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Psychosis (young people)

Being treated in hospital for psychosis

Most people we spoke to had experienced at least one hospital stay, lasting between one night to a year. Some were brought to hospital at the time of their first experience while others were admitted later. For some, the psychosis was closely associated with low mood and depression, and they had been in hospital regularly, for example because they were self-harming or had taken an overdose. Ruby said she had been admitted to hospital 250 times in 3 years and that she was sometimes “in and out” several times in a week. But not everyone we spoke to had been admitted to hospital, even when they were very unwell. Some people visited hospital as a day patient, which as Nikki (below) described, had benefits.
 

Emily self-harmed and attempted suicide when she was in hospital. While she was there she learned a lot about how to control her voices, but also started hearing external voices for the first time.

Emily self-harmed and attempted suicide when she was in hospital. While she was there she learned a lot about how to control her voices, but also started hearing external voices for the first time.

Age at interview: 23
Sex: Female
Age at diagnosis: 21
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My self-harm was out of control. They just couldn't handle me where I lived. I tried to set myself on fire, which caused two of the members of staff to be signed off, 'cos it was so traumatising to them. So they just said to me, they can't do anything. So, I had to go back into hospital. And they told me I'd be there for a couple of weeks just in crisis. And then, I'd go back to where I was living. But, it just didn't work out, because I went back there for a few visits. And when I was there, I took an overdose again. And had to go up the [hospital] and they just said to me, they can't have me back even though they were supposed to be trained and that and they was 24/7 support. Just couldn't cope with it. So I ended being in hospital for ten months and but I learned a lot. I made new friends there and I learned a lot about my voices and how to control them and try not to listen to them all the time. But when I was in there, I [clears throat] started getting like I've, I've always like internal voices so like someone inside my head telling me what to do. I started hearing voices outside as well and I'd hear like, I'd listen to music and it would sound like they were talking to me. 
 

There were times when Nikki went into hospital as a day patient, instead of staying over. Although there was a lot of travel, she could be home in the evenings and have diet coke and listen to her music.

There were times when Nikki went into hospital as a day patient, instead of staying over. Although there was a lot of travel, she could be home in the evenings and have diet coke and listen to her music.

Age at interview: 19
Sex: Female
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But I found that I got a lot of help when I was a day patient at, at an inpatient unit. And I did that for six months. And I went there every single day for six months. And this was two hours away on the bus. I had to get the bus there, took me two hours and then the bus back took another two hours. So I was travelling for four hours to be at this day patient place all day to go back again and it was so long. But it was helpful, because they had a lot of different things going on and they I saw someone all the time and it was that, that was—I think, I felt that that, I felt that that was the thing that made me able enough to have the therapy that I had and for it to help. 

Brilliant, okay. So it was 'cause you, was that because you had the sort of comfort of home in the evenings and nights, but then, the interactions that you needed in the day with the specialists.

Yeah, yeah. That was what was most helpful for me, because I hated being away from home, because I didn't have like, like my music. I didn't have my headphones. I didn't have I loved Diet Coke, for example. I didn't have access to any of that. I didn't have access to any of the normal foods I like, none of the TV like my, my family and stuff like. So it was just, I hated it for that reason. But then, being able to have a bit of both was helpful. 
 

Although Tariq was never sectioned he thinks young people shouldn’t be in a hospital environment because he feels it is “dangerous” and “frightening”.

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Although Tariq was never sectioned he thinks young people shouldn’t be in a hospital environment because he feels it is “dangerous” and “frightening”.

Age at interview: 21
Sex: Male
Age at diagnosis: 18
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I think that no young person should be in a hospital, it’s a very dangerous place for a child, it can be very frightening for a child. children and young people and adults we develop in two different ways, adults are completely different from young people we have different dependency levels and etcetera so I think on that, because in hospitals it’s only those that are eighteen and over mainly or those between thirty and over, the majority of the patients are over twenty five, they’re usually in their thirties of forties. You wouldn’t put a seventeen year old onto the same ward as a forty year old whose condition is far more worse, who poses a significant threat to all the patients. So it’s better that a child is, is around the people that love them most, their family because that’s where a child should be. And even like every professional I talk to they always say that a child’s home should not be in the hospital it should be in their own home, it should be in the school where they go to school. They shouldn’t be living in a hospital that’s not the place to be.
People could be referred to hospital admission from their EIP team or crisis team but some went directly to A&E and stayed overnight for assessment or treatment. Going to A&E in a crisis didn’t always lead to a hospital admission, and people could find they were not admitted despite feeling desperately in need of help.
 

There were times when Lucy wanted to be in hospital because she didn’t feel safe living alone, but staff thought she would be better at home.

There were times when Lucy wanted to be in hospital because she didn’t feel safe living alone, but staff thought she would be better at home.

