Psychosis (young people)
Being treated in hospital for psychosis
Most people we spoke to had experienced at least one hospital stay, lasting between one night to a year. Some were brought to hospital at the time of their first experience while others were admitted later. For some, the psychosis was closely associated with low mood and depression, and they had been in hospital regularly, for example because they were self-harming or had taken an overdose. Ruby said she had been admitted to hospital 250 times in 3 years and that she was sometimes “in and out” several times in a week. But not everyone we spoke to had been admitted to hospital, even when they were very unwell. Some people visited hospital as a day patient, which as Nikki (below) described, had benefits.
Emily self-harmed and attempted suicide when she was in hospital. While she was there she learned a lot about how to control her voices, but also started hearing external voices for the first time.
Emily self-harmed and attempted suicide when she was in hospital. While she was there she learned a lot about how to control her voices, but also started hearing external voices for the first time.
There were times when Nikki went into hospital as a day patient, instead of staying over. Although there was a lot of travel, she could be home in the evenings and have diet coke and listen to her music.
There were times when Nikki went into hospital as a day patient, instead of staying over. Although there was a lot of travel, she could be home in the evenings and have diet coke and listen to her music.
Brilliant, okay. So it was 'cause you, was that because you had the sort of comfort of home in the evenings and nights, but then, the interactions that you needed in the day with the specialists.
Yeah, yeah. That was what was most helpful for me, because I hated being away from home, because I didn't have like, like my music. I didn't have my headphones. I didn't have I loved Diet Coke, for example. I didn't have access to any of that. I didn't have access to any of the normal foods I like, none of the TV like my, my family and stuff like. So it was just, I hated it for that reason. But then, being able to have a bit of both was helpful. There were times when Lucy wanted to be in hospital because she didn’t feel safe living alone, but staff thought she would be better at home.
There were times when Lucy wanted to be in hospital because she didn’t feel safe living alone, but staff thought she would be better at home.
Hospital experiences
People were usually very unwell when they were admitted to hospital and some couldn’t remember much about their time there - Hannah said her memories were “a bit smoke and mirrors”. Sometimes medication could prevent them from thinking, or remembering about it afterwards. Most people had been treated in NHS hospitals, but Nikki had experience of a private mental health ward.
Nikki was sent to a private hospital when there were no beds available on the NHS. She feels private hospitals are run “like a business”.
Nikki was sent to a private hospital when there were no beds available on the NHS. She feels private hospitals are run “like a business”.
Like my dad can't stay with me? What on earth is going on? But then my dad had to go. Like they wouldn't let him through. And at that point as well, I had to kind of do what they said, because I was under their care now.
What kind of hospital was that that it was so different from the other ones?
Private hospital.
But it was still a child's—
Still a child's one, yeah. Adolescent, yeah. They took me into this like room with like squishy kinda seats that you find in primary school. I sat there and a doctor came and saw me and [sighs] they just kinda asked me questions about my life. What's been going on and that sort of thing and what thoughts I had and what feelings am I having? And then they said, you know, you're here voluntarily, but if you asked to leave, we will detain you. And I was absolutely terrified. And they took all my stuff. I wasn't allowed to wear any of my jewellery. They'd searched through everything and they just kinda said, ''Right, there's gonna be someone with you 24/7.'' And I was absolutely mortified, 'cause like, when I wanted to go to the toilet, I had to ask and then they had to watch me. And I'd never been in that situation before. And I was absolutely humiliated and I hated it and there was all these other people and, you know, people would come up to me and say, are you Prince Harry sort of thing and I was just like, no. And I was just terrified like not of the people, 'cause but it's just because I had no idea what was going on. Like I had no idea, but was so confused and I was, I hated being there, so I just tried to leave as soon as possible.
Did you have your own room or was it a sort of open ward or?
I had my own room. But I wasn't allowed, you're not allowed to sleep with a bra or underwear, any underwear on. And someone watches you while you're sleeping, the whole time. You are not allowed anything of your belongings with you, no, your toothbrush, all of that, they all stay in like the a locker and you're not allowed access to any of it.
