Imagine a different way. 

Mental health wards do not work, even mental health professionals admit that they don’t work and are not nice places.  They admit that they would not wish to be there themselves and that they are very stressful environments when they should be a place of sanctuary and respite.

As some examples (names changed to protect identities), there is the case of my friend’s son who tried to kill himself two weeks after release, Susan  who has been in one for months and never gets changed out of a blue dressing gown and just sits and looks dead most days, Laura who had so much pent up tension that she will attack at the slightest provocation, Ken, so distressed after a ward-round that with super-human strength he ripped up paving slabs and hurled them through the glass windows, Katie who’s arms are covered in scratches haunted by her own rape fantasies, Clara who hurt herself after having her section upgraded, Amy who rants and screens, Charlotte so haunted by an abuse by close family members that she is constantly arguing with non-existent voices or me, who can’t remember when she last laughed and is struggling not to become religious. They don’t work and worse than that they often make people worse. A suicidal lad I met in one said as much. If something isn’t working, and with 1in4 on medication for mental health issues, it isn’t working then you examine the problem and try and fix it, do not just carry on blindly.

Lean engineering is a big thing in the private sector. It’s a way to build in efficiency and eliminate waste, essentially a common-sense approach where you first identify the problem areas, sort them into manageable chunks and then brainstorm and implement solutions. As a first step though you look for quick wins, things that could be changed easily and have an immediate impact. This instantly draws our attention to the smoking ban, something not implemented in prisons but for some reason, for people who have generally done nothing wrong, is within mental health wards.  Now this is a national not local decision, so not that simple to overturn, but one that if it was would make a big impact very quickly and contrary to what you might think could increase the smoking cessation rate within the wards.

Like prohibition the smoking ban does nothing to stop people smoking. What it does do is turn patients into smugglers and nurses into police, causing an unnecessary divide between people who are meant to be on the same side. It causes smoking in rooms and toilets and furtively in the courtyard. This is nasty for everyone. This is easy to fix. Imagine though if smoking was allowed but disapproved of it. You can smoke in the courtyard but there is a strong anti-smoking ethos in the ward. You can smoke but you are faced with the facts that people with severe mental health issues die on average 17 years earlier due to their alcohol and tobacco use [citation needed]. All anti-smoking treatments are available, and their use is encouraged. The staff and patients are therefore on the same side. Having a cigarette can be a reason for people to come and talk to you. No one wants to smoke, but like it or not it calms the nerves and knowing you are hurting yourself can give strength in situations that seem out of your control. This would cost nothing to implement, free up staff and prevent the comradery between patients and split for the staff. It also gives the nurses more time to focus on the patients and the patients a calming mechanism to ease their talking about the traumatic periods in their lives. Trauma of some sort or another generally encountered by all people in there. 

Once the quick win is in place, we can start talking about the more serious issues, disorganisation and police of emotions over actions. 

A mental health ward is not and never should be a prison but often they feel as such. No talking therapy is offered, no clear criteria for release and no freedom. It is not a prison but maybe if it was more like that it would be better. As quoted from the Big Issue, “if you are a wrong-un they throw money at you”, yet for mental health patients there are not the rehabilitation resources available to prisoners, no opportunities to learn a trade or improve your reading or arithmetic, just enjoyable but generally futile children’s craft activities, karaoke or mindfulness sessions.  Also all people in prisons have a clear idea of why they are there and how long they will be there, a curtesy that it not applied to mental health patients who often struggle to understand how they got there in the first place or have any idea what they need to do to acquire release, with some people who still appear very ill released before others that seem far more stable.

It appears that these days the release criteria is such that you will take your medication regularly and not talk back, that you accept that you are ill and that is it. But what is ill and what is “better”. It seems that “better” is often “polite to those in charge however much you are hurting inside”. Emotions are good. Emotions show you are still alive and living, emotions show where you are hurt and what has hurt you. When people don’t show emotion that is when you have lost them, that is when they have given up. Don’t police emotions, police actions. Actions speak louder than words in any environment. 

I for example had a graffiti issue when in captivity. I found I needed a way to release the inner turmoil and, not being a fan of self-harm, wrote my angst on the walls.  Some was poignant, much simply a tirade of swear words. I have photographs. It’s an interesting Turner prize idea. But that is not the point. The point is it is vandalism and should not be allowed. I should have been told not to do this, or depot injected, or had my leave curtailed, instead it was allowed to continue unchecked with staff looking on in bemusement or sometimes interest. As another example after Laura ripped a large chunk of my hair out, the issue was swept under the carpet and life continues as if nothing had happened.

Now maybe this is not the worst, staff need to understand that anger is a reaction to being let down, something seemingly small for someone in control of their own life can be devastating for people under extreme stress and the ward is a place of extreme stress. Be efficient with your working and keep people informed especially if there is going to be a change of plan and especially with section 17 leave arrangements. 

Make the wards more homely. Allow people and encourage them to put pictures up, allow people to spend time in each other’s rooms or alternatively make the quiet rooms somewhere with sofas and if they have TVs in them make sure they work. 

More than anything the staff should listen

There are a lot of questions and many improvements that I could suggest. A petty change box for one, this is just a sample. 

In the words of somebody “everything is impossible until someone does it”. Transforming the wards will not be easy but it can be done.