Age at interview: 22
Sex: Female
Age at diagnosis: 21
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I mean, my parents have said I could stay with them. But I don't really want to move back home. And at times when I felt really, really unsafe, I've asked to go into hospital. But they just kind of ignore, or say "Oh, maybe next week, we'll think about that." Or, you know, "Looking at your notes, we might want to admit you, but actually we've met you and we don't think you'd find it very easy in hospital, so we think you're better to stay at home." Which is quite difficult. Because I think sometimes, you know - I wouldn't ask to go there unless I was desperate, because no one wants to be in hospital. But I was desperate. And they don't really listen that much.
Some people who went to A&E experiencing paranoia and delusions, didn’t feel comfortable being in hospital and left before they were admitted or had received any treatment. Green Lettuce was waiting to be given a hospital bed when he was struggling with paranoia and voices. He sat in a corridor for hours waiting to see a doctor and because of his paranoia he thought everyone was against him, so he went home.

Hospital experiences 

People were usually very unwell when they were admitted to hospital and some couldn’t remember much about their time there - Hannah said her memories were “a bit smoke and mirrors”. Sometimes medication could prevent them from thinking, or remembering about it afterwards. Most people had been treated in NHS hospitals, but Nikki had experience of a private mental health ward.
 

Nikki was sent to a private hospital when there were no beds available on the NHS. She feels private hospitals are run “like a business”.

Nikki was sent to a private hospital when there were no beds available on the NHS. She feels private hospitals are run “like a business”.

Age at interview: 19
Sex: Female
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My Godmum, my Godmum came with us and we went to this place [sigh]. When I got there, I just saw a massive massive walls in barbed wire and I was just like, what is this? [Laughs]. So honestly, what is this? It was a, we went inside I wasn't allowed to like I got into the, the main entrance kind of bit. All doors were locked. My, I said, you know, I'm, I was sent here sort of thing. And a couple of people from the ward came and got me. And they said, ''Right, your, your dad and your Godmum has to go now. We are gonna take all your stuff. You can't wear your rings we are gonna check for everything like all that sort of stuff.'' And I was actually terrified, 'cause I didn't know what a mental health hospital was. I'd only known what general hospitals were like and I thought it was gonna be similar. I was not prepared at all and then I got there and they were just like, right, your dad may have to go and we are gonna have your stuff right cool, come with us and I'm just like, what? 

Like my dad can't stay with me? What on earth is going on? But then my dad had to go. Like they wouldn't let him through. And at that point as well, I had to kind of do what they said, because I was under their care now. 

What kind of hospital was that that it was so different from the other ones?

Private hospital. 

But it was still a child's—

Still a child's one, yeah. Adolescent, yeah. They took me into this like room with like squishy kinda seats that you find in primary school. I sat there and a doctor came and saw me and [sighs] they just kinda asked me questions about my life. What's been going on and that sort of thing and what thoughts I had and what feelings am I having? And then they said, you know, you're here voluntarily, but if you asked to leave, we will detain you. And I was absolutely terrified. And they took all my stuff. I wasn't allowed to wear any of my jewellery. They'd searched through everything and they just kinda said, ''Right, there's gonna be someone with you 24/7.'' And I was absolutely mortified, 'cause like, when I wanted to go to the toilet, I had to ask and then they had to watch me. And I'd never been in that situation before. And I was absolutely humiliated and I hated it and there was all these other people and, you know, people would come up to me and say, are you Prince Harry sort of thing and I was just like, no. And I was just terrified like not of the people, 'cause but it's just because I had no idea what was going on. Like I had no idea, but was so confused and I was, I hated being there, so I just tried to leave as soon as possible. 

Did you have your own room or was it a sort of open ward or?

I had my own room. But I wasn't allowed, you're not allowed to sleep with a bra or underwear, any underwear on. And someone watches you while you're sleeping, the whole time. You are not allowed anything of your belongings with you, no, your toothbrush, all of that, they all stay in like the a locker and you're not allowed access to any of it. 

And did they explain why they, why that was happening?

They just said, it's for people's safety. You know, I'm not really sure what damage a bra can do, but you know, there was their rules. It's very different when I went to a NHS hospital. I was allowed everything in my room. I got there and there was, I wasn't followed all the time. They, they allowed me to have my stuff. I felt a little bit more free, because my dad was allowed to take me out for like a drink or something, which was nice. —

And do you think that was to do with where you were at the time you went in or just the way the institution functioned.

Just the institution, yeah, yeah. I think private ones they, you know, they're very hot on security and safety. NHS have, they are as well, but, you know, they allow you your freedom a little bit more. 

And when it came to going home, what was that process like? Who made that decision?

