Three years, seven months, and 19 days. This is the length of time I spent incarcerated inside the psychiatric system. I look back on my years living on inpatient wards with a mixture of grief and sorrow. And I still wonder: is institutionalised care really the only option for the most critical cases?
When I was 27, I had a psychotic episode. Psychosis is merciless. It preyed upon everything I knew about myself and left behind a dark void of a person. I was sectioned under the Mental Health Act and detained against my will in hospital.
I arrived on the ward depressed and delusional. A psychiatrist quickly diagnosed me with bipolar disorder and prescribed medication. My mood lifted; the doctors tinkered with cocktails of drugs until the delusions subsided. Being here was a holiday for my mind, a place of safety, a place to get better.
But life on a psychiatric ward is regimented and controlled. I took my medication at the same time every day, ate at the same time and slept at the same time. I lost my autonomy: staff dictated when I went outside and for how long. They counted the cutlery after every meal before I was allowed to leave the dining room to check I had not taken anything I could harm myself with; any sharp objects I owned – razors, tweezers, even glass makeup bottles – were taken from me and kept in the security cupboard. I was searched whenever I came back from going outside.
I know this was done to protect me, other patients and staff – but it was suffocating. At 18, I had trekked across Nepal on my own – now all my freedom and autonomy had been taken away.
In the year to March 2021, there were 53,239 new detentions under the Mental Health Act – an increase of 4.5% on the previous year. Mental health professionals will say to you that they always avoid keeping people out of hospitals if they can: long hospital stays can lead to dependency and institutionalisation, rather than the autonomy and freedom people need to make long-term recovery.
Currently, 8 million people are shut out of NHS mental health care because they don’t qualify as ill enough, and a further 1.6 million who do are sitting on waiting lists. With this in mind, it is easy to see how mental ill health can spiral out of control. This crisis in care 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 met patients who had languished on psychiatric inpatient wards for years – some even decades. It is no life. I got used to the alarms going off all through the day and night as staff rushed to the bedroom of whichever patient was the latest to have self-harmed. If a patient couldn’t be managed, they were taken to seclusion, a completely bare room. The aim of putting them there was to calm them down. I could hear their cries and shouting and it still haunts me.
One time, a fellow patient stopped taking her medication and relapsed. She wrote expletives on the walls in felt-tip pen, wrecked the ward garden and smashed her bedroom window with a snooker ball. Another day, a patient came into my room and swallowed the batteries out of my television remote control and had to be rushed to A&E. I learned after that never to leave my door open again.
I owe my life to the staff on the ward – their inexhaustible energy and supply of compassion and patience gave me back my dignity and self-worth. I learned the importance of taking care of myself. “Self-care” has been hijacked by advertisers as millennial, middle-class platitude, but it is so much more than an expensive bubble bath. It is making sure I take my medication on time. It is ensuring I am not under too much stress academically or professionally. It is cultivating my friendships and support network. Most importantly, self-care is a mentality; it is forgiving myself and prioritising time and kindness for myself.
I also started an Open University course while an inpatient. It gave me purpose, drive and motivation. I was no longer just a patient or a diagnosis; I was a student with aspirations and goals.
Still, I do question whether I really needed to be in hospital for as long as I was beyond my initial crisis period. I became, as Sylvia Plath wrote, imprisoned by the bell jar, “stewing in my own sour air”. The jar – my mental state and the rules of the institution – smothered me over the years as I fought to get better. The psychiatric ward taught me many things, but mainly it taught me how important freedom is. We must have a national conversation about whether the best way of treating patients with severe and enduring mental illness is to leave them on psychiatric wards.
As I recovered from my illness, every step towards being free was a small victory. I gradually began to care about my appearance, having stopped bothering when I first fell ill. When I was discharged, I would go for long walks in the park, read and write in cafes, and go out for drinks with friends. Regaining my freedom was like going from sepia to colour. I still think back to my time in the psychiatric ward and wonder how my fellow patients are doing. Are they out now, living their lives, or are they still confined to the labyrinth of hospital life? I pause, and then I move on. Now I have to write my own story.
Jen McPherson is a student and freelance journalist