Over the last few posts I mentioned that I was in hospital. I am now in an alternative to admission/step down house...its so much better:) anyway I thought I would write a blog on being on a psych ward!
When I was first admitted back at the beginning of March (8 weeks ago..eeek) there were no NHS beds in my local trust at all, so I was sent to the Priory in Hove. Bed shortage is a national problem, with 104 beds cut across here, and 1,700 beds being cut across the country since 2011. This is backdropped with the inequality in funding between acute (general) trusts and especially acute hospitals and mental health trusts...but that’s for a different post.
So lets get back to me! I had reached complete crisis point, and my CPN was really worried because of my thoughts, an so the crisis team were involved and I was admitted to the local psych unit for a week, I was given a week by Dr Cruella (not her real name) and so unconciouslly pretend I was a lot better than I was and was released. 10 days later after an OD I was seen by the crisis team who basically told me to just get on with it...I wasn’t coping I had gone back to work with service user involvement far too soon, the dissociation was extremely bad (which is how I took the OD as I was dissociating at the time) but I was sent home none the less. Two hours later I was back in A&E having self harmed and had to see the crisis team once again. This time they were a lot more sympathetic and understanding. This is not like me any more, I don’t do things for “attention” I was really suffering and in major distress. Luckily they took notice. They gave me the choice whether to go home overnight and go to The Sanctuary in the morning (an alternative to admission house) or be admitted that night. As I cant control my dissociation, and I was in so much distress – which increases the dissociation – I decided to allow them to admit me. Looking back it was the right decision. I couldn't guarantee my safety, and I needed the support of being an inpatient - and 8 weeks later I was discharged.
The Priory was amazing from any mental health or physical health ward I had ever been on! It was a complete eye opener to how the other side live. The Priory was much calmer than any unit I have ever been in – and that’s a few! I think (and one of the staff told me) that because its private (although a lot of people were using their insurance) people came in a lot earlier than is possible in the NHS, and so don't get to that crisis point that I had. The rooms were lovely and having a TV in there was very useful as it meant that when I didn't want to socialise that I didn’t have to, also I could watch what I wanted to rather than what everyone wanted to. So the environment in general was a lot better and cared for...not saying that the NHS isn't, just the private sector tend to have a lot more money. The main difference for me was that the staff ratio was a lot higher and so people had time for you and had more time to be able to talk to you as well as medication. Although I was on 15 minute obs the whole two weeks and wasn’t allowed out on my own, they always managed to have someone to take me out if Gemma was unable to come (she worked down the road!!). At first I was extremely nervous and thought that the other patients would look down on me because I was an NHS patient rather than a private one, but this wasn’t the case at all, we all got on really well. Obviously I got on better with some people than others, as in any situation. But no one looked down on me for being in a private hospital paid for by the NHS.
I was there for 2 weeks, and the best thing that happened in the long term is that they really looked at my issues and what medication would help, which has meant an almost complete change, and it is helping. They have given me an anti-anxiety (pregablin) one to improve my sleep...a complete change to how the NHS was treating it with sleeping tablets, as my biggest problem with sleep wasn’t that I couldn't it was that I was so scared of it that I fought it, as I think that I have mentioned before. Also although there is no medication that helps stop dissociation (only therapy) the medication that he added to my anti-psychotic (aripriprozole) were a mood stabiliser (lamotrogine), as there were anecdotal evidence that this combination can help with dissociation to some degree. I think that this is because it helps with the PTSD and distress with this and so reduces the feelings of being overwhelmed which lead to the dissociation. At this point I hadn’t really mentioned the DID, and so this wasn’t part of the conversation we had. I have found that some doctors, consultants especially in the NHS (and even more within mental health) have a very Us and Them attitude, even with the growing service user movement. This was not the case with the Doctor that I had in the Priory, it was a joint decision. I am not saying that in the NHS this is never the case – in fact I know its not having had a brilliant psychiatrist in north Wales – or that all private sector doctors were as good as Dr Rank. He explained all the pros and cons of the medication change and that he wasn’t going to stop my antidepressant until the lamotragine was up to therapeutic dose as it takes a while as is done slowly. I think the big thing was I had faith in him, and that he knew what he was doing and was doing it in my best interests.
The other difference from the NHS is that there is a program of CBT therapy all day every day. I guess if your paying £600 a night you expect some kind of therapy to help you recover. I am sure that the NHS would love to be able to do this, but constraints mean that this isn’t possible...but more of that later. I joined in a few of the groups, both on anxiety and depression. They weren't basic CBT, but a lot more in-depth, for instance a group was on Marlow's Hierarchy of Need, and another afternoon group (hour and a half) on challenging the automatic negative thoughts, and many others. However there was no pressure to attend the groups if you didn't feel well enough. For the Private patients they was also indervidual therapy. They were going to allow me to have a few sessions, but I was moved...
Then came the fateful day that they had a phone call from my local NHS unit, and I was recalled back. I literally cried for the hour I had to pack before the taxi arrived! And it was a shock back to reality. Back to the NHS where the nurses and the MDT (multidisciplinary team) have so much paperwork that they find it difficult to have time for patients, and where people are a lot more ill because of the lack of beds so people are a lot more ill when they are admitted.
I was lucky in that I knew the staff and they still knew me. I also knew that they were approachable should I need time, but in the 6 weeks that I was on the ward I can count on my hands the number of times that my named nurse came to see me and most (All except one) were my primary nurse, came to talk to me. I have no idea what is written as most of the time I kept myself to myself, and away from any dramas.
Like in any hospital, whether it be physical or mental, NHS or private night staff do have the most time for patients, its a pity that most of the time most people (not me!) are asleep!
The major difference for me from going from the Priory to NHS was activities. The Activity workers really did try their best to have activities as much as possible and as much wide variety to suit all the patients on the 36 bed unit. But apart from the one basic session of CBT a week there is no therapy. They are lucky that they now have a psychologist in post and that is a massive step in the right direction, but she is overworked for the amount that is needed from what I saw. But there is no specialised support, for example no hearing voices group for people who are hearing voices so that they could use peer support with a facilitator to be able to learn different ways to cope with their symptoms and therefore maybe help them get better. Sorry getting on my high horse again about how I would do things.
6 weeks now seems like a long time, but it really wasn’t. I made friends, friends that I hope to have for a very long time, we had laughs, we supported each other and became close. It is a very intense environment to be in, but that intensity can be used for good.
As you can probably guess I didn't get on with my consultant on the ward. It would make me physically sick knowing that I had to see her. I really tried to make the most of it, and explain what I wanted and needed from her by writing it down. In the most important ward round of them all (the one when I was meant to be discharged back to a flat that I just wasn’t coping in) my CPN was fantastic and very well advocated for me and my discharge was delayed! I also believe I wasn’t well enough to be discharged at that point, but she just didn't seem to get that from me. I feel that because I have an Emotional Unstable Personality Disorder secondary diagnosis some psychiatrists don't feel that long admissions are good for this diagnosis. What I say is take people as they are and what they need rather than by their diagnosis!!!
The worst ward round of them all was my last one. I was hoping that it would have been a nice goodbye type of ward round I couldn’t have been more wrong. I had been refused criminal compensation for what I had been through and was asking for her to write a letter in support of my application to appeal. Dr Cruella said that I should just forget my past...if I could do that I would have done it a long time ago!
I seem to be very down on the NHS, its not that, just that because there is less money than in the private sector that there is less opportunities. But I do think that at least most people whether they work for private or the NHS are in the job because they care, and that did come across in both places.
I am glad to be out of hospital now, and looking forward to moving to a more suitable accommodation.