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When Do Prescribed Safety Measures in a Psychiatric Unit Become Restrictive Punishment?


I began writing in April 2018 when worsening symptoms of PTSD and depression stopped me working as an ED nurse. Writing is therapy.

Speaking as an inpatient of psychiatric ward detained under a section three, I would like to talk about the difference between protective restrictions, put in place for health and safety where the individual is proven to be a risk to themselves or anyone else and punishment like restrictions that seem to outweigh the presented risk.

During my two and half months of admission, I have experienced different levels of limitations dependant on my mood, anxiety, behaviour and severity of my suicidal ideation.

Entering the Psychiatric Ward

On arrival, I was totally lost and confused, I was reluctant to be admitted but agreed to so I could be informal and not sectioned. This was after two months of intensive treatment in the community, reaching high doses of antidepressants, antipsychotics and PRN medication to ease anxiety and aid sleep.

My mood was persistently low with high anxiety as a result of my previously untreated PTSD, leading to intense suicidal ideation. Needless to say, psychiatric admission seemed a significant step backwards in terms of recovery and returning to some type of work, be it nursing or something else.

Therefore, I stayed in my room for days at a time; I don’t think I left or ate in the first week. Despite the fact that as an informal patient, I could have left the building at any time, I just didn’t have it in me.

Following the first meeting with the consultant, I discussed with honestly how serious my suicidal thoughts had been and continued to be. At this point, still an informal patient, I was placed on ‘levels’, this is one-to-one nursing where you’re in the line of sight at all times and I was unable to leave the hospital unescorted.

Not surprisingly, I didn’t feel the need to ask to leave the ward for any reason and spent a lot of time sitting or lying down anxiously or typing at my desk as I had recently discovered an interest in poetry prior to my admission.

I Was Moved Near the Nurse's Station

In order to lose the ‘levels’ and regain some privacy and freedom, I would need to move rooms nearer the nurse’s station and my belongings would be taken away, leaving only books to read, draw and few pencils. The thinking being that I would be closer to staff if I ‘needed a chat’, which has never happened and I thought very unlikely to change, also I guess they would be nearer in case of a suicide attempt.

This turned into a living nightmare.

As the nurse’s station was part of a central area on the ward with a frequently used lounge area where people would meet at all hours of the day. Often in play, there would be raised voices and bumps from folk jumping around. This was extremely triggering for me, especially when a man in psychosis arrived and spent all day every day ranting at the staff at the nurse’s station about some awful things. He also had a wildness in his eyes that reminded me of my dad which I could barely tolerate.

At this point, in desperation, I asked for self-discharge as I was still informal and in theory, I could leave this environment that was no longer therapeutic. I was slammed with a section 5:2 to stop me leaving over the weekend which was then made a section 2 on Monday.

There I am locked in, to a horrible situation. My frequent requests to change rooms as my mood plummeted and anxiety reached an all-time high were denied time after time. I attempted to take my life five times or more during this period. Only one of which was highlighted to the staff. Instead of moving my room which would have been beneficial to me, I was placed back on levels.

One-to-one nursing with the door open at all times so I had a front-row seat to the row outside. Words cannot describe how awful I felt and how I felt like a prisoner, not a patient.

Switching Rooms

During a meeting that takes place daily to discuss requests such as leave and activities, I requested again to leave that awful room, to my absolute surprise, five or six people raised their hands to offer to swap with me.

I couldn’t believe it, what an amazing gesture, just when I needed it, for the first time in a long time I felt valued as a person. Later on, after a discussion with the consultant who thought I’d already moved as he had requested the week before, was in full support of me swapping rooms which I did later and what a difference it made to have a quiet space to rest and write, despite them removing all my possessions again.

There’s something particularly degrading about losing items such as clothing, so you have to ask each time you shower or change. Yet still an improvement in contrast to my previous room.

Gradually the anxiety and low mood seemed to improve slightly until I hit a rough week related to my mother’s birthday and a few other knockbacks, I attempted to take my own life again, a few times, again only one reached the nurses' awareness. This resulted in returning back to levels, only for a few days this time before I return to 15-minute checks and my room stripped of all belongings again.

Over time, I collected my belonging backs and have tried my best to behave, with no further reported attempts at suicide although I have tried a few times in secret, it would appear that I’m really not very good at it so I’ve decided to play the game and stop trying.

Regaining My Freedom

After a short time, I was only being checked every hour and was granted leave to walk the grounds on my own, attend the gym for two hours each day and leave the ground with family and friends which was amazing. I felt so lucky to have this time to myself and a little freedom.

However, I recently suffered another setback and deterioration of my mental health due to a series of little stressors. Again, my section 17 leave has been rescinded; I’m back on 15-minute observations, and I cannot leave the hospital unescorted. Due to the business of the ward, it seems pointless asking, so in my room I remain, sometimes for days at a time. Occasionally, I am granted escorted leave for the gym which is essential for my physical and mental health. For this I’m grateful but the containment is soul-destroying.

Recently, I met with a solicitor who would have guided me through a tribunal to dispute my section which seemed like a good idea when I was free to leave for the gym etc. but seemed like a stressful waste of time since my deterioration, the increased observations and my leave being removed.

She explained that it was up to the ward to justify their decision to detain someone against their will when they’ve committed no crime and are simply unwell. It made me think about how the ‘safety measures’ and how they really did feel more like punishments. It must be difficult to gain a balance I’m sure but my isolated and lack of exercise seems disproportionate to the risk I pose to myself.

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