Ward environments made a real difference when I was detained under the Mental Health Act

The way staff act and the activities on offer on wards really matter when you are hospitalised, writes Mark Ellerby

NHS sign
Picture: Rex Features/Phaney

Since being diagnosed with schizophrenia, I’ve been detained under the Mental Health Act three times. Once for 13 months, one time for six months and the other time for three months.

Of these three detentions the longest admission – to an old-style asylum hospital that I was really concerned about being admitted to – was actually the best experience. By contrast, I found the two shorter admissions to hospitals to be very restrictive.

It’s important to explain and understand why this was the case. When people are detained, particularly for long admissions – a year (or longer) is a large chunk of your life – it is so important for hospitals to have the right environment for patients.

The first hospital I was in, the old asylum, had a leisure centre, library, games room, cinema, a non-alcoholic bar, gardening for the patients and even a shop and post office.

However it was not the activities in themselves that made the difference, it was the fact that the patients did them together. We talked to each other and socialised. Staff engaged with us too.

I was there for just over a year and met friends (I know had my admission been longer I may well have found elements of the hospital more restrictive). Yet I had completely different experiences when I was later detained at two other, more modern, hospitals.

On those wards, the staff didn’t engage with patients. They simply sat back and took notes. When I tried to talk to them I got told off because they could not spend time with you individually. Without proper social contact, patients simply sat staring into space. I spent hours on end just watching the clock race round waiting for the highlight of the day – the next meal.

When you’re detained under the Act you often can’t leave hospital without permission, so you’re confined to activities on offer on wards.

Yet at the ward I was in for six months the only ‘activity’ was people watching TV all day. This was difficult for me, and a lot of patients, as the TV made me paranoid. I used to think the people in programmes were talking about me all day. I could not spend all day in there. Yet the TV was in the day room – the only place patients could access outside our bedrooms.

Another factor that makes a big difference when you’re detained is how many visitors you receive. This can be difficult where there are issues of distance, or time constraints due to relatives’ or friends’ work commitments.

I was fortunate that during my section my family came for a few hours every day and relieved the pressure of being on the ward the whole time. However once visiting hours were over the feeling of being stuck with nothing to do quickly returned.

I remember one doctor glibly telling me “we have a pool room”. I also remember thinking there was no way I could spend all day every day playing pool.

The experience was a big contrast to my 13 month detention in the old asylum-style hospital. There the patients had facilities to motivate them.

My local day centre is also very lively and sociable. There are courses for everyone and staff who facilitate the social side. But being detained under the Mental Health Act and restricted to a ward often means being cut off from such places.

The French philosopher Michel Foucault labelled the setting up of the very first psychiatric hospitals as part of “the great confinement”.

Was Foucault right? I have mixed views. Being detained in hospital can feel like being locked up from the outside world – one time I was kept on intensive therapy ward behind locked doors. When I was discharged I could almost smell the sense of freedom.

But at other times my hospital admissions were quite enjoyable. I made new friends and met new people. I saw firsthand how a ward environment makes a real difference to whether hospitals live up to, rather than challenge, their popular image of confinement.

Mark Ellerby is the author of ‘The Stages of Schizophrenia’ books

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