The doctors there really. But most of the time it was 'cause I was begging to leave [laughs]. And they're under pressure 'cause they don’t have many beds. And I just said, ''Look, I'm fine, I'm fine. Look I won't, I will never hurt myself again. I promise. It's fine. I want to go. I want like.'' And they just let me. And that was how it was most of the time. 

And how long did you stay in for each time?

R: The first few times was very short. It was about a couple of weeks each time. The last time I was there for about five or six weeks. They were, they were all quite short, because I was just begging to get out, 'cause I hated every second of being there. It made me feel worse and I hated it. I hated it so much. All of my comforts, they were gone. Everything I was used to they were gone. I wasn't allowed my phone. I didn't have my family there. There was no source of strength or happiness in there for me. Kept me safe, yeah. But it didn't, it didn't improve me at all. 
People could be transferred once or twice between hospitals during their hospital stay without being told why they were being moved. People could be put on an open ward in hospital, or be given their own rooms. However, having your own space didn’t necessarily mean privacy or comfort. Nikki had someone “watching” her while she was sleeping in a private hospital and wasn’t allowed to keep any personal items in her room, including underwear. This was the opposite of her experience in NHS hospitals. 

Making friends with other inpatients could be important and therapeutic. Hannah took most comfort from talking to other people who were inpatients, hearing about their problems and knowing that there were other people who were suffering as well. People could become very attached to friends they made and rely on their support, or want to be there to help them. Hannah found it distressing when she wasn’t allowed into the room of a friend she’d made, who she could hear was having a breakdown. Barry made a friend in hospital who was very patient with him and used to sit on the bean bags in the corner and chat away to him for ages. When she left hospital his delusions increased.

For some people, being in hospital when they were extremely unwell was a frightening time. Becky remembered it as “the worst time of my life, not being able to ever picture a way out”. Experiencing psychosis meant people could act out of character and some described being restrained, injected with a tranquilizer, or put in an empty room on their own. Luke said in the first few days “you’re a horrible human being”, violent, prejudiced, “trapped” “psychotic”. When he was first admitted to hospital Joseph had an “insane amount of energy” and was cartwheeling down the corridor and going into “Jackie Chan sort of karate mode”. He remembers kicking a light and breaking it and five “huge stacked guys” holding him down. He thinks he must have resisted but he now accepts “it was necessary for them to do that”.
 

During the first week in hospital Luke was “scared” and “destructive”, but after the medication began to work he returned to being his “normal” self. He has “great memories” of staff on the ward and goes back to see them.

During the first week in hospital Luke was “scared” and “destructive”, but after the medication began to work he returned to being his “normal” self. He has “great memories” of staff on the ward and goes back to see them.

Age at interview: 21
Sex: Male
Age at diagnosis: 19
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From my experience, the first week, you're still - you're so agitated that you've been sectioned, you're so - you're a little bit scared. You're not allowed any leave. You're not allowed out of the hospital any time of the day. You're a bit destructive. I remember picking up a, one of those sort of traffic cone shaped - the cleaning cones. I remember picking one of those up and trying to bash everyone round the head with it. And, yeah. Can't remember why, but - you know - I'm psychotic, I'm allowed to. But. And then you sort of become friends with everyone. You start to have a bit more - yeah, have a lot of respect for the staff. Because after you've been medicated and you've been brought back down, you are your normal self. You're - for me, I'm - you know - normal Luke, respectful guy.

And I've got great memories of with the staff. You know, I still often go back and see them. And they're fantastic. And you - you sort of indulge yourself in occupational therapy. You can find yourself watching telly, or - you know - making a pizza. Or going outside, and playing croquet with the occupational therapist. And then it was always [clears throat]. You can only - It's only going to be as good as you make it. And I've made some great friends from being in the hospital, both times I've been in.
 

Max describes having a delusion in hospital and trying to go after a member of staff. He was put in a ‘de-escalation room’ and began pulling his own hair out.

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Max describes having a delusion in hospital and trying to go after a member of staff. He was put in a ‘de-escalation room’ and began pulling his own hair out.

Age at interview: 19
Sex: Male
Age at diagnosis: 16
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I had delusions that one of because there was - I'm going to say the names - there was one of the workers that I got along really well with, was called [name] but that was like a shortened name for [full name] and in my head there was - they were two separate people. 
And obviously being a worker, having a nickname and having a real name, people use, the same person, for the same name.

And I thought [the longer version of her name] was this girl’s father. And I thought because they were always talking about mental health difficulties and they were using [the longer version of the name] because she takes mates and stuff like that, I thought this girl’s father was making me ill. I thought was, she was, he was making me ill and I had no control. And I thought. She used to play the banjo.