And did they explain why they, why that was happening?
They just said, it's for people's safety. You know, I'm not really sure what damage a bra can do, but you know, there was their rules. It's very different when I went to a NHS hospital. I was allowed everything in my room. I got there and there was, I wasn't followed all the time. They, they allowed me to have my stuff. I felt a little bit more free, because my dad was allowed to take me out for like a drink or something, which was nice. —
And do you think that was to do with where you were at the time you went in or just the way the institution functioned.
Just the institution, yeah, yeah. I think private ones they, you know, they're very hot on security and safety. NHS have, they are as well, but, you know, they allow you your freedom a little bit more.
And when it came to going home, what was that process like? Who made that decision?
The doctors there really. But most of the time it was 'cause I was begging to leave [laughs]. And they're under pressure 'cause they don’t have many beds. And I just said, ''Look, I'm fine, I'm fine. Look I won't, I will never hurt myself again. I promise. It's fine. I want to go. I want like.'' And they just let me. And that was how it was most of the time.
And how long did you stay in for each time?
R: The first few times was very short. It was about a couple of weeks each time. The last time I was there for about five or six weeks. They were, they were all quite short, because I was just begging to get out, 'cause I hated every second of being there. It made me feel worse and I hated it. I hated it so much. All of my comforts, they were gone. Everything I was used to they were gone. I wasn't allowed my phone. I didn't have my family there. There was no source of strength or happiness in there for me. Kept me safe, yeah. But it didn't, it didn't improve me at all.
Making friends with other inpatients could be important and therapeutic. Hannah took most comfort from talking to other people who were inpatients, hearing about their problems and knowing that there were other people who were suffering as well. People could become very attached to friends they made and rely on their support, or want to be there to help them. Hannah found it distressing when she wasn’t allowed into the room of a friend she’d made, who she could hear was having a breakdown. Barry made a friend in hospital who was very patient with him and used to sit on the bean bags in the corner and chat away to him for ages. When she left hospital his delusions increased.
For some people, being in hospital when they were extremely unwell was a frightening time. Becky remembered it as “the worst time of my life, not being able to ever picture a way out”. Experiencing psychosis meant people could act out of character and some described being restrained, injected with a tranquilizer, or put in an empty room on their own. Luke said in the first few days “you’re a horrible human being”, violent, prejudiced, “trapped” “psychotic”. When he was first admitted to hospital Joseph had an “insane amount of energy” and was cartwheeling down the corridor and going into “Jackie Chan sort of karate mode”. He remembers kicking a light and breaking it and five “huge stacked guys” holding him down. He thinks he must have resisted but he now accepts “it was necessary for them to do that”.
During the first week in hospital Luke was “scared” and “destructive”, but after the medication began to work he returned to being his “normal” self. He has “great memories” of staff on the ward and goes back to see them.
During the first week in hospital Luke was “scared” and “destructive”, but after the medication began to work he returned to being his “normal” self. He has “great memories” of staff on the ward and goes back to see them.
And I've got great memories of with the staff. You know, I still often go back and see them. And they're fantastic. And you - you sort of indulge yourself in occupational therapy. You can find yourself watching telly, or - you know - making a pizza. Or going outside, and playing croquet with the occupational therapist. And then it was always [clears throat]. You can only - It's only going to be as good as you make it. And I've made some great friends from being in the hospital, both times I've been in.Fran works in a training centre for mental health staff and thinks there have been improvements in training about restraining patients.
Fran works in a training centre for mental health staff and thinks there have been improvements in training about restraining patients.
Yeah, yeah. So when you, when you say, when, when you say training, like working with staff, training them or training them about different issues and things, what, what do you do?
