News & views Members' blogs Card Games & Colouring Books: an Inpatient Perspective on being Sectioned Jennifer Reese, April 2021 A heavy stillness sits over the ward garden in the blistering summer heat. The black leather bean bag I’m sat on is hot to the touch, sweat from the back of my legs makes it slippery when I move. I have my eyes closed; I’m listening to the Occupational Therapist encouraging two patients to throw colourful balls into a bucket. He cheers enthusiastically, even when they miss. The ward is so hot, it was impossible to sleep last night. The staff are worried about us becoming dehydrated. Each afternoon a Health Care Assistant comes round with a box off cheap ice lollies wrapped in thin white paper, that leave sugary smears around people’s mouths and leak trails down my fingers. In film versions of psychiatric hospitals patients engage with a curated programme of creative therapy. They sit around in delicate circles and have meaningful epiphanies. At the end of the film, they’re picked up by a loving family member, packed into the car with a new- found fragile sense of hope, tenderly wanting to live again. This has not been my experience. For me psychiatric hospital is the metal clang of a police cell door until a bed becomes available, a six hour wait in A&E to be assessed. It’s a place free from sharp edges, a blue plastic matt pressed against my face during restraint, an indifferent anonymous bubble separate from the obligations of day-to-day life. Mostly it’s a crushingly overwhelmingly boring desert of time, punctuated by the sudden high-pitched beeping of alarms, the sound of running feet and jangling keys. Psychiatric hospital is staring out of windows and roaming corridors and waiting and waiting and waiting. My Ward Round meeting is on a Thursday afternoon, this is the only time I see a Psychiatrist. He wears a suit jacket that seems slightly too small, the sleeves ride up awkwardly. He smiles broadly at me and asks how my week has been. So far, I’ve only been allowed thirty minutes leave per day when a staff member is free to escort me. Waiting for leave is a different type of waiting from counting the days before you’re allowed to pick up the scattered pieces of a real life. It’s an itchy anticipation, a desperate staring at the clock. When other people have leave and yours has been revoked there’s a small, pointy jealousy as they’re signed out, their outfit recorded in a fat folder kept under the nurse’s station, in case they run away, and the police need a description. I lay sprawled across an armchair in the women’s television lounge waiting for my turn to go outside. The shift change handover meeting took longer than usual today. A young nurse puts her head around the door, ‘Did you want to go out on leave Jen?’ I nod quickly, scrabbling up from my chair. ‘I just need to get my shoes’ I say hurriedly. If I’m not quick she may be called away by an alarm or asked something by another patient that’ll tie her up. I run down the corridor to my bedroom and swing the door open wide. Sat on my bed is a middle-aged woman holding an apple. She’s leant forward; the early evening light casts a long shadow across the room. I stand in the doorway and stare at her, confused as to why she’s in my bedroom. She sits silently and then slowly says, without turning her head, ‘This isn’t your room.’ I look around disorientated, the bedding is different, there are no books on the windowsill. I’m so confused then I realise, in my haste I’ve gone down the wrong corridor. I was detained at this hospital in the Spring, this was my room then. I apologise and back out slowly. She remains sat, her face in profile, staring at the apple in the half light. The days bleed into each other. I know it’s Saturday because the clean linen trolley is parked next to the breakfast trolley. I take my time, laying out the crisp white sheets on the floor. There are no groups at the weekend, changing my bed sheets is the only activity I have, so I make it last. There’s a singing group on a Friday, two or three patients sit in the art room as the Occupational Therapist passes around photocopied lyrics to Louis Armstrong’s ‘What a Wonderful World’. They sing tunelessly and out of time. I stare out the window at a magpie with a twig in its beak and wonder when I’ll be allowed to recommence my life. Some days I lay on the floor of my room and stare at the ceiling to look at something different. Sometimes I ask for a Lorazapam because I’m bored, and I want to sink into a blue medicated haze and feel nothing at all for two hours. Patients queue up 20 minutes before dinner, listening out for the whirring metallic clang of the food hatch opening. For dessert there are slabs of old-fashioned school puddings- treacle sponge with ladles of pale chemical yellow custard, slippery trifle that’s mostly cream. I eat because I’m bored, I eat because I miss my family, I eat because my new medication makes me hungry all the time, an insatiable gnawing hunger that craves starchy crisps and chocolate bars. My thighs thicken, my clothes become tight. I start wearing jogging bottoms so I can eat more comfortably. I sit with other patients in the television lounge for hours in front of reruns of Midsummer Murders and The Bill. In the evenings we watch holiday programmes; tanned presenters stand on beautiful beaches talking to the camera, while we wait for supper, small individually wrapped packets of cheese and crackers and thin bitter hot chocolates, before being called to queue up for night medication. In the 3 months I spend detained in hospital the emotional skills group runs twice. The nurses take turns reading from a booklet designed to be used in the community. When they ask how we can distract ourselves from emotional distress the booklet lists meeting friends, a walk in the park. We replace them with ‘playing cards with other patients’ and ‘colouring’. I’m told I need talking therapies and the Psychiatrist thinks it’ll be better if this starts in the community. After I’m discharged it’ll be six months before I’m assessed for therapy. Six months of self-injury and dissociative seizures, phone calls to the crisis line and the threat of being detained again. Often since my last admission I think of the woman holding the apple, sat in her anonymous bedroom in the dusky summer evening light. I think of that moment of confusion, where I wasn’t sure who she was. I wonder that maybe we’ve travelled in time and I am that woman, and she is me, hair hung loose, stooped forward, resigned and alone. After each psychiatric admission, I’ve lost something of myself in those neon lit rooms with windows that only open an inch. I think now that a part of me is still sat in that bedroom waiting, for someone to say I can finally go home. * The Mental Health Act White Paper The Mental Health Act 1983 is a piece of legislation in England and Wales setting out when and how people can be detained (“held under section” or “sectioned”) and hospitalised for mental health treatment, even if it is against their wishes. In 2017, an independent review of the Mental Health Act was announced, intending to address concerns about the rising number of detentions and disproportionate number of people from racialised communities being detained under the Act. It concluded in 2018 and you can read the report here. In January 2021 the government released a White Paper on the Mental Health Act, setting out their proposals for future legislation based on recommendations made in the review. It is now open to a public, online consultation until the 21st April. You can read NSUN’s initial response here. After the consultation closes, final policy decisions will be made and a revised Bill will be released, “when Parliamentary time allows''. The consultation is in the form of a long survey, and it is worth noting that you do not need to answer all of the questions. Depending on how much you know about the Act, it might be helpful to read more about the Act before you respond - for example, you can read Rethink Mental Illness’ resource on the Mental Health Act here or their page on responding to the consultation here. You can also watch NSUN’s Q&A webinar on the Mental Health Act White Paper. Jennifer provides an insight into what it’s actually like to be detained under the act, specifically focussing on the inpatient environment on wards. “Therapeutic benefit” is one of the newly proposed “guiding principles” of the Act, defined as: “ensuring patients are supported to get better, so they can be discharged from the act”. While this is a new key principle, the actual meaning of therapeutic benefit is vague within the White Paper, and there is a lack of clarity on how it would be applied. You can share your thoughts and experiences directly with the online consultation, or you can email us (by the 16th April) so we can include your views in our response, which we will publish.