Most people with mental health problems can be treated as an outpatient. However, there are times where this might not be possible doctors may encourage a person to be treated as an inpatient to benefit from the range of treatments and therapies available in a hospital. Inpatient care might be necessary to keep people safe, and to give health professionals time to assess and treat mental health problems more intensively.
People often believed that they had to be admitted to hospital to have ECT, but staying in hospital is not always necessary, and people can have treatments like ECT as an outpatient. Some people we spoke to thought being an outpatient was better: that it was better for their recovery if they were at home with family rather than in a hospital. When Cathy was admitted to hospital with depression, she was put in a mother and baby unit with her 6 month old and given ECT. She hated being in the unit because she was with her baby and away from her family and her husband. She pretended she was better, although she wasn’t’, just so she could go home.
Mandie turned down ECT because she didn’t want to be admitted to hospital. She was put off by seeing the ward and felt she would be better off at home with her children.
Mandie turned down ECT because she didn’t want to be admitted to hospital. She was put off by seeing the ward and felt she would be better off at home with her children.
Age at interview: 39
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
And it was my husband that convinced me out of it. I think the main reason he convinced me out of it on that day, there and then, rather than us coming home, was because the hospital was set up in such an unpleasant way. It was just an instantly frightening environment, you know, there was gates and locks. I remember walking in, and I’ll never forget this to the day I die, there was a woman being manhandled, by three people, and she was screaming at the top of their voices. And she was the first thing I saw as, and the reception just ignored her, and she just said, “Can I help you?” “Not really.” And I was already panicking, sorry, already panicking, thinking, “Oh, I can’t be in this place, I can’t be in this place.” And then we went in and she said, “Well, let’s come and have a talk about it.” And so my husband sat and talked to this woman. And I think, it all got a bit bizarre really, because they said, “Well, when, as she has this treatment, she won’t be allowed to come home.” And that’s what really annoyed my husband, because he said, “The only thing that’s keeping Mandie alive is me, her love for me, and her children. She feels, she loves her kids but, you know, there’s no connection.” And, and he said, you know, “If you take her away from her kids, you’re taking away the only reason she has to live.”
And I remember thinking, “But I walk on the beach every day.” However tough a day it was, I would take the kids for a walk on the beach, even if it was for five minutes, throw a few stones in the sea. It, and it didn’t feel good, but I knew I was doing the right things. And I thought, “But you’re going to lock me in a room. How is that going to help?” “Oh, because we have to monitor the drugs you have to take, and all.” So I could understand that. And so then we said, “Well, what about if?” Because we were still going through this, “Well, let’s go for this.” So, we were saying, “Well, what about if we took Mandie, if, I’ll bring Mandie in at 4 o’clock in the morning, if you like, so she can have her medicines, and then we’ll take her home again. So you can monitor, and make sure her heart’s coping, and all the rest of it.” And they said, “Well, no, she needs to be here to be part of the therapy.” We said, “Well, what therapy?” And they said, “Well, during the day she’ll get to do some art.” And that’s when it all went a bit bizarre really, because that’s when they lost us, because we went, “Art?” And he, “Yes, and she can make things.” And [husband’s name] went, “Well, do you make a basket perhaps?” And he said, “Well, no, because it’s good for them to have therapy.” And he said, “Right, so you want her to sit in a room with people like that woman out there doing art as opposed to a 2-year-old, and a 4-year-old doing art?” And that’s when we, they lost us, because they had no connection with me as a person. They didn’t want to listen to who I was, they didn’t want to listen to what helped me, or had been helping me, for over a year. They just wanted to do what they wanted to do, in the environment they wanted to do it.
When Steve’s wife was transferred from a private to an NHS hospital he noticed it wasn’t a relaxing environment for her. He felt it was better for her, and for the NHS, when she had ECT as an outpatient.
When Steve’s wife was transferred from a private to an NHS hospital he noticed it wasn’t a relaxing environment for her. He felt it was better for her, and for the NHS, when she had ECT as an outpatient.
Age at interview: 60
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
You know, in those days she went to a private hospital. It was quite, you know, pleasant for her to be in. It was like a sort of hotel where she had her own room and everything. But then when BUPA pulled the plug on her she went the NHS, the NHS route and it was, it wasn’t the holiday hotel sort of situation. They were “people” there extremely ill and it wasn’t really a relaxing environment for her to be in. So I was quite pleased that she was able to get ECT as an outpatient. Better for her, and better for the NHS, because it was an expensive process for her to be kept in a room for a month when all she was doing was hanging around waiting for her next session of ECT. Which was twice a week. That was all they were giving her.
So the rest of the time she was just waiting there for the next episode.