Ah, first, ah. Trying to think. Yeah, in, I was gonna say in the olden days I remember, it’s not that long ago. When I first got put on a ward, it all completely kicks off on a psychiatric ward. And people do a lot. And they become very dangerously violent. And usually it’s not their fault. But you get them in a restraint hold and you put them in a cell which isn’t that different to a police cell. You inject them with loads of drugs and basically you pin the person down until they’ve calmed down. That has been looked at, the restraint process, and they’ve said, “This isn’t right. We shouldn’t be doing this to ill people.”
So they’ve kind of engineered a completely new way where you lock arms instead. And so when you put the person in the room you don’t drag them. You like walk them. Actually it looks really sweet and really funny like three people, like that. And then you don’t hold them down and put the injection in their bum. You make sure they’ve got in to the room in a safe way. You give them a tablet to calm them down, which is more if they want the tablet, and you wait for them to calm down. It’s only in extremes that you put it... And basically I do stuff like help to teach people to do stuff like that rather than… Or there’s kind of care plans, where, most mentally ill people aren’t involved in their own care plan at all. And I’ve helped to design the new care plan and stuff. So I do stuff like that.
It sounds good.
It is really interesting as well. I like the psychology of it, yeah.
Some people were also given access to other therapies such as CBT (Cognitive Behavioural Therapy), dance therapy, art therapy, life skills and mindfulness. Not everyone found therapeutic activities helpful at the time. Nikki said “a lot of the time I was just bored”. Others didn’t feel well enough to benefit from therapies: Becky said “when you're having the worst day of your life and you don't wanna live anymore and they suggest going for a walk or something and you think, why on earth are you saying that to me?”
Interactions with staff in hospital
Interactions with health professionals and administrative and clerical staff in hospital were often an important part of people’s experience of being treated in hospital. Most people described a mix of good and bad experiences with staff. Joseph had some very positive experiences and said the staff could be “amazing” and would stop to chat with him whenever he needed to talk. Green Lettuce felt that there were some staff who clearly “just cared”.
However, people we spoke to also described poor communication and long waits to hear from doctors making decisions. A few felt that medical staff did not take them seriously or understand how unwell they felt. Andrew X said once when he was being admitted, the ward manager “had a go” at him because he’d had to get out of bed to do an assessment. Joseph never heard voices as part of his psychotic experience, but while he was in hospital he had a different medical professional each week come to him and say: “So Joseph, are you hearing thoughts today?” which he found frustrating. Hannah felt that the staff in hospital “just didn’t seem to care very much”.
Some people felt staff were “disrespectful”: Ruby overheard a staff member referring to her as a “frequent flyer” and when a new nurse introduced herself as Ruby’s nurse for the day, the cleaner commented sarcastically “lucky you”.
Being treated as a human being was important to Andrew X. He had mixed experiences with practitioners, and said some of the people who made the most difference to him in hospital were the receptionist or cleaner who he could have a “bit of banter” with.
Being treated as a human being was important to Andrew X. He had mixed experiences with practitioners, and said some of the people who made the most difference to him in hospital were the receptionist or cleaner who he could have a “bit of banter” with.
The difference is—
That they have made the differences, those positive, you know, those positive, because they're just, connected, connected me like I'm a human being. But there've also been some pretty poor, poor practitioners out there who have caused me a lot of damage, lasting damage. So it's really, it's a shame that that level of consistency is not there. But often, often it's like you get the most, I have found the people who've made the most difference in my journey haven't been necessarily the mental health nurses or the psychiatrist, they've been like the cleaner you have a bit of banter with. You can have a joke with or the cook who knows that you like ribs done in a particular way and will do them and like show you a bit of encouragement, a bit of kindness, a bit of humanity or you know, the receptionist that is able to have a joke and a laugh with you or the health care assistant who is a bit down to earth and will show a bit of themselves, you know, they'll not be afraid to be human and, and they've made the difference, I mean, particularly when I've been psychotic, because when you've lost contact with reality then the best thing to bring you back down to earth is someone being human towards you. When you've lost contact with reality, you don't need forced, artificial interactions – that just makes it worse. You need some humanity. That's why the Early Intervention Psychosis Services work so well, because they're just humans. They are not, they're not pretending to be some sort of super mental health nurse. They are just, let's go and grab a coffee and talk about stuff. Sameeha remembers a member of staff being “off handish” and “rude”. She says you can tell when staff don’t want to be there and don’t have any sympathy.
