A Patient's Experience in and After a Hospital
Virtually everyone we talked to had spent time in a mental health facility at some point due to severe mental health issues. Although many people had only been admitted to the hospital once or twice, others had been admitted multiple times (six to eight times; Anna related that she had been admitted to the hospital twenty-four times). A few individuals were unable to recall the total number of times they had spent time in medical facilities.
People can either voluntarily or involuntarily check themselves into hospitals. If a person is found to have a mental illness that requires immediate treatment because they pose a serious and immediate risk to themselves or to others and there is no less restrictive alternative, then they may be subjected to involuntary treatment under the terms of the Mental Health Act. For instance, a psychiatrist must confirm that the individual suffers from a mental illness that requires immediate treatment. Some of the people we talked to had started out as voluntary patients in either a private or public hospital, but they were eventually forced to become patients against their will and were transferred to a public hospital. An independent Mental Health Review Board or Tribunal is responsible for conducting routine reviews of the circumstances surrounding all involuntary patients. In the Australian state of Victoria, this body was formerly known as the Mental Health Review Board but is now known as the Mental Health Tribunal (MHT). Prior to 2014, it was the responsibility of the MHRB to decide whether or not to continue or revoke involuntary treatment orders. Since 2014, it has been the responsibility of the MHT to make Extended Involuntary Treatment Orders after an application has been made by a mental health service. The Tribunal is also responsible for hearing appeals from patients regarding the involuntary nature of their treatment.
Being admitted
Even if they claimed they were very ill at the time, the majority of people remembered being admitted to the hospital at some point. Some patients were referred to us after seeing their primary care physician or after consulting with a psychiatrist. A few individuals checked themselves in by going straight to the hospital, while others were brought in on an emergency basis following an unsuccessful suicide attempt (e.g., g (via medical transport) A few of them disclosed to us that they were coerced into going to the hospital. Maria was taken to a psychiatric ward after the police were called and she 'threw all of the doctor's paperwork on the ground' in the middle of a consultation.
After that, I did nothing but sleep the whole day. Then, around seven in the evening, my daughter called me, and at that point I was kind of faking it, drifting in and out of consciousness. I was aware of the phone ringing. I said, "Hello " And then she introduces herself by saying, "Hi, Mom, it's [daughter]" And I said, "Yeah " And then she asks, "Are you doing okay? " " I said, "Yeah, yeah, yeah, I'm fine, love" I said, "I'm just tired I'm sorry, but you've really jolted me awake. And then she asks, "Are you sure about that?" And I responded, "Yes, [daughter], don't worry; everything is fine"
And, in any case, I concluded our discussion, and somewhere between five and ten minutes later, I received a call from a friend. And then she says to Helen, "Daughter just called me," before hanging up. It's clear that she's concerned about you. Due to the fact that [daughter] was living on the opposite side of town at this point in time And then she asks, "Are you doing okay?" " And I just started bawling my eyes out. She then asks, "Helen, what's the matter?" You okay " And I said, "No" And then she asks, "What's the matter?" " And I said, "I've done something stupid" And her response is, "What?" " And I said, "I've taken an overdose" And then she calls out "Helen" As a result, she arrived at my location within a few minutes, placed a call for an ambulance, and, of course, rushed me to the hospital.
And I was in there, in the ward for about a week before they put me in the psychiatric unit at the hospital. And I was there because I was having mental health issues. After that, a nurse arrived and helped me into a wheelchair, and a security guard accompanied us the rest of the way. In addition to that, he was armed, if my recollection serves me correctly. I don't know if I was hallucinating or if I just can't recall what happened. But I had no choice but to sit there and sob my eyes out, as you well know. And while I was thinking that, the nurse was attempting to put me at ease. She told me, "Helen, it's not as bad as you're thinking," you know, because I'm thinking of all the terrible movies that I've seen on TV where people have been locked up and banging on the doors, wanting to get out, and that sort of thing. She said, "Helen, it's not as bad as you're thinking." And that was the only thing that I could think of at the time And then she told me, "You need to clear your mind of those negative thoughts." It's not a big deal at all"
As soon as I was wheeled in, you know, and I saw, you know, everything was sort of quite open and friendly and that, I calmed down. So there you have it. And I don't know how long I was in there, but it was probably close to a month. Did it do me any good Not really at all, no Because I just felt like a number and because, you know, you just had this routine, I don't think I accomplished anything by being in there. I don't think I got anywhere.
