much always willing to help, and some don't look up from their newspaper when they grunt their replies.
But no one comes to work with even a tacit acceptance that it's ok for them to be shouted at, goaded, sworn at, pushed or punched by patients who are simply stoned and drunk.
All of this happened during the wee small hours of Monday morning. 'Skinny drunk coke head', having been massively abusive, threatening and loud (and having made self harming gestures), was restrained by staff. It might have something to do with the amount of forms that need to be filled in afterwards, but full on restraint does not happen all that often. When it happens, it is because it NEEDS to happen in order to prevent harm. I have been restrained. Maybe four times. And every time, it has been necessary because I couldn't control myself. If a patient can not or will not control themselves, then the staff control your actions for you.
It's certainly not something they do for fun. Of that I am convinced.
After 'skinny drunk coke head' had been restrained, and his bedroom made safe, it was the turn of 'exceptionally gobby one' to start. Needless to say, she had plenty of opinions about the restraint,
about the qualifications of the staff, about abuse, neglect and generally bad treatment.
All of this whilst the rest of us are trying to sleep.
It's just annoying. Downright inconsiderate, and ALL about behaviour, not illness.
Other weeks are different.
Very different.
This is one of those different weeks.
It's difficult to pinpoint what and when the change happened.
But on sunday night, a group of about 5 patients decided to get wasted on cocaine and vodka. There wasn't much hiding it going on. By the time the night staff came on duty, the atmosphere was volatile, to say the least. Everyone was milling around the nurses station, patients were high, drunk and aggressive. Shouting at staff, refusing to move, and demanding to be allowed to go outside and smoke, despite knowing that the doors are locked for everyone at 9pm.
I must say that this really irritates me.
The reason why is that the drug taking and drinking is not as a result of being ill. Neither was the shouting at staff. Nor was what came later. And because the staff know damn well that this behaviour is not mental health related, they get stroppy. Rightly so.
I'm no saint. Good god, I'm no saint. I've been out, got drunk and been abusive. And I faced serious consequences. That is exactly how it should be. Bad, or illegal, behaviour- despite the fact that we are in hospital- is STILL bad, or illegal, behaviour. If you're going to do it, don't whine about the consequences. And don't, BUT DONT, blame staff.
Some staff are good. Some are, quite frankly, shit. Some are pretty much always willing to help, and some don't look up from their newspaper when they grunt their replies.
But no one comes to work with even a tacit acceptance that it's ok for them to be shouted at, goaded, sworn at, pushed or punched by patients who are simply stoned and drunk.
All of this happened during the wee small hours of Monday morning. 'Skinny drunk coke head', having been massively abusive, threatening and loud (and having made self harming gestures), was restrained by staff. It might have something to do with the amount of forms that need to be filled in afterwards, but full on restraint does not happen all that often. When it happens, it is because it NEEDS to happen in order to prevent harm. I have been restrained. Maybe four times. And every time, it has been necessary because I couldn't control myself. If a patient can not or will not control themselves, then the staff control your actions for you.
It's certainly not something they do for fun. Of that I am convinced.
After 'skinny drunk coke head' had been restrained, and his bedroom made safe, it was the turn of 'exceptionally gobby one' to start. Needless to say, she had plenty of opinions about the restraint,
about the qualifications of the staff, about abuse, neglect and generally bad treatment.
All of this whilst the rest of us are trying to sleep.
It's just annoying. Downright inconsiderate, and ALL about behaviour, not illness.
Sunday 10 March 2013
The medics!
What's the common perception of psychiatrists? At a guess, it would be older male, beard (very Freudian), distant, detached, arrogant, over paid, with something approaching pressure sores for never leaving the other side of their desks. And definitely, but definitely, out of touch. A penchant for diagnosing personality disorders for anyone with the temerity to disagree with their wisdom.
There may well be psychiatrists who satisfy this description. But not that I've met.
The psychs that I've met are all young- ish. Even the consultants. They're interested, hardworking, and invested clinicians. Perhaps with a hint of arrogance. But, I must confess that if I'd studied and trained for as long as they have, I'd be a touch arrogant.
What's struck me about my RC (responsible clinician. The bloke who has responsibility for my care) is that he is always aware of the power imbalance and the ethical dimensions of detaining someone and authorising medicating them by force if necessary.
