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Depression and recovery in Australia

Treatment in hospital

Of the people we spoke to, about one in four had some experience of hospitalisation for depression, perinatal depression, psychosis and depression, or eating disorders. A few people had been hospitalised for more than one of these conditions. Some participants were hospitalised in relation to suicide attempts or if they were not responding to other forms of treatment. Most people had been hospitalised voluntarily. Some admitted themselves, and others agreed to their doctor’s suggestion, although the definition of ‘voluntary’ could be debatable. As Suzi said, ‘there were times when I was a voluntary admission with the thing of - oh if you discharge we’ll certify you.’
 
Many people saw hospitalisation as a big step and an indication that their condition was serious. Emma whose GP suggested she be admitted to a mother/and baby unit for her perinatal depression said while she trusted her GP’s judgement it was difficult to accept: ‘And I remember thinking, "I'm not that bad. Yes I am. No, I'm not". Because again it's almost like being slapped with another label that you're an actual in-patient mental health case now. So it's the next level.’ Jane described her first night in a secure psychiatric facility due to severe perinatal depression as ‘scary’, while jack, an older man, admitted himself to a psychiatric hospital in full knowledge that the price would be his career, so stigmatised was mental illness at that time.
 
Daily life in hospital was described as highly structured and often authoritarian, and people reacted differently to this. Some found it disempowering and resisted by being ‘difficult patients’, while others accepted it as just part of the hospital experience.
 

Paul described his stay in a high dependency unit and being separated from his children.

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Age at interview: 39
Sex: Male
Age at diagnosis: 29
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I was in there a lot longer this time because well obviously things were a lot more serious. ah it was real hard in there, just mind numbing day, just - but of course that’s what it was all about. It was go there and nothing to think about. No phones, newspaper in the morning, TV during the day. Not a very big place at all but it did what it’s there to do and so after a while then I was transferred back to the hospital that I’d been at before. and you know over that time I didn’t see my boys for, it’d be a couple of months, which was pretty hard. 

Aspects of hospital life people commented on included experiences of being on high levels of medication, having a daily routine imposed on them, lack of choice about therapies provided, staff-patient interactions, and relationships with fellow patients. Jules said she sometimes had to leave during conversations with other patients: ‘Watching them not want to go home, because they don't want to go back the isolation and the loneliness, and it's a pretty sad situation where people would prefer to be in a psychiatric clinic.’ Shaz and Suzi, each hospitalised initially for anorexia, talked about friendships among patients as being problematic – Suzi found she had to cut ties after discharge to avoid peer pressure to lose weight again (see Getting better’).
 

Shaz described her experience of being hospitalised for anorexia and being discouraged from...

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Age at interview: 46
Sex: Female
Age at diagnosis: 19
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Well when I was in the private clinic, they never really had anyone that was like going to hurt themselves or anything, you know, but it was like, you know, they’d rattle the bell and you’d all go up and get your medication, and um. Then you’d get up in the morning and they’d have their morning meeting and discuss what - like they sort of tried to arrange the day. And we’d have like sessions where we could go down to the music room like in groups and we could all choose a different record and listen to, you know, we’d all sit on bean bags and chill out listening to this mu - selection of music and that was good, you know.
 
This was their way of rehabilitating us, you know. And then we had like occupational therapy which we got to do like sewing or pottery or, you know. It was a very good hospital to be in, very good. But… it was very difficult from the point that any friends you made were there for the same reason that you were. So they really discouraged making friendships, because… we all had different issues. It’s not as if there was only anorexics, you know, there was all different issues that were there. But... the days just drifted away, just, the nine months just went, you know, and. It wasn’t bad. It wasn’t a nasty experience. It’s not as if there were bars on the windows or anything. But… it was difficult. It was hard. It was sad. But Mum used to come and visit me every day. 
 
It must have broke her heart just to see me… you know and like it had gotten to the point that I was on a lot of medication. I was like a walking zombie. And some days I wouldn’t even remember that she’d come to visit. But then even then I was hyperactive sort of. I was still having severe - like I’d, I couldn’t sleep. I wanted to sleep during the day but I couldn’t sleep at night. And I used to just sit up all night doing tapestries and stuff. And they were trying to - I was even taking sleeping tablets but - and this is the thing, for some reason I seem to have a very, very high tolerance to medication. Like they really had to have me on large doses.
 
 

Ron accepted that his numerous hospitalisations for depression had helped him, but had...