While Brian and Charlie were incarcerated, they were taken to the hospital for treatment. Charlie "got in trouble" with the law, served time in a women's prison and a suicide cell, and then was committed to a forensic hospital where she was placed in solitary confinement.
That is such an intriguing fact. Mm, so then, after six months, you became very ill, and then they actually – were you in the psychiatric prison system after that, or was it an external psychiatric facility...
I was I was in the [psychosocial unit] for a total of three months. I have a feeling that they had a psychiatric ward there. That was fine, but at that point I wasn't receiving the appropriate treatment at all. There, I was basically just treated like a number, if you know what I mean. But that is something that I did not at all get from the psychological system.
Could you elaborate on what you mean by that and describe what it was like when it happened?
To clarify, I was still experiencing health problems. I was aiming my shots at the [psychosocial unit] with billiard balls and throwing them around the room. I was yelling for assistance, but no one came to assist me despite my efforts. I never did, and the thought of that persists in my head.
Then, how would that affect them, and would they respond to that by showing restraint or...
No, just ignored me Yeah Consequently, by the time it was all said and done, I had begun to feel a little bit disenchanted with the way things were proceeding, and oh my God. When I think back on it, however, I can say that it was quite the adventure. Yeah
I was in such bad health. They decided to go in a different direction, so I spent the night in [prison]. And they put me in secluded housing, and in the end they said – I still don't know to this day whether it was recorded because I was talking to myself as if there was no tomorrow. They said it was because I was acting as if there was no tomorrow. And they said, "Look, we've decided that we're not going to put you out on the ward or out into the gaol system." You need to get yourself to the hospital right away. After that, they transported me to the [prison assessment center], also known as assessment prison, and then a couple of days later, they transferred me to the [mental health hospital]. And there I remained for the better part of nine years, if I'm not mistaken.
A few individuals expressed their frustration at the challenging process of actually being referred to a hospital when they were experiencing severe illness. Lisa described how she was getting "worse and worse" until "eventually" her psychiatrist recommended that she check into a private psychiatric ward. It is possible that a delay in going to the hospital will be distressing. A consultation with a psychiatrist was scheduled for Carlo to take place before he could be admitted to a private hospital. Carlo reported that after the appointment was canceled, there was no alternative made available to him, and he was forced to wait, which "freaked" him out.
Then I went to the restroom, where I just sat down and screamed and sobbed and screamed until I could no longer contain myself. They also secured the door to the restroom. They eventually got someone to talk to me about it, but not before they wouldn't let anyone else into the restroom. She claimed that she was a social worker and talked to me for approximately half an hour. During that time, I explained to her that my social worker was driving me crazy, that I was reaching my breaking point, and that I needed to be hospitalized as soon as possible. However, they would not let me in. And, I simply had to leave, and you know, then the voice of the [social worker] came and said, "Now – now come and see me," and I had to leave. Therefore, I went to her office and had a conversation with the [social worker]. [Laughs]
Wow
Mm Therefore, it was challenging, but – yes
Do you have any idea why they would have chosen not to accept you?
To tell you the truth, I believe – no, they didn't really say – They didn't tell me that they didn't have any beds or any other reason; in fact, they didn't give me any reason at all. They just flat-out refused to let me in. I can't really comment on that either. They did not provide me with any new understanding in any way. It was almost as if they lacked a psychiatric ward, if you know what I mean [laughs] In addition to this, I was petrified of going to the hospital because I was petrified that I would receive electric shock therapy, and I was petrified of receiving electric shock therapy.
When they arrived at the hospital for the first time, some patients recalled having to go through the admission process. Sarah believed the evaluation procedure was too "administrative," and she believed that someone ought to have made an effort to calm her down and listen to her story. Carlo stated that he had the impression that "they were trying to interrogate" him, and the fact that they asked to take his photo made him feel as though he was "a criminal." Lisa recalled that her person and all of her belongings were searched for anything that could be used for self-harm. She distinctly remembers the hospital staff taking away her razors, blow dryers, and straighteners, all of which could only be used in the presence of a medical professional.
