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Depression

Hospital based treatment for depression

Getting a bed in a NHS psychiatric hospital usually happens when someone is considered very ill (e.g. a danger to themselves or others). It can be voluntary or through being 'sectioned'. Sometimes it can be difficult to get an NHS bed, and one woman once felt she had to act-up a little to get one. If someone has private health insurance, they may be able to go to a private psychiatric hospital. Hospitals also have Accident and Emergency as well as Outpatient departments which people use when they do not need to be admitted to a psychiatric hospital.

 

Felt she had to present 'dramatically' in order to get into hospital.

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Age at interview: 58
Sex: Female
Age at diagnosis: 20
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And, well, I was quite some weeks ill before I got taken to hospital, because, certainly in 1994, I think it's still the case, it's very difficult to get a hospital bed for quite severe mental illness. You've got to be suicidal.

And were you suicidal?

I was feeling suicidal. I was also quite violent at times. I mean in my own doctor's surgery, I swept all the things off his desk you know. I mean I did realise I was really ill when they called for an ambulance to take me into mental hospital. The same time there was a part of me, kind of watching what I was doing' saying, "Right, well make it really dramatic." I wasn't pretending exactly, but I knew I had to make a song and dance to get heard.

 

He felt he got better care at a London-based outpatients clinic compared with local services.

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Age at interview: 35
Sex: Male
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But in the last year or so, as well as the sort of the depression and anxiety yes, and I've been going to the [name] hospital, for about five years now, since 1998 in fact, after the doctors locally, and the psychiatrists as I say weren't sort of up to much really. I somehow felt.... I did think I had schizophrenia, but I saw a Professor [name], at the [hospital], and he said that I haven't got that condition, or schizophrenia. And I thought, "Have I got manic depression or any other things?" I think he said well, I haven't really.

Experiences of NHS psychiatric hospitals were mixed for some of the people we interviewed. In most peoples' experience, psychiatric hospitals did not usually live up to highly negative community stereotypes (e.g. as lunatic asylums, a place for 'nutters'). But people (as well as families) who had negative and stigmatised impressions of psychiatric hospitals could feel ashamed and fearful about being hospitalised. Especially in past times, there were aspects of NHS hospitals that were very poor. One woman described a 1970s experience of a psychiatric hospital “like something out of Dickens”.

 

Describes her mother's shame about her hospitalisation. (Played by an actor)

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Age at interview: 33
Sex: Female
Age at diagnosis: 24
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It's probably the public's view of' my Mum's always been very ashamed and didn't want to tell people that I was in a psychiatric hospital. Didn't want anyone to know I was in there. Wouldn't tell anyone. Always a big secret. And that in itself didn't have a good effect on me [laugh]. Because it made me feel ashamed of myself and that I was in there. 

 

Describes an experience of sexual misconduct by a member of staff at a hospital over 20 years ago.

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Age at interview: 58
Sex: Female
Age at diagnosis: 20
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It's amazing that I've forgotten this. When I was in hospital, one of the doctors actually sexually abused me.

Really?

Yup. He didn't rape me. And I have to say that I consented. And this was four days after I had thrown myself in the reservoir.

Right.

And he was an Indian doctor, I mean a properly qualified psychiatrist who was working at the hospital. I at the point where I was rescued from the reservoir, I was put into an emergency ward, and he was one of the doctors on that ward. And he approached me sexually and I kind of, half-agreed. And then, of course, was told not to tell anybody. And it was obvious from what he told me that he'd had lots of encounters of this kind. So I didn't tell anybody. But looking back, that was my first experience of sex.

At twenty, which in those days wasn't as late as it might be in these days.

You weren't well enough to'?

To know what I was doing. But of course I felt guilty, because I felt that I could have said no. But obviously my own, the own body's own natural desires at twenty are quite strong. So that was my first, and to tell it to explain just how it affected me emotionally, it was a year before I could look an Indian man in the face. I am not a racist person at all, and I don't feel that way now, but it took me a year, every time I saw a male Indian, I would recoil. That was the association with the attack.

 

Describes a negative and frightening experience of an NHS hospital in the 1970s.

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Age at interview: 60
Sex: Female
Age at diagnosis: 27
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They kept me for 5 days and that was appalling. It was like something out of Dickens. It was a big Victorian building, more like a lunatic asylum to be honest, [pause] than a mental hospital. There was, they put me on this seriously ill ward, which consisted of a row of beds, a lot of very strange women. It was completely a different experience I had here, you know, one came up to me and said, 'How long are you here for?' And I said, 'Oh, I've been told just a few days'. 'Oh, I was told that and that was 6 months ago'. Which frightened me. Then there was this elderly lady who'd taken all her clothes off and nobody stopped her, and she was, you, I don't know, shouting and carrying on whatever. It was awful.