And I thought she was doing it, and it was going to do something to me. I lost control. I went after her, and it’s not something I’d have done. And I think if any other person done that, or even if I did that and I wasn’t ill, they'd have control over their own actions, they - and it’s not acceptable, and that wouldn’t ever happen. I, I think I - it was more fear than anything else. There was no severe, any bad, serious damage. I think it shocked her quite a lot, and I had about four or five staff around me, pulling me away. I went to the de-escalation room, and then I starting realising what I was doing. I was, I was literally hitting my head. And I was basically trying to punch myself, because it’s the complete opposite of my personality. I’ve, I’ve always done things. I’ve got a group on Facebook with a couple of hundred people who struggle. I’m always trying to support people, and I just really hated myself for it. I was literally pulling hair out. So I would get bits of hair in my hand, I was pulling my hair. And by the time I left the de-escalation room I had lumps in my head. And even though you couldn’t see the hair missing there I, I lost control.
 

Fran works in a training centre for mental health staff and thinks there have been improvements in training about restraining patients.

Fran works in a training centre for mental health staff and thinks there have been improvements in training about restraining patients.

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That’s not really a hospital. It’s a training centre and it’s not really dealing with ill people. It’s more dealing with staff. And that’s a completely different vibe really. I mean they’ve tried to get me to go on to the wards and do whatever before. I’m not massively on it because I’m gonna know loads of those people on the wards from when I was ill. So it’s just like too much.

Yeah, yeah. So when you, when you say, when, when you say training, like working with staff, training them or training them about different issues and things, what, what do you do?

Ah, first, ah. Trying to think. Yeah, in, I was gonna say in the olden days I remember, it’s not that long ago. When I first got put on a ward, it all completely kicks off on a psychiatric ward. And people do a lot. And they become very dangerously violent. And usually it’s not their fault. But you get them in a restraint hold and you put them in a cell which isn’t that different to a police cell. You inject them with loads of drugs and basically you pin the person down until they’ve calmed down. That has been looked at, the restraint process, and they’ve said, “This isn’t right. We shouldn’t be doing this to ill people.” 

So they’ve kind of engineered a completely new way where you lock arms instead. And so when you put the person in the room you don’t drag them. You like walk them. Actually it looks really sweet and really funny like three people, like that. And then you don’t hold them down and put the injection in their bum. You make sure they’ve got in to the room in a safe way. You give them a tablet to calm them down, which is more if they want the tablet, and you wait for them to calm down. It’s only in extremes that you put it... And basically I do stuff like help to teach people to do stuff like that rather than… Or there’s kind of care plans, where, most mentally ill people aren’t involved in their own care plan at all. And I’ve helped to design the new care plan and stuff. So I do stuff like that.

It sounds good.

It is really interesting as well. I like the psychology of it, yeah.
While in hospital people were usually prescribed medication to reduce or control their symptoms and to help them sleep. Medication, and rest, could make people feel better quite quickly, or it could take a while to start to work, and sometimes didn’t help at all. Sameeha remembers the moment she began to feel better two weeks into her hospital stay. But Barry was in hospital for a year and had periods of just sitting and staring at a wall and not eating. He slowly got better with the support worker’s help.

Some people were also given access to other therapies such as CBT (Cognitive Behavioural Therapy), dance therapy, art therapy, life skills and mindfulness. Not everyone found therapeutic activities helpful at the time. Nikki said “a lot of the time I was just bored”. Others didn’t feel well enough to benefit from therapies: Becky said “when you're having the worst day of your life and you don't wanna live anymore and they suggest going for a walk or something and you think, why on earth are you saying that to me?”

Interactions with staff in hospital

Interactions with health professionals and administrative and clerical staff in hospital were often an important part of people’s experience of being treated in hospital. Most people described a mix of good and bad experiences with staff. Joseph had some very positive experiences and said the staff could be “amazing” and would stop to chat with him whenever he needed to talk. Green Lettuce felt that there were some staff who clearly “just cared”. 

However, people we spoke to also described poor communication and long waits to hear from doctors making decisions. A few felt that medical staff did not take them seriously or understand how unwell they felt. Andrew X said once when he was being admitted, the ward manager “had a go” at him because he’d had to get out of bed to do an assessment. Joseph never heard voices as part of his psychotic experience, but while he was in hospital he had a different medical professional each week come to him and say: “So Joseph, are you hearing thoughts today?” which he found frustrating. Hannah felt that the staff in hospital “just didn’t seem to care very much”. 

Some people felt staff were “disrespectful”: Ruby overheard a staff member referring to her as a “frequent flyer” and when a new nurse introduced herself as Ruby’s nurse for the day, the cleaner commented sarcastically “lucky you”.
 

Being treated as a human being was important to Andrew X. He had mixed experiences with practitioners, and said some of the people who made the most difference to him in hospital were the receptionist or cleaner who he could have a “bit of banter” with.

Being treated as a human being was important to Andrew X. He had mixed experiences with practitioners, and said some of the people who made the most difference to him in hospital were the receptionist or cleaner who he could have a “bit of banter” with.