Fewer than half of the individuals with whom we engaged in conversation had, at some point in their lives, been subjected to an involuntary admission. A few patients voluntarily checked themselves into the hospital, but their condition was later upgraded while they were there. Gurvinder believed that the decision to make him an involuntary patient on the second day of his stay, at a time when mental health professionals had not really heard about or understood his symptoms, "wasn't really an informed decision." He lost his appeal of the decision, but he can now understand "where they [were] coming from" because he had attempted suicide and was "very paranoid."
I believe that everyone's experience with compulsory treatment has been a negative one, because if it weren't, it would be voluntary treatment. There is not a single person on the face of the earth who does not despise the system and despise everyone involved in it for the coercive treatment they have received. I mean, there are some people who get really resentful, and they'll never let go of it, which is, in my opinion, a terrible mistake. But even now, after, say, ten or fifteen years have passed, they still can't seem to let go of the rage and hatred they once felt. I don't know, all I can say is that I hope they'll think about it again. But, you know, I mean, when I went in, when I was an involuntary patient for the second time in 1998, I accepted when I was there after I had been medicated quite heavily to be brought down to ground level. This was when I was in there after I had been brought down to ground level. I conceded that, you know, especially in light of the fact that I was ill, and I accepted that I was ill.
A significant number of people shared their experiences of being coerced, either directly or indirectly, into agreeing to go to the hospital voluntarily on the grounds that, if they did not, they would be admitted involuntarily anyway. This could be very subtle pressure, or it could be more direct; Ann was told by the admitting nurse at a private hospital that because she was at risk of self-harm and suicide, if she didn't 'follow the guidelines,' they would make her an involuntary patient at a public hospital. The nurse made this threat because Ann was at risk of self-harm and suicide. When Alice was rushed to the emergency room of a hospital, she was concerned about the impact that her hospitalization might have on her professional life. She was able to recall the therapist assuring her that if she entered the facility voluntarily, it would be less likely to have a negative impact on her condition. Despite this, she was forced to become a patient against her will, and the next day, the Mental Health Review Board decided that she would remain a patient against her will.
And how many members of your family were present at this time? Or have you been more or less handling all of this on your own?
Oh no, both of my parents were at the house. I was as well; however, I had no idea that they were going to show up; however, they had called me and, as far as I can recall, I was reluctant for them to enter the house. I had no idea that they were going to come. Not the house, but rather the fact that I didn't want to see them; however, they eventually discovered that I was at home, which is when things started to go wrong, yes.
That's fine, but after that, you find yourself in the hospital, right?
Yes, I really did not want to go, but I simply had no other option. It was a very traumatic experience, but I just had to accept it and agree with whatever was, whatever they wanted to do, yeah, I wasn't happy about it, but I didn't want to make anything more difficult, so I kind of, I had to, it was a very traumatic experience, but I had to accept it and agree with it, yeah.
You mentioned that you had to "kind of suck it up and go in," and I was wondering if you could elaborate on why you felt that way.
Oh, because I didn't want to get in trouble with anyone, so I just did what I thought was right in that situation.
You mentioned earlier that it was a harrowing experience, especially because you were coerced into going to...
Yes, it was, and yes, it was a stressful experience.
…hospital You, on the other hand, were the one who chose to go.
Yeah
Could you elaborate a little bit more on that, as well as what took place while you were in the hospital?
Oh yeah, while I was in the hospital, I was having a lot of trouble sleeping. In fact, I've had a lot of trouble sleeping in general, and in the time leading up to that, I had months and months of sleeping on and off really, sometimes well, sometimes poorly, really short hours, and other things like that. The stay in the hospital was not a pleasant one, but I think they gave me some sleeping pills, and those pills assisted me in falling asleep and staying asleep for a short period of time. After that, when I got home, I kind of thought, "Well, now what?" Oh, I had better start sleeping better because I don't want to come back to the hospital again, I don't want to come back, you know.' On the other hand, I did not enjoy my time spent in the hospital because there is a lack of autonomy and patients are restricted in their activities.