Sameeha remembers a member of staff being “off handish” and “rude”. She says you can tell when staff don’t want to be there and don’t have any sympathy.
So was he a member of staff?
Yeah, he was a nurse, yeah.
He was a nurse, yeah. Did you have much more dealings with him then or?
[clears throat] No, like occasionally. But I, in that time period as well [clears throat].
Are you okay?
Oh, no, no I've just got a cough. In that time period yeah, a lot of them were like that to be fair. It was like you know you can tell when someone, someone's intent isn't right or someone's intent isn't coming from the right place. I didn't really have much dealings with him, apart from that, but he was always very off handish, very kind of rude, kind of he didn't wanna be there kinda thing. So I always got that kind of atmosphere from him. But I, in that hospital I was only there for a week and then I got moved to another one. So, yeah, that was fine with him. Ruby, who has had regular hospital stays because of her mental health, has had good experience with staff in general hospital wards. She has found regular staff are well trained and keep her safe, although agency staff need to be more aware.
Ruby, who has had regular hospital stays because of her mental health, has had good experience with staff in general hospital wards. She has found regular staff are well trained and keep her safe, although agency staff need to be more aware.
Talking to me gently. Just generally chatting to me as well. But when I'm not in distress, because although being admitted, I was in distress. My BPD means that that can dissipate very quickly as well as it can come on very quickly. So I wasn't always distressed for the entirety of my stay. Yeah, just being, not judging anyone I think finding a way to let people outside for fresh air really helps. Because being, it's a locked ward, the young person's ward and being locked on a ward can be quite difficult. And yeah, if you're not allowed out at all then, yeah, it can be quite- just going outside even for five minutes fresh air can really help. But has also got me into a lot of trouble before [laughs], because there are risks that the nurses don't realise that there are, because it's a general hospital so they are not as trained. Things like the hospital shop sells Paracetamol to anyone over 16. And they also sell razors and pencil sharpeners and things like that. So, it, it can be a risk if you're out on your own. And agency staff, like the staff on the ward that are normally on the ward they know now, because it's they, they are aware it's happened. But agency staff don't tend to know. And so, when you're quite unwell, you can kind of talk your way into a situation that actually ends up hurting you more.
Some people were so unwell they were kept in hospital involuntarily under a section of the Mental Health Act 1983 (known as being “sectioned”). People can be detained under a section of the Mental Health Act to allow medical staff to examine, assess and treat them. Even if people go to hospital voluntarily, they can be detained there for further treatment without their consent. Medical professionals must consult with a range of people, including a person’s nearest relative, before sectioning a person. The Mental Health Act sets out when it is legal to detain and treat someone, who is authorised to do it, and what procedures should be followed. People are sectioned for a certain length of time, and can have the section removed: be ‘de-sectioned’. An assessment about whether to section someone is made based on their condition at that time.
Emily went into hospital voluntarily but then was sectioned.
Emily went into hospital voluntarily but then was sectioned.
Was that the same the first time?
When I went in the first time I was informal, yeah and then I got sectioned.
What was that like for you that process of getting sectioned?
It's weird, 'cos when I thought of being sectioned before, I thought it meant, you know, not allowed out, straightjackets and all that sort of thing. But they do it, the way it's done is quite well done, to be honest. They phone like your next of kin and ask what they think and so they phoned my mum and talked to her about it and what she thought was best. And then you go in there and you've got two AMHPs I think they're called. Yeah, Acute Mental Health Practitioner or something. And then you've got the psychiatrist in there. And there's also a nurse who sits next to you and so you've got these three people in front of you and they ask you questions about what's going on and you'd say about the voices and what you are seeing. They'd say, you know, what would you do if you left hospital and you would probably say like I'm gonna kill myself, you know. I remember arguing with them saying, it's not their choice. It was my choice. But because of that, that's when they sectioned me. And I was on a section for about seven months I think in total.