While a few people we spoke to had never stayed in a mental health inpatient unit, most people had stayed in one for at least a few days. Many believed that being an inpatient had advantages, e.g. being cared for when unable to care for yourself, talking with others in similar situations. Some carers were also relieved when a loved one was admitted to hospital. Dafydd was relieved that his wife was in a safe place, where she could be properly supervised so she couldn’t self-harm, and where she could get better. David Y and Steve found they could concentrate on looking after the children rather than having to look after their partners as well.
People entered hospital under very different circumstances. People generally had to have severe mental health problems to be admitted, and some were so ill they could not remember getting there. But others did remember, and had made a decision to go voluntarily. Still others were in hospital under ‘section’ (see for more ‘
Compulsory detention and treatment’). When people first went to hospital, their poor mental health and anxieties about what might happen there, made it a difficult experience. Some worried about the stigma of being admitted to a mental health unit, and how others would look at them. But as people recovered, many felt better about being in hospital. Matt’s wife was very reluctant to have ECT. He believes that part of the reason his wife was admitted to hospital was so that they could talk to her about having ECT while she was an inpatient. She didn’t want people to know she was ill, and was worried people would find out she was in hospital. But she did reluctantly agree to ECT and that was the beginning of her slow recovery (for more see ‘
Other people’s reactions to mental health and ECT’).
Before being admitted to an inpatient unit, people often said they had no idea what to expect, or had unrealistic expectations. For example, some thought they were going to a place to rest like a “spa” or “hotel”, but found the reality frightening. Others expected the worse, but ended up having a more positive experience.
Kathleen describes her first experience of a psychiatric ward as horrible, even though she had a room to herself where she spent most of her time. She went in voluntarily, but was later sectioned.
Kathleen describes her first experience of a psychiatric ward as horrible, even though she had a room to herself where she spent most of her time. She went in voluntarily, but was later sectioned.
Age at interview: 51
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
I know a lot more about it now. At the time, I didn’t quite understand. They use a whole different language don’t they? Like you won’t know this but like clothes ‘privileges’. Like my psychiatrist arranging my admission over the phone and saying oh I could have clothes privileges. I thought what on earth are clothes privileges? It meant I could have my own instead of hospital clothes. And I had my own room actually which was nice, because most the rooms were not single rooms except the secure rooms. There were two seclusion rooms and a couple of rooms, which were single rooms with cameras in.
My experience was, I can’t remember much about it. I was so, I was so distressed at the time, I spent my whole time in my room and I very rarely ventured out of my room. I was very ashamed, embarrassed. That was just me, and it just felt terrible. I hadn’t wanted to go in there, you know, it was just really terrible that I had to be an inpatient. But I had gone in voluntarily, but then I still wasn’t really given the option. It was said well if you don’t go in voluntarily then we’ll make you, you’ll have to go in. They said that every time. Every time to me. And then I’ve gone in voluntarily and then while I’ve been in there they’ve then sectioned me. I’ve been sectioned, virtually every time I think. I supposed they’re just worried for my safety.
And we had a named nurse each day. There’s a big sort of kitchen dining room area where we would have a community meeting each morning after breakfast. There was an activities leader and she would do relaxation and those that could go out of ward had a walk as well. But I still just, I found that, particularly that first admission, just horrible, because I’d never experienced anything like that before and I found that, yes, very hard, mainly because I felt so ashamed of everything. Ashamed of being ill, ashamed of what had been going on.
Suzanne was catatonic when she first went into hospital. She hated it at the beginning and wanted to be at home but by the end of her stay she didn’t mind being in hospital.
Suzanne was catatonic when she first went into hospital. She hated it at the beginning and wanted to be at home but by the end of her stay she didn’t mind being in hospital.
HIDE TEXT
PRINT TRANSCRIPT
But by the time I was admitted into hospital or a short time afterwards I became catatonic and the medication that they were giving me wasn’t really having any effect and I was so… kind of, I was totally despondent and I wasn’t able to interact with people or to speak or to eat and I was just kind of …I think of it as a time when where I just merely existed for a period. Where I didn’t really have any input into anything, neither the decision about the ECT treatment nor anything.
And yes, it was horrible. I hated it. I absolutely hated it. And then towards the end of the stay in the hospital, I was there for about six weeks or so and towards the end of the stay I didn’t mind it at all, but I hated it in the beginning because I just wanted to be around people I loved and I just wanted the compassion from your family that you get. And, I wanted to be around people who knew me when I’m well as well, and I was being kind of interviewed by large groups of people and I wasn’t really being given any information about what was going on or what the medication was doing. Or I kept asking when I was going to go home, i.e. when was I going to be better and they said they didn’t know and that just scared even more, because I thought, “Oh my God I’m going to be in here for years”. So it was really traumatic and in that I felt worse by being in hospital. I didn’t feel like it was any form of therapy in the first few weeks but…
The conditions on wards varied widely. Some wards had private rooms, lots of contact with staff, the opportunity to make friends with people going through similar experiences, and therapeutic activities for those who felt able. However, others felt chaotic, unsafe and lacked private spaces. Some wards didn’t have anything for people to do, were poorly furnished and served bad food, and there was little interaction with staff.