Age at interview: 24
Sex: Male
Age at diagnosis: 14
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Sometimes you do wonder how and why some of these mental health professionals are working. I say that, but there are some absolutely amazing inspirational practitioners who, who without whom I wouldn't be here. People who have really helped me in my journey in my life. 

The difference is—

That they have made the differences, those positive, you know, those positive, because they're just, connected, connected me like I'm a human being. But there've also been some pretty poor, poor practitioners out there who have caused me a lot of damage, lasting damage. So it's really, it's a shame that that level of consistency is not there. But often, often it's like you get the most, I have found the people who've made the most difference in my journey haven't been necessarily the mental health nurses or the psychiatrist, they've been like the cleaner you have a bit of banter with. You can have a joke with or the cook who knows that you like ribs done in a particular way and will do them and like show you a bit of encouragement, a bit of kindness, a bit of humanity or you know, the receptionist that is able to have a joke and a laugh with you or the health care assistant who is a bit down to earth and will show a bit of themselves, you know, they'll not be afraid to be human and, and they've made the difference, I mean, particularly when I've been psychotic, because when you've lost contact with reality then the best thing to bring you back down to earth is someone being human towards you. When you've lost contact with reality, you don't need forced, artificial interactions – that just makes it worse. You need some humanity. That's why the Early Intervention Psychosis Services work so well, because they're just humans. They are not, they're not pretending to be some sort of super mental health nurse. They are just, let's go and grab a coffee and talk about stuff. 
 

Sameeha remembers a member of staff being “off handish” and “rude”. She says you can tell when staff don’t want to be there and don’t have any sympathy.

Sameeha remembers a member of staff being “off handish” and “rude”. She says you can tell when staff don’t want to be there and don’t have any sympathy.

Age at interview: 22
Sex: Female
Age at diagnosis: 21
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I remember, this period, I, when I was in the hospital, I was watching this guy and this girl was talking and he was being really horrible. He, he was rolling his eyes and he was like, uh, and I think in that period because you just react momentarily. And I slapped the drink out of his hand, because I was just so angry at the way he was treating her. And he grabbed me by the arm and like threw me in a room. So I was like, oh, you don't, people don't need to be this horrible. Every, every person in these rooms are suffering. You don't if you're not made for this job. If you don't sympathise or you don't understand simply don't do it. You don't have to force yourself amongst these people, because they don't wanna be amongst you if you're not ready for them, do you know what I mean? You just wanna be surrounded by people who are open minded who like look kindly to others. 

So was he a member of staff?

Yeah, he was a nurse, yeah. 

He was a nurse, yeah. Did you have much more dealings with him then or?

[clears throat] No, like occasionally. But I, in that time period as well [clears throat]. 

Are you okay?

Oh, no, no I've just got a cough. In that time period yeah, a lot of them were like that to be fair. It was like you know you can tell when someone, someone's intent isn't right or someone's intent isn't coming from the right place. I didn't really have much dealings with him, apart from that, but he was always very off handish, very kind of rude, kind of he didn't wanna be there kinda thing. So I always got that kind of atmosphere from him. But I, in that hospital I was only there for a week and then I got moved to another one. So, yeah, that was fine with him. 
 

Ruby, who has had regular hospital stays because of her mental health, has had good experience with staff in general hospital wards. She has found regular staff are well trained and keep her safe, although agency staff need to be more aware.

Ruby, who has had regular hospital stays because of her mental health, has had good experience with staff in general hospital wards. She has found regular staff are well trained and keep her safe, although agency staff need to be more aware.

Age at interview: 22
Sex: Female
Age at diagnosis: 19
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So most of my experiences again have been good with admissions to hospital. I was generally admitted to the same ward, so the staff knew me quite well. And they are now more trained than they were, because, because I kept being re-admitted, they went, 'cause it was a, a young person's ward. So locally, the young person's ward goes up to 25. So they went to Adult Mental Health Services, and said can you tell us how to deal with the difficulties that I had. Generally, yeah, everyone was very positive and trying to keep me safe. 

Talking to me gently. Just generally chatting to me as well. But when I'm not in distress, because although being admitted, I was in distress. My BPD means that that can dissipate very quickly as well as it can come on very quickly. So I wasn't always distressed for the entirety of my stay. Yeah, just being, not judging anyone I think finding a way to let people outside for fresh air really helps. Because being, it's a locked ward, the young person's ward and being locked on a ward can be quite difficult. And yeah, if you're not allowed out at all then, yeah, it can be quite- just going outside even for five minutes fresh air can really help. But has also got me into a lot of trouble before [laughs], because there are risks that the nurses don't realise that there are, because it's a general hospital so they are not as trained. Things like the hospital shop sells Paracetamol to anyone over 16. And they also sell razors and pencil sharpeners and things like that. So, it, it can be a risk if you're out on your own. And agency staff, like the staff on the ward that are normally on the ward they know now, because it's they, they are aware it's happened. But agency staff don't tend to know. And so, when you're quite unwell, you can kind of talk your way into a situation that actually ends up hurting you more.
Being sectioned