And at the time do you remember how that sort of seemed to you and how it felt?
It made everything worse for me, because you knew you couldn't escape the hospital. And even though they were there to help there is 21 other patients who have their own problems. There, there was a lady who would just scream all day. There was other ladies who would throw chairs. And you'd see people self-harming. And, I mean, I saw one lady ligaturing in the garden once. So it's hard to cope with that on top of everything you were dealing with already, because you've got these voices in your head and you are seeing things that no-one else can see, but then you've got this other people who are actually there, screaming and it just adds to everything. And sometimes it's like the worst place to be if you've got a mental illness.Andrew X talks about what he calls the ‘quasi section’ – when you’re threatened with being sectioned if you don’t stay voluntarily.
Andrew X talks about what he calls the ‘quasi section’ – when you’re threatened with being sectioned if you don’t stay voluntarily.
When Becky went into hospital voluntarily the second time she felt more “in control” and “everybody was really lovely”. When you’re unwell she says you’ve got to “let somebody else take over”.
When Becky went into hospital voluntarily the second time she felt more “in control” and “everybody was really lovely”. When you’re unwell she says you’ve got to “let somebody else take over”.
Barry explains that he was kept in hospital first under “section two” then under “section three” of the mental Health Act.
Barry explains that he was kept in hospital first under “section two” then under “section three” of the mental Health Act.
Oh right, okay.
The section two, you can be hold for up to twenty eight days. And whether you like it or not, but you have the option to appeal. And they do this because they feel that it’s for your own safety or others around you, for you to be under an inpatient service. Within those twenty eight days, they need to decide whether or not they are going to put you as a – I should know this. As an informal patient. The, that way you can - you’re being, you’re being - you’re receiving support at an inpatient service, but you have the free will to leave whenever you like.
Or if they feel like you need the support, for your safety or others around you, they put you on section three, which lasts up to six months. I was put on section three twice because at the end of the six months they still thought I needed the support.
You were only in, sort of went inpatient as it were for a month, and then?
No. I stayed at the hospital I was at.
Oh you, did the same time? Okay.
And the section three followed, before the section two ran out, and I was just -
Okay. So that means [inaudible]
Yeah. I was basically put in this one ward, and then I was put - over a two and a half month, month period. I was put in a - I was put in a ward.
But some were able to avoid staying in hospital under section. Dominic had never stayed overnight in hospital and his family opted to look after him instead. He stayed at home under what he described as “house arrest”. The agreement was that he would be sectioned if he left the house. Fran’s mother suggested that Fran live with her instead of being sectioned and Andrew X had a “commissioning arrangement” that meant he could be treated while living at home.
You can read more about being in hospital under a section of the Mental Health Act in other related modules: Experience of Psychosis, Mental Health: Ethnic Minority Experiences, Experiences of antidepressants.
Leaving hospital
Discharge from hospital is usually planned by a multidisciplinary team, and people sometimes have to wait for medication to be ordered. Some people remember being told they were going home but then having to wait for days before they were discharged, without being told why.
Sameeha describes desperately wanting to leave hospital and having to wait because doctors were on leave or too busy.
Sameeha describes desperately wanting to leave hospital and having to wait because doctors were on leave or too busy.
Do you remember how many sort of days it was that you were in that position where you knew you were ready to go.
I think it was four or five days I'd say, yeah.
But for many, leaving hospital was a difficult and stressful period, and for those who had been in hospital for a long time, being home brought new challenges. As well as coming to terms with what had happened, people had to deal with the emotional impact of their psychosis on their loved ones, the disruption to their plans for study and a career, and the loss of long standing friendships. When Fran came out she said “all my friends were either going to university or getting jobs or x, y, z. And I was just unemployed and really, really miserable and didn’t know what to do with my life”. Some faced periods of low mood and depression, further psychotic experiences, and homelessness.
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