More recent experiences of hospitals included positive experiences. For instance, people reported getting better medication in hospitals, as well as consultations with health professionals (e.g. psychiatrists, nurses, occupational therapists); much needed rest; physical and creative activities; emotional support, 'relief about being in the same boat' as others, and counselling/therapy. All such experiences could be helpful.

 

Describes the comfort felt when she realised in hospital that others felt similar to her.

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Age at interview: 60
Sex: Female
Age at diagnosis: 27
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When I went in '85. The relief that all these people who were suffering' I felt, I'm not odd, they're all like this. And we were an amazing comfort to each other. Groups of people, again there weren't people you would naturally, you know, what's the word' polarise to or whatever, you'd go to in the outside world. But in there, I remember one was a male prostitute, other people who just weren't in my type of life, and it's like a club for them that ward. And even years later, if you seem them on the street, you make a point of saying, 'How are you, are you ok?'. And we gave each other amazing comfort just though talking and understanding each other, and that was as much if not more help than the doctors. I mean the medication of course helps because it dulls everything, but that was an immense help, people like that.

 

Describes getting excellent care at an NHS hospital outpatient clinic.

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Age at interview: 73
Sex: Male
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We were being treated by the top, the top man at the mental hospital place at the [Hospital], the professor there, and that sort of gave a bit more cred. And he was able to change my medication onto what, onto what's called sertraline. Now this has many, many less side effects than dothiepin and all the rest, for me. Whether it is for everybody else I don't'. I don't know, but it got rid of my stomach aches, wind, indigestion and all that sort of thing, and diarrhoea which was kind of a nervous reaction. And of course, whilst you're depressed I was thinking all those things were possibly cancer or something like that. And it's easy to convince yourself that it might well be because you don't reason straight. So cognitive therapy was, for me, the answer.

 

Describes getting helpful treatment and partaking in beneficial activities in an NHS hospital.

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Age at interview: 69
Sex: Male
Age at diagnosis: 39
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There were young psychiatrists on the ward who were prepared to listen to me for periods but it was just, I mean, it was just listening really, I don't think any' you know very practical thing came out of that. But then the, I was recommended for a thing called cognitive therapy. I was given ten-week course of cognitive therapy. 

While you were in the hospital?

While I was in the hospital, I think that must've been towards the end of my six months. So that, and that was by the chap he was the best' he was supposed to be the best one of the cognitive therapists I was told [papers rustling]. And I did find that, find that very useful.

So just things like that, a few things like that with cognitive therapy. You know I think they helped quite a bit. It was a sort of beginning of self, self-help, it was an experience that I could do something for myself. And I was also doing a lot of things like pottery and so forth, I was good at that. They gave me a few, some extra time to do that on my own because I was very keen on doing that. So I got back into painting which I hadn't done for many years, and I had a box of paints in the hospital and stuff by my bed that I could, that I could use. I mean I did drawings of other patients, even one or two people paid me for drawing their children which was very, which helped quite a bit.

Being able to paint and do pottery, how, how did that help?

Well it was something I' just something I loved doing, and being able to do something that I really loved doing, it made a huge difference I think.

Not all the problems in NHS hospitals have been fixed though. Certainly, there were mixed feelings about the care now available in the NHS. There was a sense that some staff care and the experience could be empowering, but also ideas that NHS hospitals are geared more to 'containing' patients, rather than really demonstrating care. There were numerous accounts of an over-emphasis on medication, or staff who made little attempt to engage with patients who were depressed and in need of encouragement.

A number of people also described how they had become 'institutionalised' in short time periods and so needed to learn how to live in the real world again. Those who had been on mixed wards found the practice of mixing depressed patients with other non-depressed (yet seriously ill) patients disturbing.

 

Explains that while some staff do care and you can feel safe in NHS hospitals, staff can appear...

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Age at interview: 33
Sex: Female
Age at diagnosis: 24
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You know, you're, you're in a place. It's not a [pause] the nurses, I mean some of the nurses care, yes. They care. I'm not going to start slagging them off, but I think some of them become desensitised as to what and who they are dealing with. And they kind of put labels on people a lot of the time, and they kind of saw me as an overdose I think, and nothing else really, or not much else.'I'm not completely anti them, and they have helped me. 

They have been there when I've needed them. They have contained me. It's like a kind of'. I look at the psychiatric hospital as a kind of intensive care unit for mentally ill people because it's only really quite'. if you are in a crisis that you go in there.

You are having something really major going on. Otherwise you'. there is no way you'd get in there. So it's kind of an intensive' it's a kind of containment. It's a place of safety. When I am in there I feel contained and I feel [pause] I suppose I feel safe.

 
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Believes there is an over emphasis on medication for sedation in the NHS hospital she went to.