Some people were so unwell they were kept in hospital involuntarily under a section of the Mental Health Act 1983 (known as being “sectioned”). People can be detained under a section of the Mental Health Act to allow medical staff to examine, assess and treat them. Even if people go to hospital voluntarily, they can be detained there for further treatment without their consent. Medical professionals must consult with a range of people, including a person’s nearest relative, before sectioning a person. The Mental Health Act sets out when it is legal to detain and treat someone, who is authorised to do it, and what procedures should be followed. People are sectioned for a certain length of time, and can have the section removed: be ‘de-sectioned’. An assessment about whether to section someone is made based on their condition at that time.
 

Emily went into hospital voluntarily but then was sectioned.

Emily went into hospital voluntarily but then was sectioned.

Age at interview: 23
Sex: Female
Age at diagnosis: 21
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I was, I went in there informally. But after a little while they sectioned me to keep me safe and keep me from leaving when I shouldn't, really. 

Was that the same the first time?

When I went in the first time I was informal, yeah and then I got sectioned. 

What was that like for you that process of getting sectioned?

It's weird, 'cos when I thought of being sectioned before, I thought it meant, you know, not allowed out, straightjackets and all that sort of thing. But they do it, the way it's done is quite well done, to be honest. They phone like your next of kin and ask what they think and so they phoned my mum and talked to her about it and what she thought was best. And then you go in there and you've got two AMHPs I think they're called. Yeah, Acute Mental Health Practitioner or something. And then you've got the psychiatrist in there. And there's also a nurse who sits next to you and so you've got these three people in front of you and they ask you questions about what's going on and you'd say about the voices and what you are seeing. They'd say, you know, what would you do if you left hospital and you would probably say like I'm gonna kill myself, you know. I remember arguing with them saying, it's not their choice. It was my choice. But because of that, that's when they sectioned me. And I was on a section for about seven months I think in total. 

And at the time do you remember how that sort of seemed to you and how it felt?

It made everything worse for me, because you knew you couldn't escape the hospital. And even though they were there to help there is 21 other patients who have their own problems. There, there was a lady who would just scream all day. There was other ladies who would throw chairs. And you'd see people self-harming. And, I mean, I saw one lady ligaturing in the garden once. So it's hard to cope with that on top of everything you were dealing with already, because you've got these voices in your head and you are seeing things that no-one else can see, but then you've got this other people who are actually there, screaming and it just adds to everything. And sometimes it's like the worst place to be if you've got a mental illness.
Some people felt that the possibility of being sectioned was used as a threat when they were very unwell. Andrew X (below) said “a lot of the time you're given these choices, ‘do what we say or we'll section you’”. When Nikki was admitted to a private hospital, although she was in hospital voluntarily she was told that if she asked to leave she would be detained.
 

Andrew X talks about what he calls the ‘quasi section’ – when you’re threatened with being sectioned if you don’t stay voluntarily.

Andrew X talks about what he calls the ‘quasi section’ – when you’re threatened with being sectioned if you don’t stay voluntarily.

Age at interview: 24
Sex: Male
Age at diagnosis: 14
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Talking about whether your liberty should be taken away. That's pretty heavy stuff. So fortunately I wasn't sectioned. But they do this—I call it the quasi section, because it's not actually sectioning. What it is, ‘[name], you have to do what we say or we'll section you under the Mental Health Act’. So that's what I call the quasi section. And in a way you have less rights that way than you do if you actually got sectioned properly. I think it's something that actually healthcare professionals need to be really cognoscente of, because you know, you need to be able to give people the space to—if someone needs to be sectioned, they need to be sectioned, right, they don't just suddenly because they disagree with you need to be sectioned. You need to be either section them under the Mental Health Act or they are not sectioned and they are free to choose. It's a personal bug bear. I mean it happens a lot and particularly in CAMHS, because a lot of the time you're given these choices, do what we say or we'll section you. That shouldn't be as a threat. It's not- the legal mechanisms are not there for it to be used as a threat. In my life, if I'm a danger to myself or others you need to section me. If I'm not, I'm not sectionable, welcome me. Anyway, so I had that Mental Health Act assessment.
Fran who was sectioned said “it’s not like a prison but it’s the same ethos, you cannot get out” and Luke described it as “a huge power that a psychiatrist has”. Sameeha said she wasn’t told anything: “I was literally just thrown in, sectioned and they just said, you need to wear this”. Becky hated being sectioned but realised afterwards that they “only wanted the best” for her.
 