In my opinion, I was detained under section 3 in some part because I knew that if I went missing as an informal patient, I wouldnt meet the criteria for a 136, nor would a mental health assessment , outside of the hospital, have detained me. I've never believed that I suffer from a mental disorder of a degree to warrant detention. It's the nature, and interplay, of disorders that make me detainable.But I digress!!
Ward rounds are weekly meetings between me- the patient- and all of the relevant professionals involved in your care. (This is called the MDT, or multi disciplinary team. Mental Health likes its acronyms a lot!)
If there is a patient alive who has not felt trepidation at the thought of their impending ward round, I'll be amazed. They're not designed (I hope) to engender fear. But they do. It's the place where the power imbalance is most keenly felt. You are the patient. They are the experts.
Ideally, everyone should have a common goal. To get you well enough to be safely discharged. Unfortunately, they sometimes end up getting 'stuck' in a discussion of misdemeanors (fag out of the window, anyone?) that don't really have anything to do with mental health or dangerousness to self or others'. Smoking in bedrooms is illegal. It's also, in general, tolerated by staff - who have more important things to deal with than minor misbehaviour. But these things can reduce a ward round to a farce, especially if tensions are already running high.
These are meetings that can get fractious.
Nerves feature heavily for me here. Even after 9 months, I still sleep poorly on the eve of a ward round. I'm often quite hyperactive afterwards, as well.
A nervous aspie is a tactless aspie. I have been known to tell the consultant that the suit he is wearing is not as nice as the one he wore last week, that he has herpes (a cold sore), that he looks better without the beard (he IS a bit of a Freudian!), that he is completely wrong for not giving me more leave, etc etc. I have seen people forcibly removed from their ward rounds, and many people 'storm' out of theirs. I have seen the doctor leave on one occasion. I have seen the nurse who is note- taking sniggering more than once. And That same nurse nod off, only to be woken up by a direct question from the doctor.
Fractiousness is often quite funny, it must be said.
He's Italian, my RC, with quite a strong accent. He doesn't seem to like direct questions. He likes to announce that he is not working alone- he is merely one part of the team. And yet woe betide anyone who thinks they know their way around the mental health act or BNF better than he does.
In a surreal 5 minutes a while ago, he asked me how I'd like him to respond to me if he sees me out and about. Would I like him to ignore me, or to stop and say 'hello'? My reply was that he could buy me a pint! But, more seriously, I have mild prosoplognosia (face blindness). I often don't recognise people by their face. It's their voice, clothes, build and walk that informs me about the identity of the person. So, it stands a good chance that I wouldn't recognise him, especially out of context. But I find the idea of ignoring someone who you've been legally responsible for for the best part of a year a bit of a strange one.
This is the sort of thing that modern day psychiatrists ask, and are interested in the answers to.
A lot of what goes on with the consultant is extremely serious (suicidal thoughts this week?) Indeed, it can be life savingly important. Prescribing psychotropic medication is a serious business. So is giving leave to a patient who was suicidally depressed a few weeks ago. Maintaining hope when dealing with a patient who, having just been released from jail, keeps going on vodka binges and slashing their throat, is (we may assume) not an easy task. Keeping focus, and the patients' best interests genuinely in mind, when that patient is delusional and aggressive, making obscene gestures, swearing at you in Italian, and threatening to irrevocably alter the child-bearing capacity of close family members, is no mean feat.
It's also what the nurses deal with day in and day out. But that's another story.
I've been impressed by the shrinks here. The junior doctors (SHO's) often don't want to work in psychiatry. Most of them are GP's in waiting. The turn up en masse in August and February, and are very much thrown in at the deep end. The first task for the last SHO was to put me on a 5(2) - she told me a couple of months later that she was told exactly what to do by the nurses, as she hadn't a clue! But they learn quickly.
I think, across the board, the medics do care. They make mistakes, and I'm my experience they are very ready to apologise and move on. That's a good experience for patients, who might very well be detained and as a result have very little control over the decisions that affect them. Knowing that the people with the power are interested in collaborative working goes some way to ensuring that patients don't feel done unto.
And this can only help to facilitate recovery. It's helping me, anyway.
There may well be psychiatrists who satisfy this description. But not that I've met.
The psychs that I've met are all young- ish. Even the consultants. They're interested, hardworking, and invested clinicians. Perhaps with a hint of arrogance. But, I must confess that if I'd studied and trained for as long as they have, I'd be a touch arrogant.