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Age at interview: 43
Sex: Female
Age at diagnosis: 40
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Yes, it's right, in the NHS it's more, "Oh, we'll give you another tablet to make you shut-up," and that is obvious in the NHS. Because it was a long time before I would take any medication because I'm not a great lover of any form of tablet.... And it was only they pers..., in the end, in the private hospital before, before I left there, they'd persuaded me that I needed to try some medication and OK, yes, you know, it did work at the time. But then I went then to a NHS hospital, and not only for myself, but I saw so many people who had been taking just about every drug the psychiatrist wanted to give them just to keep them quiet... and change from a totally different person to like a vegetable, not knowing what they were doing or anything, you know, totally wondering whether that person's going to live next week because of the state they're in through the medication they had been given. If I had taken every single drug that they wanted me to take in the NHS I probably would still be there now.
 
 

He feels that hospital staff need to be more engaging and nurturing of depressed patients who...

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Age at interview: 69
Sex: Male
Age at diagnosis: 39
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As far as I was concerned I felt that the staff on the whole were too busy with their own affairs to want to pay any attention to someone like me. But a lot of that was probably me, rather than their attitude. I think the only thing I would say which I have said to a few nurses, I said, "The people who are in that very sensitive state need more reassurance of care than a normal person." 

Some, some nurses I believe, part of their training is to treat mental patients as being normal people. Well that's alright looked at from the point of the view of say you are capable of doing things like shaving yourself so' but on the other hand, they're not like normal people in that they' they're mostly having a very strong experience of their own worthlessness, they need to be built up. 

And I mean, there are one or two things like, for instance, the office on the ward, there's' you often have nurses who are sitting in there. They may be sort of on duty at the time, but they're sitting in there, and they're not welcoming to you they're sort of waiting for you to come in and draw yourself to their attention. Then it can make a huge difference, in fact to the whole atmosphere of the ward I think. If they are just sitting there, and there's a feeling, well I don't really want to be bothered with any patients at the moment, which I mean that happens as well and that is, it's, that isn't very good I don't think.

 

Did not like the NHS hospital she went into when she could not get into a private hospital.

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Age at interview: 39
Sex: Female
Age at diagnosis: 33
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And why did you have to go into a NHS hospital?

Because my insurance [pause] cover hadn't run out but because I was seeing a NHS psychiatrist and he was concerned about me and, ultimately, he sectioned me, they refused to transfer me to a private hospital because I was specifically under a NHS consultant, and they felt it was inappropriate to change that.

Who's they, the insurance?

I think the combination of the insurance and the doctors. And I was furious [laughing], absolutely furious about that because it was a horrible place. I can't remember the exact event that precipitated me going into hospital, I think it basically...it had got to the point where my husband felt he couldn't cope with me. So I... I did go into hospital and I remember putting a plastic bag over my head in there, and I remember that the nurse just took it off my head, didn't say a word to me and walked away. And it just really, sort of enforced the feelings that they just didn't care at all.

It really symbolises what you're saying about that system.

So, and then I didn't eat for 3 weeks while I was in there, and they didn't seem to notice.

 

Describes how she became institutionalised in an NHS hospital by the routines and safety, making...

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Age at interview: 33
Sex: Female
Age at diagnosis: 24
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I think I became' in eight weeks, I very quickly became institutionalised myself. I was scared to come out because I was in this enclosed world where I knew what was going to happen. 

There were routines, mealtimes, getting up times, medication times, OT times. There were routines and I had no responsibilities. I didn't have, because I live, I'm single and I, you know, I pay a mortgage on this house. I have responsibilities, I have to work to pay the bills and things, and the bills need to be paid and the cat needs to be fed and, you know, I don't have children but I have certain responsibilities and suddenly I had no responsibility. I was being cared for, or I was in a place where I didn't have to think about anything, and nobody could touch me.

Some people had private health insurance that allowed them to get a bed in a private hospital. Private hospitals were described as akin to a nice “hotel”, generally with staff who appeared engaged and “caring”. There was a wider range of treatments that were more readily available than in the NHS, including complementary therapies (e.g. group therapy, massage, yoga, meditation). However, private hospitals were not always highly rated. For instance, one woman escaped from a private hospital while suicidal and thought that the staff there were mostly agency staff.

 

Was pleasantly surprised by her welcome at a private psychiatric hospital.

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Age at interview: 24
Sex: Female
Age at diagnosis: 14
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So I went in, and it was like a hotel. It wasn't anything like I expected it to be. Walked in, really friendly receptionist, you know, 'Hi, you must be [participant's name].' and you know she knew my name, and I was just like, oh my God, you know. What have people been saying? And next thing you know this little lady runs over, and she must have been about five foot, and she was lovely, really friendly face, really welcoming made me feel you know, quite secure, made me feel quite happy. She came over, 'Hi [name],' you know, introduced herself, she said, 'lovely to meet you, listen, go through to the music room, have a seat, help yourself to coffee, are you her boyfriend her husband or..?' you know, [name] was like, 'Yeah, hi, I'm [name], I'm her partner.' And so and so. 

