Most people with mental health problems can be treated as an outpatient. However, there are times where this might not be possible doctors may encourage a person to be treated as an inpatient to benefit from the range of treatments and therapies available in a hospital. Inpatient care might be necessary to keep people safe, and to give health professionals time to assess and treat mental health problems more intensively.
People often believed that they had to be admitted to hospital to have ECT, but staying in hospital is not always necessary, and people can have treatments like ECT as an outpatient. Some people we spoke to thought being an outpatient was better: that it was better for their recovery if they were at home with family rather than in a hospital. When Cathy was admitted to hospital with depression, she was put in a mother and baby unit with her 6 month old and given ECT. She hated being in the unit because she was with her baby and away from her family and her husband. She pretended she was better, although she wasn’t’, just so she could go home.
Mandie turned down ECT because she didn’t want to be admitted to hospital. She was put off by seeing the ward and felt she would be better off at home with her children.
When Steves wife was transferred from a private to an NHS hospital he noticed it wasn’t a relaxing environment for her. He felt it was better for her, and for the NHS, when she had ECT as an outpatient.
While a few people we spoke to had never stayed in a mental health inpatient unit, most people had stayed in one for at least a few days. Many believed that being an inpatient had advantages, e.g. being cared for when unable to care for yourself, talking with others in similar situations. Some carers were also relieved when a loved one was admitted to hospital. Dafydd was relieved that his wife was in a safe place, where she could be properly supervised so she couldn’t self-harm, and where she could get better. David Y and Steve found they could concentrate on looking after the children rather than having to look after their partners as well.
People entered hospital under very different circumstances. People generally had to have severe mental health problems to be admitted, and some were so ill they could not remember getting there. But others did remember, and had made a decision to go voluntarily. Still others were in hospital under ‘section’ (see for more ‘Compulsory detention and treatment’). When people first went to hospital, their poor mental health and anxieties about what might happen there, made it a difficult experience. Some worried about the stigma of being admitted to a mental health unit, and how others would look at them. But as people recovered, many felt better about being in hospital. Matt’s wife was very reluctant to have ECT. He believes that part of the reason his wife was admitted to hospital was so that they could talk to her about having ECT while she was an inpatient. She didn’t want people to know she was ill, and was worried people would find out she was in hospital. But she did reluctantly agree to ECT and that was the beginning of her slow recovery (for more see ‘Other people’s reactions to mental health and ECT’).
Before being admitted to an inpatient unit, people often said they had no idea what to expect, or had unrealistic expectations. For example, some thought they were going to a place to rest like a “spa” or “hotel”, but found the reality frightening. Others expected the worse, but ended up having a more positive experience.
Kathleen describes her first experience of a psychiatric ward as horrible, even though she had a room to herself where she spent most of her time. She went in voluntarily, but was later sectioned.
Suzanne was catatonic when she first went into hospital. She hated it at the beginning and wanted to be at home but by the end of her stay she didn’t mind being in hospital.
The conditions on wards varied widely. Some wards had private rooms, lots of contact with staff, the opportunity to make friends with people going through similar experiences, and therapeutic activities for those who felt able. However, others felt chaotic, unsafe and lacked private spaces. Some wards didn’t have anything for people to do, were poorly furnished and served bad food, and there was little interaction with staff.
David Y says the dormitory in the psychiatric hospital where his partner stayed twenty years ago wasn’t a nice place. They weren’t looked after and there were no therapeutic activities.
Tristan said the hospital was a strange, but mostly calm environment for his wife and she responded to it very positively. Higher doses of medication allowed her to get the rest she needed.
Catherine Y spent time on a young person’s ward when she was a teenager. They did art therapy and drama therapy, which created a better way for the teenagers to explain their feelings.
People in very different stages and severity of mental health seemed to be put together in hospital, and this caused some to feel uncomfortable and unsafe. Jenny said hospitals are “not easy places for the, the quieter, more reticent people with depression and anxiety”. Some young people and teenagers who were put in adult wards found this daunting.
Sheila didn’t want to leave her husband in hospital with very poorly people. Unlike when Sheila worked in psychiatric units over twenty years ago, there was nothing for him to do as he recovered.
Some people like Helen and Beattie had experienced what life was like in the old “asylums” – the last of which were closed during 1990s. Asylums were separate institutions where people could often live for a large portion of their lives. They often had many in house facilities such as hairdressers, dentists, even farms and ballrooms. Helen said when her second baby was taken into care, her husband and in-laws forced her to admit herself to a mental hospital, which she describes as “infamous” as there were deaths under suspicious circumstances.
Carys thinks the situation in inpatient hospitals has improved in recent years, but that the wards where her daughter had stayed years ago were awful. Her daughter ran away from these institutions several times.
While there were certainly reports of bad experiences in hospital, most people felt in general that the staff in hospitals were very good. Sheila said on the whole staff were supportive, even though some didn’t seem bothered. During one of his admissions to hospital, Sunil said he was only seen by a consultant for a few minutes once a week and was mostly seen by relatively junior, inexperienced, registrars. He felt his treatment was “grossly mismanaged” (see for more ‘Medication for mental health conditions: effectiveness and side effects’). Accounts of mistreatment by staff was rare, but Sue made a complaint about two members of staff abusing her, although the hospital did not take her complaint forward. She felt that having had ECT she was “powerless”, and the staff thought they could treat her in any way they want to. You can read more about relations with medical staff here ‘Relationship with Health and Social Care’.