When Becky went into hospital voluntarily the second time she felt more “in control” and “everybody was really lovely”. When you’re unwell she says you’ve got to “let somebody else take over”.

When Becky went into hospital voluntarily the second time she felt more “in control” and “everybody was really lovely”. When you’re unwell she says you’ve got to “let somebody else take over”.

Age at interview: 24
Sex: Female
Age at diagnosis: 20
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I mean, because I was sectioned obviously, there was some times when I was shouting and screaming, kicking, things like that, I was treated completely differently to when I was walked in the next time just wanting to feel better. But that's just because I had not, I hadn't got a clue what I was doing the first time I was—I was on so much medication, I didn't know where I was, things like that. And it just seemed scary, 'cause it feels like everybody is trying to take control. But the second time I felt more in control and that was, that's important I think. But yeah, at the end of the day, they, they do the same things and it is your frame of mind and the people that are in there as well. Everybody is so lovely and understanding. Everybody knows to an extent what you are going through 'cause they've either seen it, been through it and at the end of the day, you don't know what's best for you otherwise you wouldn't be in there, so you've just gotta let somebody else take over while you can't. So it, it did help me. I hated it at the time. And I thought it was the end of the world, but I'm still glad that I went. 
 

Barry explains that he was kept in hospital first under “section two” then under “section three” of the mental Health Act.

Barry explains that he was kept in hospital first under “section two” then under “section three” of the mental Health Act.

Age at interview: 19
Sex: Male
Age at diagnosis: 16
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I was first put under section two.

Oh right, okay. 

The section two, you can be hold for up to twenty eight days. And whether you like it or not, but you have the option to appeal. And they do this because they feel that it’s for your own safety or others around you, for you to be under an inpatient service. Within those twenty eight days, they need to decide whether or not they are going to put you as a – I should know this. As an informal patient. The, that way you can - you’re being, you’re being - you’re receiving support at an inpatient service, but you have the free will to leave whenever you like.

Or if they feel like you need the support, for your safety or others around you, they put you on section three, which lasts up to six months. I was put on section three twice because at the end of the six months they still thought I needed the support. 

You were only in, sort of went inpatient as it were for a month, and then?

No. I stayed at the hospital I was at.

Oh you, did the same time? Okay. 

And the section three followed, before the section two ran out, and I was just -

Okay. So that means [inaudible]

Yeah. I was basically put in this one ward, and then I was put - over a two and a half month, month period. I was put in a - I was put in a ward.
 

When he collapsed, Joseph was taken by ambulance to hospital and assessed for “everything under the sun”. After a week he got the “three signatures” and was sectioned.

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When he collapsed, Joseph was taken by ambulance to hospital and assessed for “everything under the sun”. After a week he got the “three signatures” and was sectioned.

Age at interview: 22
Sex: Male
Age at diagnosis: 21
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On the whole it all happened over the space of a week, with build-up. And then I was admitted to hospital. Went into hospital, treated for - tested for everything under the sun, in terms of physical health checks. Lumbar puncture, and brain scans, everything. Was there for about a week, whilst having the peaks, in terms I'd say of the episode. Friends and family very concerned, visiting me. And then eventually we got the three signatures to say okay, it's a mental health disorder and think we should Section two. So that's when I moved to an acute ward. I was there for about a week, maybe two. Before I was then moved back down to near where my parents live.
Being “sectioned” could involve a long process of assessment. Luke said the first time he was in hospital he was sectioned and the process took time and involved “a lot more red tape” but the second time it was “wham bang, thank you ma’am” and he was in a ward bed within eight hours of the police coming to get him at home. You can read elsewhere about what it was like having an initial assessment while in crisis

But some were able to avoid staying in hospital under section. Dominic had never stayed overnight in hospital and his family opted to look after him instead. He stayed at home under what he described as “house arrest”. The agreement was that he would be sectioned if he left the house. Fran’s mother suggested that Fran live with her instead of being sectioned and Andrew X had a “commissioning arrangement” that meant he could be treated while living at home.

You can read more about being in hospital under a section of the Mental Health Act in other related modules: Experience of PsychosisMental Health: Ethnic Minority ExperiencesExperiences of antidepressants.

Leaving hospital

Discharge from hospital is usually planned by a multidisciplinary team, and people sometimes have to wait for medication to be ordered. Some people remember being told they were going home but then having to wait for days before they were discharged, without being told why.
 

Sameeha describes desperately wanting to leave hospital and having to wait because doctors were on leave or too busy.

Sameeha describes desperately wanting to leave hospital and having to wait because doctors were on leave or too busy.