She could see we were both very tense, very nervous you know, sort of looking round everywhere, trying to work things out. There were people everywhere. You've got nurses walking around in you know normal clothes. You've got people that are living there, you've got family and friends that have come to visit people living there, you've got therapists, psychologists, psychiatrists, doctors, GPs everybody in this place. Just bobbing round, doing their own thing, completely uninterested in you.
 
 
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Says that while some nurses did care in her NHS hospital, there was more care that felt genuine...

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Age at interview: 43
Sex: Female
Age at diagnosis: 40
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The private hospital was, there was a lot of love, a lot of care in there, sincere care. And I won't knock the NHS because they are obviously very limited to money in a way, but there was no care, not in the sense of'. you feel like you are'. I wouldn't say the word is alien, but, when' In the private hospital you felt like you were being treated as a human being and they were understanding and, you know, you felt they understood. You felt that yes, you could get well here because they cared. 

Whereas in the NHS it was like'. when, if you needed to talk to somebody, if you wanted a nurse at all you had to go to them' and you had to say you know, 'Look I need someone to talk to', rather than' Privately people can see you need someone to talk to, or a nurse was allocated to you and so many people, and you had to have some private time with them everyday, whatever. Whereas in the NHS it was like, if you were lucky, if you went to say you wanted to speak to someone, it wouldn't necessarily be there, and then because as I say they were all too busy. And you might be lucky to see one that day, you might not, by which time you might be in a worse state. 

And there were several times when I was in an even worse state because there was no one to talk to there when I needed to. But then I can't knock all because some of the nurses there, some of the nurses are generally genuinely there because they want to care for people and they were different. But there's an awful lot there who' you felt as though it was people saying to you, 'Oh, for goodness sake pull yourself out of it', and, 'Get yourself together', which you don't want, it's the last thing at the end of the day. I just don't think that there is enough, in regards to, against private and NHS, there is just not enough funding to be able to' I don't know, train the nurses in a certain way. I think that nurses in a private hospital are trained totally different to ones trained in an NHS, you know, there was a hug there when you needed it in a private hospital, but there was nothing like that in the NHS .
 

Experiences of accident & emergency departments in hospitals were mixed. After suicide attempts, it is possible for people be met by a lack of empathy or even hostility from staff who may not comprehend their mental despair. Nevertheless, some non-mental health professionals can be supportive.

 

Describes a suicide attempt where he was not met by empathy by hospital staff.

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Age at interview: 75
Sex: Male
Age at diagnosis: 35
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I did take an overdose on one occasion, when things were quite desperate. Some of these well'. quite a lot of antidepressants and paracetamol' That was a pretty horrendous experience. And my wife helped me out of bed because she could see there was something wrong, and pulled me down the stairs and got me into the car. Took me to hospital where they pumped me out. 

And'. I can remember being almost unconscious, and with a doctor and nurses around the bed. And the doctor said to one of the nurses, "Go and get so and so' we've got about 10 minutes or he'll be gone". And I could hear him, and I just thought, "I wish you'd leave me alone. I'm warm and comfortable. I don't want this". But they did their stuff and got me round [pause]. And that was'. that was not nice because I'd frightened my wife, which wasn't fair. 

And I also had to run the gauntlet with the medical people who were something less than sympathetic. But they were looking at it from a medical point of view. So that's not my place to judge what they were saying. But it was not any easy thing' and I must have been in quite a deep state of depression to' to contemplate that [pause]'. Yeh I regret doing that.
 
 
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Describes a suicide attempt where the surgeon was keen for her to tell at least one parent about...

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Age at interview: 20
Sex: Female
Age at diagnosis: 19
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The surgeon had asked me if I had told anyone the truth about what had happened, and I admitted that I hadn't. And he said that he wanted me to at least tell my parents before I left hospital, and you know I was putting it off by thinking I'd rather go home and tell them at home, you know, when I could stay there with them. 

But when my dad was there the surgeon came in and asked if I'd told him yet. And then of course I had to say, no I hadn't, so he went out, and my dad asked what all that was about, and so I told him that I'd had depression for a while and I'd been taking antidepressants, and that the reason I was there was that I had cut my wrists. 

And you know he just looked stunned for a while, and didn't say much. Like I said, I wasn't very close to him at the time. So he... he then wanted to know if I'd told my mum yet, and I said I hadn't, so then he said he'd bring her up the next day, for me to tell her. So, then the next day they both came up, and he left me alone to tell her and she, she just looked distraught, when I told her [pause]. She looked like a pit had just opened up in front of her.

Last reviewed September 2017.

Last updated September 2017.

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