On What To Expect on the Psych Ward

You’re staring down the prospect of being admitted. You’ve never been to a psych ward before, but you’ve seen the movies. You know they’re sterile, white places, like all hospitals are, the floor is tiled and there’s a room with a bed with straps on where they tie screaming patients down for everyone else’s safety. Straightjackets will almost certainly be involved and there’s that one patient sat in the corner muttering to themselves about killing everyone. The nurses all have needles at the ready to deal with unruly patients, of which there are plenty. None of them give a shit and they all have stony, emotionless expressions. The doctors want you on seventy tablets a day and when you leave, if you do, you too will have the same blank expression, completely void of all emotion and creativity.

You’d think by now such stereotypes would be archaic and irrelevant, that we all know better, and new patients, when faced with the prospect of impending admission, would treat this as a space to recover and get well. The photo at the top of this article is what a lot of people imagine. In reality, it’s much more likely to look something like this.

typical_room

As you can see, cover photo and fear is, well… not the case. I’ve had to reassure many friends on this subject, and I had those fears myself. An admission is never pleasant but it’s made terrifying by age-old stereotypes for first-timers. I remember my first time being shocked the fact they had carpet. And wallpaper. I don’t know what I’d anticipated but it certainly wasn’t that the place would be almost homely.

Of course every psych ward is different, and whether it’s a public or private ward tends to make a pretty big difference, but here’s a few common threads to reassure you.

First off straightjackets are pretty much illegal now. You certainly won’t see any of those. There often is an isolation room where patients who are agitated can go until they’ve calmed down, but usually this is only used if they’re really kicking off, which isn’t all that common. Sedation is a last-resort. Nurses have to do observations, or ‘obs’, which is just where they’ll check on you every certain amount of time, which varies depending on how much of a risk you’re deemed to be. Most people come in on ten minute obs, so the nurses check in every ten minutes. They don’t tend to pester or anything, just have a look to see if you’re okay. The closer you get to recovery, the longer the period of time between checks. The higher risk you are, you may end up on 1:1 (one to one) of which there are different levels, but the basic premise is there’s a nurse with you at all times. Sometimes they only need to be within eyesight, other times at arm’s length, higher risk patients may end up with more than one nurse with them. This sounds scary, but often I’ve found 1:1 nurses can be really helpful, from having mundane conversations about everyday life, to 24hr support. Most patients will stay around 10 or 15 minute obs though.

For the most part, nothing much happens. I’ll be honest, it gets boring. It’s always a good idea to make friends with other patients so you have a way to pass the time and not get lonely, but it’s a good idea to pack some things to keep you entertained. If you’re a reader, you will go through books at an unprecedented rate. When you first arrive, nurses will go through your possessions and remove anything which may be harmful, this often includes wires, glass bottles, shaving razors, aerosols, belts and scarves, and other things. Last I heard they’d loosened the reins a little with this, but either way, I’d expect they’d still take chargers, so for electronics, you’ll have to hand them in at the nurses’ office when they’re low on charge for them to charge them. Talking of electronics, I can’t honestly say I’ve ever had anything stolen while in hospital, but it does happen, so be a bit cautious about leaving stuff around. The hospital will often put on some form of activities to keep patients from getting bored (in NHS hospital this is often occupational therapy, which is a fancy way of saying crafts and glitter, private tend to do more therapeutic based stuff) though sometimes you can just get a bit bored of this too (there’s only so many times you can do some colouring in before it loses its charm) so like I say, bring something to pass the time.

If you’re having a bad mental health day, there are nurses about just about all the time. Sometimes places are under-staffed so you might have to wait until someone finishes obs to talk, but there’s always someone there. If your crises are well-timed, your worker might be around to offer more fleshed out support. If your problem doesn’t feel like something that talking will fix, you can ask for PRN, which is emergency medication, usually some kind of benzo. Often just sitting in the living room around other people can help.

Routine wise, I mentioned they often do OT or if private, therapy. Usually meds are dispensed at different times of the day, depending on when you’re prescribed to take them (if you take them at all, if you don’t, you don’t need to bother with this bit) but if you take them in the evening, prepare for a queue. If you got there first, lucky you, it’s over and done with with no queuing. If you’re nowhere near, then I’d advise just going back to your room or carrying on as you were for a while and aiming for last. Queues for meds can take longer than an hour to do everyone. At most places you will also see your consultant once a week and you can discuss how everything’s going and any changes to your medication is done here mostly. Nurses also have handover twice a day, which just means ‘changing from day shift to night shift’. Usually this is finished by about 8:30, both AM and PM. If you need a nurse during this time, you might struggle as usually there’s only one about and they’re doing obs.