Age at interview: 22
Sex: Female
Age at diagnosis: 21
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I wished that the, they would just allowed me to go home because during that time period, it was Christmas time and it was difficult, 'cause obviously the doctors were on holiday. Everyone was off. And the nurses, I was like, I want to, I want to go home. I really don’t need to be here. There's no reason for me to be here, but because under the Health Act and being sectioned they were just like, we can't do it. We're sorry. And I'm just like, you're not judging it case by case, you're just, you're just following protocol and I don't understand why you can't look at me as a person and be like you'll clearly fine, you can go and just sign the paperwork later. So I was trapped in there for longer than I needed to be. And that was making me so irritated, so like upset. And it eventually, on the day that I was supposed to, they were, they were supposed to leave and I think it was like right before new year's. And we were supposed to see the doctor, my mum had come. And eventually, at the last minute, he was like, oh, the nurse came in and she was like, sorry, he can't see you today he's really busy. And I was just like, no, I, I don't think you understand, I'm not doing it. And then, obviously, my mum got angry, because I was like, I'm not doing it. I'm not staying here. I'm not doing it. And then I was like, listen, at least sort out where I can go for leave and doing the meeting tomorrow, so that I can be released. Because I'm not staying here any more. It's so, I don't think you understand how stressful it is. And because we kept insisting that eventually we did get that leave and then we came back for the meeting so I could get released. But it was so annoying. It was all paperwork. It was all paperwork and it wasn't about me at all. It was like, oh, we've gotta allow for the leave. The doctor needs. And I was just like, it's so pointless, because you don't understand that people, you should just listen to them, like you should really just listen to them, 'cause being in that place it's, I don't, I can't speak for anyone else, but for myself. But it's, it's so like you feel so trapped, so imprisoned. So, you're not able to do anything. Every like two hours, they're coming in with a torch in your room lighting up checking you're not doing something to yourself. So, it's just, it's just really stressful, do you know what I mean? Just that time period, even like escaping like being able to leave it's the biggest relief, the biggest relief.

Do you remember how many sort of days it was that you were in that position where you knew you were ready to go.

I think it was four or five days I'd say, yeah. 
After leaving hospital, people usually receive a follow-up visit within 3 to 7 days from a community team. Not everyone wanted continued support: Sameeha, for example, felt fully recovered when she left hospital after a single psychotic experience and didn’t want any further support.

But for many, leaving hospital was a difficult and stressful period, and for those who had been in hospital for a long time, being home brought new challenges. As well as coming to terms with what had happened, people had to deal with the emotional impact of their psychosis on their loved ones, the disruption to their plans for study and a career, and the loss of long standing friendships. When Fran came out she said “all my friends were either going to university or getting jobs or x, y, z. And I was just unemployed and really, really miserable and didn’t know what to do with my life”. Some faced periods of low mood and depression, further psychotic experiences, and homelessness.
 

Chapman had difficulty talking to his psychiatrist and was discharged when he was still unwell because he had been taking drugs while in hospital. He was homeless so returned to “the streets”.

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Chapman had difficulty talking to his psychiatrist and was discharged when he was still unwell because he had been taking drugs while in hospital. He was homeless so returned to “the streets”.

Age at interview: 23
Sex: Male
Age at diagnosis: 20
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And so you said that when you went to the hospital, you didn’t really want to talk to the doctor. 

Yeah

Why, why did you not want to talk to him?

Because I still don’t have a voice and I’m still trying to get my voice back. I didn’t know what to say as well. 

Right

Because I couldn’t speak at the time and I didn’t know to speak. I know it sounds stupid but I didn’t know what to say. I couldn’t, couldn’t explain myself properly to the doctor what was going on.

So is it that you couldn’t find the right words to sort of describe?

Yeah, it’s difficult.

And did the doctor try to help you to do that or…?

No, he was just saying, “What do you see, what do you hear?” It’s difficult to explain what you hear and what you see.

So you weren’t, I don’t know you didn’t feel like they were very helpful then?

No.

Okay and you said they gave you this diagnosis…

Yeah

…this is, they gave you the paranoid schizophrenia…

Yeah, yeah

…diagnosis. And you don’t, did you say you don’t agree with that or…?

No, I just think he just got fed up of me because I was, I was taking drugs in the hospital, I was taking crack and heroin in the hospital ward. 

In, in the hospital?

Yeah and I think he got fed up of that, because I tested, my urine sample tested positive for crack and cannabis and heroin. So I think he got fed up of it or something, but it must’ve been something like just ticked him off and he thought no I’ll just diagnose him with paranoid schizophrenia. And get him out of here.

How did you feel about that then, getting that diagnosis when…?

I wasn’t bothered, I was like, “Oh okay.” 

Right. So, they sent you home then?

Yeah, I was on, I was on the streets and my asylum claim got rejected so I had to sleep rough for about six months.

For six months?

Yeah, for about a year.
Despite what could be a difficult period, some talked about how the self-help techniques they had been shown in hospital and the friends they had made helped them to move forward with their lives.
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