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Age at interview: 62
Sex: Male
Age at diagnosis: 27
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Uh… well, as you were speaking the thought came into my life and I visualised back in a (city) public hospital and realising how little control you have, even though I was a voluntary patient, I wasn’t scheduled, but how little control you have in the day to day running of that place and what happens to you. You’re really at the beck and call of the doctor who comes at a certain time, or whenever, or the system and the timetables and, and you really lose, when you’re in a institution, you lose that ability to choose when you want to eat, when you want to sleep, where you want to go, can you go outside.
 
And it is not a very - it’s not a good, not a very good experience, it diminishes you as a person, you become just a - I don’t know what the word is - but it’s very hard to maintain your sense of self in an institution where everything is more or less uh dictated to you because they are the rules, they are the procedures and the protocols. And even, even the acts of kindness that could be given to you by staff are limited because they’re not allowed to show that, so there’s not much caring, or there’s actually not much hope, I don’t think. Because people follow an ideology, the medic - a medical model that says this is this and this will always happen and - but that’s not true.
 
Some people objected to the controlling environment of hospital. Jack described his efforts at first resisting, then subverting group therapy until his doctors agreed to his discharge. Jules took a very active role in decisions about her medication and treatment, and tried to advocate for other patients, while Suzi contrasted her experience in hospital for anorexia being treated as a ‘good’ patient to later being hospitalised for depression, when she described her behaviour as much more assertive.
 

Group therapy was mandatory at the psychiatric hospital Jack admitted himself into in the late...

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Age at interview: 71
Sex: Male
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I went and sought help and that can be, that was a hell of an experience because it was all group therapy, under the control of psychiatrists.
 
Professional people obviously, but it’s run mainly by nurses with that type of background. And I always remember the first special I had, it was just on me, I refused to talk and I got locked up in Ward One. And you don’t want to get locked up with Ward One because all the crazies are down there. And I can always remember they gave me a shot of Largactil (chlorpromazine) and it was like a clock spring unwinding like that. But you were sitting there, doped out of your brain and people are clawing, oh crawling, oh you’ve got no - I never had any idea of how bad it really was. 
 
But anyway, they took me back in and I suppose that really taught me, so I, I let out little pieces but I listened to what everybody else said. As a result, I knew more about them than they knew about me, so it, I become bad for the unit where I was because I could control what was going on. And I woke up to that too and I asked to leave so they let me leave.
 
 

Jules actively maintained a strong sense of self in hospital, adopting an assertive relationship...

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Age at interview: 61
Sex: Female
Age at diagnosis: 55
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And my external psychiatrist said stop the antidepressant over the three days, and he said we'll readmit you next week. And as I came off that antidepressant I felt better so when I got into the clinic the next week, that was when they were asking the questions about being happy, because I was too happy.
 
And then there was an ongoing dispute between the two psychiatrists because one said it was definitely the antidepressant, one saying it couldn't possibly be. So then there was the decision to put me on Cymbalta (duloxetine), and the experience of, it was made on a Friday afternoon, and I wasn't yet satisfied I, until there was consensus between the two after the previous experience I wasn't going to start it. 
 
So on the Saturday morning when I went down for meds and they offered me the Cymbalta (duloxetine), I said no, I am declining slash postponing starting Cymbalta (duloxetine) until there's a consensus. So you're refusing? No, I am declining postponing. You're refusing.
 
And this went on all weekend, but that Saturday afternoon a registrar I hadn't met before came into my room and she said I hear you're refusing to take Cymbalta (duloxetine). I said I'm not refusing, I'm declining postponing until there is consensus, and I started to explain why, she said I'm not interested in why. She said you're a voluntary patient, obviously you're well, you should be discharged, and walked out of the room.
 
On the Sunday night, the charge nurse with whom I thought I had got on pretty well, came into my room at 10 to eight and said she wanted 10 minutes of my time.
 
And then she said, and I'm concerned that, about the way you, I think I, you need to be coached in the way you treat the head of psychiatry. And I said why, she said well I'm concerned that you'll damage his ego. So when I met, subsequently met with him, I said to him don't worry I assured her that I thought your ego was sufficiently intact that there'd be nothing I could say or do to damage it. 
 
Courses, groups you can go to on a whole range of topics the, it's called the wellness program. 
 
The first time I went in, oh and you know, group walk in the morning et cetera, I did join in on that, not necessarily every day on the walks, and I did go to some of the groups, I didn't got to all, I stopped going to them, some of them at times because I knew that because of my own academic orientation, which is psychoanalysis but in organisations, not with patients, that there would either be a conflict between the presenter’s point of view or there wouldn't be enough depth and I would have to shut up.
 