A few individuals voluntarily checked themselves into a private hospital, where they reported that the conditions were superior to those found in public hospitals. After having visits to both public and private hospitals, Chris shared that he has decided to enroll in a private health insurance plan. He stated that if he ended up needing to go to the hospital once more, he would check himself into a private psychiatric facility rather than "go through" the experience of staying in a public hospital once more. Discretion, personal choice, personal hospital, personal doctor, and personal medication were some of the advantages that he listed as being offered by private hospitals. When asked about her experience, Michelle referred to going to a private hospital as a "refuge" where she could just rest.
A few people brought up the fact that when they were admitted to the hospital, they were not given any information regarding the length of time they would be staying there. Although Lisa thought it was "bizarre" to have to remain in the hospital "for an indefinite period of time," she accepted the fact that she would have to remain there until the treatment was completed. This was because she wanted to make plans to return to university.
Discharge from the hospital
Some patients either couldn't remember leaving the hospital or could only recall the fact that they had "recovered" and returned home. Others recall being taken aback when they were informed that it was time for them to depart, including Brendan, who remarked, "I didn't think anything had been fixed." Some patients checked themselves out of the facility, while others were discharged after the medical staff determined that they had reached a point where the facility could no longer assist them. Michelle remembers being told, "you can't stay here forever," at the conclusion of her second stay in the hospital, which lasted for approximately eighteen months. Lisa shared her thoughts by saying, "I'd like to think that I got well enough to leave, but also, in retrospect I think I [was] just sick of being there."
How were you able to, and how do you know how that occurred...
They finally let me go after three months because, according to what they told me, "there's not much we can do with you if you're not willing to take part in the activities, you're not going to consent to treatment, and you keep on running away." Well, they just discharged me after that. They have just sent me back home again after discharging me. Therefore, I believe they ultimately stated, "You are required to take part in what it is that we provide for you." I was told, "You'll have to leave if you're not going to participate in that, and if you're not going to do that, then you'll have to leave," to which I responded, "Well, it's obvious that I want to leave." So they responded with an "okay"
Getting discharged from the hospital was a step-by-step process for some patients. Tanai participated in a "great number of interviews." On multiple occasions, Helen was given permission to spend the day at her house with her family, and once it was determined that she could "cope with that," she was released from the hospital.
Yeah Yeah
Could you just talk about, I guess what that is – because I imagine that it might also be...
Stressful
Yeah Significant change
Well, as I've already mentioned, I've never actually hit anyone, but I used to get urges to punch people and strike out at them, and I went to a doctor and a psychiatrist, and they both told me that they wanted to put me on extended leave. Do you have any experience with extended leave?
Okay, but would you be able to elaborate on that?
Yeah Therefore, extended leave functions pretty much the same way as parole within the psychiatric system. You need to get the okay from every specialist, and then it has to be reviewed by a judge from the Supreme Court. And what was I going to say after that?
Therefore, one of the physicians approached you and said, "I want to put you up on extended leave."
Oh okay, yeah, but they said, "I'm going to let you know that if you have any urges to strike out, it might be a problem come the day of the court" Oh okay, yeah, but they said that. However, there was never a problem with it. They presented their case to the judge, and the judge said, "Look, he gets these thoughts, these impulses, but he's never actually," so I've hit people in prison, but I've never hit anyone in a psychiatric hospital. The judge said that this was because "he gets these thoughts, these impulses, but he's never actually." And that turned out to be rather satisfying. The strategy worked out rather successfully over there.
Excuse me [coughs] and for me, I was trying to find lodging in which I would be able to have my children with me. And they were telling me things like, "Well, we don't know that you're actually capable of looking after your children, and we're never going to be able to find you that sort of housing and blah-blah-blah-blah," and so on and so forth. And they offered me one at some point in time—a share house—and I responded by saying, "No, I don't [laughs], I don't want that." In the end, I just came to the conclusion that the only option I had was to return to [city], find a place to stay wherever I could, and then go and stay with an aunt of mine while I tried to figure out what was going on.
And on the third attempt, they let me go free. And when I got back, I found that the apartment I needed to rent was really pricey, like, I don't know, you know, a weekly fully-furnished apartment week-by-week. On the other hand, I had made preparations for that to take place in order to facilitate my release, and it did take place; I was then freed.
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