Tthree years, seven months and 19 days. This is the time I spent incarcerated in the psychiatric system. I look back on my years living in inpatient wards with a mixture of heartache and heartache. And I still wonder: is institutionalized care really the only option for the most critical cases?
When I was 27, I had a psychotic episode. The psychosis is ruthless. It took on everything I knew about myself and left a dark void of a person. I was severed under the Mental Health Act and detained against my will in the hospital.
I arrived in the service depressed and delusional. A psychiatrist quickly diagnosed me with bipolar disorder and prescribed me medication. My mood improved; doctors tinkered with drug cocktails until the delusions died down. Being here was a vacation for my mind, a place of safety, a place to get better.
But life in a psychiatric ward is regulated and controlled. I took my meds at the same time every day, ate at the same time, and slept at the same time. I lost my autonomy: the staff told me when I went out and for how long. They would count the place settings after each meal before I was allowed to leave the dining room to check that I hadn’t taken anything to hurt myself; all the sharp objects I owned – razors, tweezers, even glass makeup bottles – were taken from me and kept in the security closet. I was searched every time I came back from going out.
I know it was done to protect me, the other patients and the staff, but it was suffocating. When I was 18, I had walked through Nepal on my own – now all my freedom and autonomy had been taken away.
In the year up to March 2021, there were 53,239 new Mental Health Act detentions – an increase of 4.5% compared to the previous year. Mental health professionals will tell you that they always avoid keeping people out of hospitals if they can: long hospital stays can lead to addiction and institutionalization, rather than autonomy and the freedom people need for long-term recovery.
Currently, 8 million people are excluded from NHS mental health care because they are not sick enough, and 1.6 million more are on waiting lists. With that in mind, it’s easy to see how mental health can get out of hand. This care crisis means that the idea of supporting people like me in our communities, where we can access professional help alongside a network of family and friends, is becoming more and more distant.
I have met patients who languished in psychiatric inpatient wards for years – some even decades. It is not life. I got used to the alarms that go off throughout the day and night as staff rush into the room of the most recent self-harming patient. If a patient could not be taken care of, he was taken to solitary confinement, a completely bare room. The point of putting them there was to calm them down. I could hear their screams and screams and it still haunts me.
Once, another patient stopped taking her medication and relapsed. She wrote swear words on the walls in felt-tip pen, destroyed the parish garden, and smashed her bedroom window with a billiard ball. Another day a patient walked into my room and swallowed the batteries from my TV remote control and had to be rushed to A&E. I later learned never to leave my door open again.
I owe my life to the service staff – their endless energy, compassion and patience have given me back my dignity and self-esteem. I learned the importance of taking care of myself. “Self-care” has been hijacked by advertisers as a millennial middle-class platitude, but it’s more than an expensive bubble bath. It’s making sure that I take my medication on time. It’s making sure I’m not overly stressed academically or professionally. It’s cultivating my friendships and my support network. Most importantly, taking care of yourself is a mindset; it’s forgiving myself and prioritizing time and kindness for myself.
I also started a course at Open University while I was hospitalized. It gave me purpose, energy and motivation. I was no longer just a patient or a diagnosis; I was a student with aspirations and goals.
Still, I wonder if I really needed to be in the hospital for as long as I was beyond my initial crisis period. I became, as Sylvia Plath wrote, imprisoned by the bell, “simmering in my own sour air”. The jar – my mental state and the rules of the institution – choked me over the years as I struggled to get better. The psychiatry department taught me a lot of things, but above all it taught me how important freedom is. We need to have a national conversation about whether the best way to treat patients with severe and persistent mental illness is to leave them in psychiatric wards.
As I recovered from my illness, every step towards freedom was a small victory. I gradually started to worry about my appearance, having stopped worrying when I first got sick. When I got out, I would take long walks in the park, read and write in cafes, and go out for drinks with friends. Finding my freedom was like going from sepia to color. I still think back to my time in the psychiatric ward and wonder how my fellow patients are doing. Are they out now, are they living their lives, or are they still confined to the maze of hospital life? I pause, then I continue. Now I have to write my own story.