What I am desperately worry about is the people in there who don't have a voice. Who perhaps never had the voice, have never had the exposure to the sort of life I've had and the level of operating that I'm used to. So how do their concerns ever get met or known, or if something goes wrong, where's their voice. So I become quite passionate when I'm in there too, about I don't know, righting of some wrongs in the system, that the, I know I have to remind myself that there's it's an organisation like any other organisation, it's not perfect.
But unfortunately the imperfections are relating to our mental health.
 
 

Suzi contrasted her behaviour when hospitalised for anorexia with when she was hospitalised for...

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Age at interview: 50
Sex: Female
Age at diagnosis: 21
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But then when I became suicidal the sort of way you were treated was a lot different. 
 
It’s almost like when you’re anorexic you seen as so good, you know, the perfect little perfect person and all you need to do is eat and you’re sort of an easy person for them to look after you. You just, you know, you just sat there and you just put the weight on, and you know, you didn’t have any outbursts of difficult behaviour and no one absconded and it was very nice. And once I’d been stripped away of that maladaptive coping mechanism of the weight loss, I became a lot more angry, a lot more volatile.
 
And I was never aggressive like some of, some patients I was in with. But it, there was a lot more sort of… antagonism… 
 
Gabrielle and Ron had experienced Electroconvulsive Therapy (ECT), and had mixed feelings about it. Gabrielle linked it to significant memory loss but thought it had probably saved her life, while Ron felt that had his depression been managed differently he might have been able to avoid ECT, but in the event it had shortened his episodes.
 

Ron reflected on his experiences with ECT.

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Age at interview: 62
Sex: Male
Age at diagnosis: 27
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I think it was factors of, of in a public hospital about the bed. About actually, you know, occupying a bed and there wasn’t enough improvement, I was basically pushed into, into uh accepting ECT, because the medication wasn’t working. Uh, and I did, because of the pressures to - because I was occupying a bed and they didn’t see, the experts didn’t see, any improvement.
 
So - and in fact I do know, having studied this st-, stuff and looked on the internet now that sometimes depressions can just lift of their own accord and change and move and each one of them is different. So we don’t all fit a, a, a timetable or a routine. But there’s still always demands for beds and that’s probably forced me into using and choosing uh to have ECT. 
 
The experience of ECT was probably coloured by One Flew Over the Cuckoo’s Nest. And [clears throat] even though the actual experience of modern electro-convulsive therapy’s not like that film, [nods] it’s still a pretty scary experience. And yes, it's after the procedure there’s always the memory loss and confusion and I think you’re treated differently than other patients in the hospital, you’ve had ECT so you must be really worse, the worse ones, or something. And it’s often used as a last resort and literature shows that too. So although I don’t have any shame now, but I used to have more shame about having ECT' ‘I must be really sick if I have to have ECT’. 
 
But I think it, possibly again, if under a - in a different regime where people could stay longer in hospitals or have different activities or a whole range of things that they were available for them, that maybe I wouldn’t have needed to have it, or even just having time to go through the experience might have made a difference. But certainly there’s more stigma with people with ECT and people rarely talk about in groups or in public or whatever. So there’s stigma within stigma as well.
 
Most people who were hospitalised felt that despite the drawbacks, their hospital admissions had been beneficial – as Suzi put it, ‘Hospitalisations more recently - while being difficult times in my life have been more positive. I’ve appreciated them trying to keep me alive. I’ve appreciated it a little bit more than back earlier.’ Gabrielle who had been hospitalised many times said about the staff in the psychiatric hospitals she had been in: ‘no difference between private or public; they’re all angels. It's a very scary experience, but I now look upon it as it saved my life.’
 

Jane appreciated her maternal and child health nurse’s efforts to have her admitted to a mother...

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Age at interview: 39
Sex: Female
Age at diagnosis: 29
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And we told her what had happened and because I'd had antenatal depression obviously they were keeping a much closer eye on me. And [son] had silent reflux, again wasn't sleeping, and as he continued to not - he fed really well though, but as he continued to not sleep I could feel myself sliding in and I couldn't stop it. And at that point we threw up red flags and said we need help. Our maternal child health nurse - because we didn't have - I'd have private health insurance but I hadn't had it for long enough to get health care, or mental health care, under that system. 
 
So we actually went to [hospital name], and they did a - pulled a swiftie and got me in on [son] having silent reflux. So we were in the mother/baby unit there for two weeks with his silent reflux. Which he did have but they kept me there for an extra week for me so he could be treated. And they were fabulous. They were just excellent. 
 

Last reviewed January 2016.
Last updated January 2016.
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