What's struck me about my RC (responsible clinician. The bloke who has responsibility for my care) is that he is always aware of the power imbalance and the ethical dimensions of detaining someone and authorising medicating them by force if necessary.
In my opinion, I was detained under section 3 in some part because I knew that if I went missing as an informal patient, I wouldnt meet the criteria for a 136, nor would a mental health assessment , outside of the hospital, have detained me. I've never believed that I suffer from a mental disorder of a degree to warrant detention. It's the nature, and interplay, of disorders that make me detainable.But I digress!!
Ward rounds are weekly meetings between me- the patient- and all of the relevant professionals involved in your care. (This is called the MDT, or multi disciplinary team. Mental Health likes its acronyms a lot!)
If there is a patient alive who has not felt trepidation at the thought of their impending ward round, I'll be amazed. They're not designed (I hope) to engender fear. But they do. It's the place where the power imbalance is most keenly felt. You are the patient. They are the experts.
Ideally, everyone should have a common goal. To get you well enough to be safely discharged. Unfortunately, they sometimes end up getting 'stuck' in a discussion of misdemeanors (fag out of the window, anyone?) that don't really have anything to do with mental health or dangerousness to self or others'. Smoking in bedrooms is illegal. It's also, in general, tolerated by staff - who have more important things to deal with than minor misbehaviour. But these things can reduce a ward round to a farce, especially if tensions are already running high.
These are meetings that can get fractious.
Nerves feature heavily for me here. Even after 9 months, I still sleep poorly on the eve of a ward round. I'm often quite hyperactive afterwards, as well.
A nervous aspie is a tactless aspie. I have been known to tell the consultant that the suit he is wearing is not as nice as the one he wore last week, that he has herpes (a cold sore), that he looks better without the beard (he IS a bit of a Freudian!), that he is completely wrong for not giving me more leave, etc etc. I have seen people forcibly removed from their ward rounds, and many people 'storm' out of theirs. I have seen the doctor leave on one occasion. I have seen the nurse who is note- taking sniggering more than once. And That same nurse nod off, only to be woken up by a direct question from the doctor.
Fractiousness is often quite funny, it must be said.
He's Italian, my RC, with quite a strong accent. He doesn't seem to like direct questions. He likes to announce that he is not working alone- he is merely one part of the team. And yet woe betide anyone who thinks they know their way around the mental health act or BNF better than he does.
In a surreal 5 minutes a while ago, he asked me how I'd like him to respond to me if he sees me out and about. Would I like him to ignore me, or to stop and say 'hello'? My reply was that he could buy me a pint! But, more seriously, I have mild prosoplognosia (face blindness). I often don't recognise people by their face. It's their voice, clothes, build and walk that informs me about the identity of the person. So, it stands a good chance that I wouldn't recognise him, especially out of context. But I find the idea of ignoring someone who you've been legally responsible for for the best part of a year a bit of a strange one.
This is the sort of thing that modern day psychiatrists ask, and are interested in the answers to.
A lot of what goes on with the consultant is extremely serious (suicidal thoughts this week?) Indeed, it can be life savingly important. Prescribing psychotropic medication is a serious business. So is giving leave to a patient who was suicidally depressed a few weeks ago. Maintaining hope when dealing with a patient who, having just been released from jail, keeps going on vodka binges and slashing their throat, is (we may assume) not an easy task. Keeping focus, and the patients' best interests genuinely in mind, when that patient is delusional and aggressive, making obscene gestures, swearing at you in Italian, and threatening to irrevocably alter the child-bearing capacity of close family members, is no mean feat.
It's also what the nurses deal with day in and day out. But that's another story.
I've been impressed by the shrinks here. The junior doctors (SHO's) often don't want to work in psychiatry. Most of them are GP's in waiting. The turn up en masse in August and February, and are very much thrown in at the deep end. The first task for the last SHO was to put me on a 5(2) - she told me a couple of months later that she was told exactly what to do by the nurses, as she hadn't a clue! But they learn quickly.
I think, across the board, the medics do care. They make mistakes, and I'm my experience they are very ready to apologise and move on. That's a good experience for patients, who might very well be detained and as a result have very little control over the decisions that affect them. Knowing that the people with the power are interested in collaborative working goes some way to ensuring that patients don't feel done unto.
And this can only help to facilitate recovery. It's helping me, anyway.
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