David Y says the dormitory in the psychiatric hospital where his partner stayed twenty years ago wasn’t a nice place. They weren’t looked after and there were no therapeutic activities.
David Y says the dormitory in the psychiatric hospital where his partner stayed twenty years ago wasn’t a nice place. They weren’t looked after and there were no therapeutic activities.
Age at interview: 52
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
And had you ever seen inside a psychiatric hospital before?
No, never. This one it’s a dormitory type but you had, one part you had the day room then the office, the consulting offices, you had a corridor, then you had women’s dormitory then after that you had the male dormitory and so the men had to walk all the way through there before, to get to their dormitory, it wasn’t right. And then at the end they had a little space where they could have a, like a little table tennis table up, well they had some, in the corridor from the day room to the dormitories there was some single beds where they had the observation, those under observation where there and at first [name of wife] was in one of them and she was taken some flowers, she put them in the vase then cut them all up and stuck then in the vase again. She’d got this vase with them all cut up flowers [laughs]. I’ve put them in the vase, [laughs] yes of course you have.
So but there, it wasn’t a nice place. She was on the ground floor dormitory a ward and there was another ward above which was worse, they had some more, they weren’t, they weren’t, it wasn’t a violent place it was very low, you had people with day, like more day to day illnesses but it wasn’t, you wouldn’t, you weren’t looked after, you cared for, you weren’t helped. You would just do what, what you wanted, it was, and it was a different thing then. I mean I went to the like the main psychiatric unit, the old asylum, [name], the only thing that was missing from there at one time was the swimming pool, it was the same tile up around everything, the same thing, the only thing missing [inaudible speech]. They used to do therapeutic activities, there were computers, there was gardening, there was woodwork, there was everything going on you know. But at the hospital my partner went to, nothing, there was a day room that was it and they went in there they smoked they watched the television and that was it. Very little interaction, I mean fortunately enough that’s gone now, the old asylum’s gone as well, got a new hospital nobody wants to go to… because they got rid of the hospitals but they kept the staff and some of their tactics, some of what went on came with it.
Tristan said the hospital was a strange, but mostly calm environment for his wife and she responded to it very positively. Higher doses of medication allowed her to get the rest she needed.
Tristan said the hospital was a strange, but mostly calm environment for his wife and she responded to it very positively. Higher doses of medication allowed her to get the rest she needed.
Age at interview: 38
Sex: Male
HIDE TEXT
PRINT TRANSCRIPT
It was obviously a very difficult thing to do for her to go in, although she didn’t have any choice in the end, it was it’s a, it’s not a very comfortable environment in some ways because it’s full of people who’ve got very serious problems a lot of whom are on a great deal of medication so it was a strange place to be. A lot of people talking in very erratic and nonsensical ways, but [name of wife] responded to it very positively. It’s actually quite a calm place the majority of the time and she felt very safe the fact that she was there got through to her she understood where she was and she understood certain things about it. She was, although I think the people we spoke to before she went in suggested that her treatment was likely to be very similar in the unit to what it was at home, in reality I have got the impression that well certainly in [name of wife]’s case she was treated more aggressively with medication including sedative medication in hospital than she ever would have been at home. and that was good for her and the big, big breakthrough was that she slept and they basically medicated her up to the eyeballs at night and she slept and as a result of that she was quite groggy for a lot of the day, took her quite a long time to recover from that but for both of us that was actually the first real progress because it was the first time she’d slept properly since she’d had [name of daughter].
Catherine Y spent time on a young person’s ward when she was a teenager. They did art therapy and drama therapy, which created a better way for the teenagers to explain their feelings.
Catherine Y spent time on a young person’s ward when she was a teenager. They did art therapy and drama therapy, which created a better way for the teenagers to explain their feelings.
Age at interview: 41
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
And I think it was a, it was interesting that as young people there was an element that all of us struggled to communicate. And maybe young people who are e-, find it easier to communicate with their peers or have somebody to talk to may fare better than those of us who really, I don’t know, it’s not, it’s not as if we weren’t intelligent enough or couldn’t communicate, I just think we weren’t able to convey how we felt in a way that was going to be understood. Which is why, I think, they had things like art therapy, because you were able to draw, draw pictures relating to how you felt. We had drama therapy, where you were playing out situations that you found difficult. That was the better way of trying to explain how we were feeling. But, yes, that communication barrier, I think, results in you just bottling everything up. And I think it becomes too much when you bottle things up if you’ve not been able to explain it to other people.
People in very different stages and severity of mental health seemed to be put together in hospital, and this caused some to feel uncomfortable and unsafe. Jenny said hospitals are “not easy places for the, the quieter, more reticent people with depression and anxiety”. Some young people and teenagers who were put in adult wards found this daunting.