I never really found hospital food to be as bad as its reputation makes out, but they are obliged to accommodate any dietary needs you might have (vegetarian, halal, kosher, allergies etc). Often you’ll choose what meals you want for the week or the next day in advance from a menu. You can also bring your own snacks in and there are always drinks about.

As to whether you’ll have your own room or be on a ward, that really depends. In most private hospitals, everyone has their own room. On NHS hospitals, there’s usually a mixture of dorms and single bedrooms, often with higher-risk patients getting their own room. Single bedrooms often have a single bed, a bedside table, a sink and wardrobe (don’t be confused by the wardrobes that have slanted or curved doors – it’s to prevent ligature risk). Dorms usually have about five beds in the room, with a sink in the corner. You’ll have a single bed and a bedside table (by the way, these can be locked at your request, it’s often sensible to do so) with a curtain to pull around so you have some privacy, though nurses will often pull it slightly aside so they can do obs without disturbing you at night. On the ward there’s also usually a main living room with a TV, a room for occupational therapy, a quiet room and a private room for patient-consultant meetings (often there’s one of each, but sometimes one room will be used for both purposes). There’s also a nurses station where you can nearly always find staff if you need them. If you’re on a ground floor, you may well have access to a courtyard of some kind which used to be for smoking, but since my last admission, smoking was banned, so I’m unsure if it can still be used for that, or even whether it’s a blanket ban across the country. From what I understand, nurses might escort you outside to smoke if you have the appropriate leave.

For baths and showers, you will probably have to ask a member of staff to unlock the bathroom (don’t worry, toilet cubicles are always unlocked unless someone’s in them) and give you some towels. If you’re in there for a while you might get a member of staff knocking on to see if you’re okay, but more than likely you’ll have some peace and quiet, unless you’re on 1:1. If you are, then yes, staff need to come in with you. I’d advise if you don’t want them seeing anything to wear a swimsuit or bikini.

If you’ve been admitted spontaneously, you may well not have many possessions on you. The hospital can lend you pyjamas, towels, some basic shampoo and conditioner and sanitary towels if necessary, but none of these are great. Especially not the sanitary towels (big, bulky fluffy things) and the shampoo’s pretty drying, so it’s best to contact someone who has access to your house or can pick some things up for you for the time being. You can use a phone on the ward if you don’t have a mobile. You won’t be without at any point, but if you want to make it a bit more pleasant, this is your best bet.

It’s useful to know your rights also, should things get a bit messy. If you are in hospital on a voluntary basis (aka, you aren’t sectioned or forcibly admitted) you can refuse medication, and you can request discharge at any time. It’s worth noting that your request for discharge will be considered by your consultant and if they don’t feel you’re safe to go home yet, they can refuse it. If they do this, I would advise against trying again for a little while. They can section you if you keep trying and you’re not well enough. You are entitled to an advocate, so if you feel you aren’t being listened to, or struggle to articulate yourself in meetings, they can push your case for you. If you have been sectioned, and you feel it’s unfairly so, you can request an appeal, though this usually is the case for longer sections as it could take a while to process.

As you get closer to discharge, you might be allowed leave. This is where you’re allowed to leave the ward and often is tailored depending on you. For example, you might only be allowed leave with a nurse or family, you might be allowed the weekend at home, or you might be allowed out alone, it depends. It nearly always has a time limit (say, an hour’s escorted leave, or the weekend at home) and it’s not really a good idea to test how lax they are with this unless you give them plenty of notice (e.g. you might be close to discharge and on weekend leave at home, you could ring a day or two before you’re due back to ask for an extra day).

All-in-all, it is definitely a structured environment with its own rules, but it is not at all like the foreboding media stereotype. It’s best to treat in-patient stays as a safe environment, where any risk to yourself is minimised, and with plenty of time to work on healing. You nearly always come out with more friends than you went in with, too.

Did I miss anything? Are there any things you’d like to know about that I haven’t mentioned? Feel free to comment asking and I’ll do my best to answer.

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