Sheila didn’t want to leave her husband in hospital with “very poorly people”. Unlike when Sheila worked in psychiatric units over twenty years ago, there was nothing for him to do as he recovered.
Sheila didn’t want to leave her husband in hospital with “very poorly people”. Unlike when Sheila worked in psychiatric units over twenty years ago, there was nothing for him to do as he recovered.
Age at interview: 64
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
And what was your first experience of psychiatric units?
I don’t know really. I’m trying to think back to I was, oh my goodness, obviously there’s some very poorly people there, do I really, really have to leave him in a place like this, when I didn’t feel that he was that poorly. They, when, the first unit he went to in [name of town] they said, “Oh he’s such a lovely man. He you know, he’s great.” And because by the time he sort of left there and went to, in fact at one stage they were just going to discharge him straight away and then they decided that he really need to go to a local, more of a local unit and I don’t know. Some of the people that were in there I really didn’t want him to be with but I knew that he needed the help and with encouragement from the staff and doctors there, he did, he did come home, but yes, you know, and over the years, obviously I’ve got to know the units a lot more and they’ve got to know me.
What’s been your relationship like with the staff at these different units?
Okay, yes, there are quite a few concerns that I’ve had about the units. A lot of it is lack of OT. The it’s, on the notice board there’s a great big timetable, but unfortunately it doesn’t happen, so I’ve sort of taken this further with managers and things, because not just for my husband but for the other patients that are in there as well, because as one man explained to me, “When I came in here a couple of weeks ago, nothing bothered me. I felt so ill that I just wanted to lay on my bed. I just didn’t want to be with people.” But he was starting to get better and feel better, but there wasn’t anything for him to do, and he was frustrated and bored, and I’ve actually found, that especially the unit that my husband’s been in for the last fourteen months there’s a lot of bored people pacing about for the lack of things to do there. So I have, you know, I don’t find it at the moment, but they’ve moved to new premises now, so I’m hoping things will change [small laugh]. But yes, I do think there needs to be more to stimulate them. I mean I’m going back to 20 odd years ago, when I worked at one of the units, there was a lovely woodwork room and there seemed to be more for the patients to do then there is now. Whereas things should have moved on more rather than gone backwards and I’ve sort of expressed my views about it.
Some people like Helen and Beattie had experienced what life was like in the old “asylums” – the last of which were closed during 1990s. Asylums were separate institutions where people could often live for a large portion of their lives. They often had many in house facilities such as hairdressers, dentists, even farms and ballrooms. Helen said when her second baby was taken into care, her husband and in-laws forced her to admit herself to a mental hospital, which she describes as “infamous” as there were deaths under suspicious circumstances.
Carys thinks the situation in inpatient hospitals has improved in recent years, but that the wards where her daughter had stayed years ago were awful. Her daughter ran away from these institutions several times.
Carys thinks the situation in inpatient hospitals has improved in recent years, but that the wards where her daughter had stayed years ago were awful. Her daughter ran away from these institutions several times.
SHOW TEXT VERSION
PRINT TRANSCRIPT
She’d spent years running away, being picked up, put into prison, bought back to the unit, locked up in the most horrific secure unit that you’ve ever come across. Absolutely awful. The regime there was, I should think it was probably worse than the prison regime. Nobody was allowed to go to their lockers after 10 o’clock in the morning. Nobody was allowed to go and lie on their bed regardless. All the staff wore grey battle dress style uniforms. The, they had, their food was absolutely extraordinary. It was awful. I don’t know how they managed to be so ghastly. They weren’t allowed mugs of any kind. They had thin plastic beakers. There was no hot drinks, in case of accidents. Every single stick of furniture was screwed to the floor. There were bars on all the windows.
The way people were spoken to, including visitors families, was just incredible in its awfulness, absolutely dreadful. And because she continually ran away, mainly because she didn’t want to be in the hospital obviously [laughs] that’s why they decided to lock her up.
While there were certainly reports of bad experiences in hospital, most people felt in general that the staff in hospitals were very good. Sheila said on the whole staff were supportive, even though some didn’t seem bothered. During one of his admissions to hospital, Sunil said he was only seen by a consultant for a few minutes once a week and was mostly seen by relatively junior, inexperienced, registrars. He felt his treatment was “grossly mismanaged” (see for more ‘
Medication for mental health conditions: effectiveness and side effects’). Accounts of mistreatment by staff was rare, but Sue made a complaint about two members of staff abusing her, although the hospital did not take her complaint forward. She felt that having had ECT she was “powerless”, and the staff thought they could treat her in any way they want to. You can read more about relations with medical staff here ‘
Relationship with Health and Social Care’.
Last reviewed January 2018.
Copyright © 2024 University of Oxford. All rights reserved.
