Psychiatric hospital. The most unreported place on earth, you see more on current TV about death row, isolated tribes of the Amazon rain forest and the deepest part of the ocean. I bet everyone has an image of what they would expect, based on the old faithfuls, One Flew Over The Cuckoos Nest, Girl Interrupted, Shutter Island etc. Those of you with a bit of perspective might have stepped back a little and assumed that it’s clearly nothing like that, surely there’s not a queue for medication, forcible injections, physical restraints, isolation cells and people breaking out every day. Surely not. Well, actually, yes.
I’ve been unlucky enough to experience all angles of being an inpatient,a number of different hospitals, both acute and intensive care wards, as both an adolescent and an adult. There is a lot of difference between all of them. However, there is one big difference evident throughout my life, that between the acute ward and ‘the low stimulus environment’ – Psychiatric intensive care (PICU).
There’s a number of reasons for a PICU admission, but at the fundamental level, you’re deemed to need more ‘intensive care’, a higher staff ratio, less stimulus, less people. In Lancashire, the average acute ward has 20 Beds, the PICU, an average of 6, with the same number of staff each day and night. Having a rare and complex diagnosis, if i’m unwell enough to need hospital admission, then i’m normally unwell enough to need a PICU. Ben and Tee at their most destructive can be extremely difficult to manage, to the point of almost needing forensic services – a whole different level.
My previous PICU admissions have all been transfers from acute wards, meaning that the acute ward felt they could no longer keep me safe. It’s now care planned to go straight to the PICU, to save the trauma of a transfer. When Ben and Tee are at their lowest, Tee is extremely suicidal and acts upon her intentions many times a day in whatever means possible. Ben, can be, and was, extremely violent and aggressive, targeting members of staff, other patients and property. This ticks both the PICU boxes: being a danger to self or others.
The PICU is sold as being low stimulus, but the more common phrase you hear on the ward is ‘restrictive’. The acute wards are based on least restrictive practice, you make your own drinks, go outside when you want to, interact with the other patients etc. pretty much just being observed and kept safe as you do so. The PICU is different, they can adjust the environment to keep you safe, your care plan is much more specific and your observations more prominent – you receive intensive care. But yes, what you see in the films, is not alien to a PICU patient.
My experience on the PICU was uncommon, however i saw it happen to other patients occasionally, so it was defiantly not just me. I was in restraint for around 6 hours a day for the 8 weeks, this involved numerous IM medications. I was in seclusion over this period every day for an average of 13 hours, and then a long term segregation in which I didn’t leave seclusion for 9 days. I was restricted in all sorts of ways, 1 square of toilet paper per visit – no matter what, no paper or polystyrene cups, access to a plastic cup for a matter of seconds, finger food (sandwiches) at all times – without a plate, no toothbrush, specific clothing, no magazines, no crayons, no music, no bed sheets, no mattress, no curtains, limited access to the shower, observed at all times by at least one member of staff, no phone, no shoes or socks. If it could be restricted, it was. After around 8 weeks, as things settled with Ben and Tee, the restrictions were lessened slowly and one by one, for a further 20 weeks, I experienced the PICU environment.
After a while, you get used to the environment, being observed taking a shower becomes the norm, waiting outside your bedroom to be fobbed in comes naturally, having no laces in your shoes is on trend. The people you share the PICU with become your family, watching them be restrained is heartbreaking, but it’s a harsh reminder of the environment. Having fewer patients, meant that they each were given an explanation of DID, the staff had time to introduce myself, Ben and Tee all separately and the other patients developed their own relationships with each of us – something that is almost impossible on the acute ward. The PICU has its positives, you have less people to argue over the telly with and infinitely better relationships with the staff, they have time to get to know your story and your care plan, and they’re all on the same page – something that’s fundamental when working with DID.
I guess everyone’s experience of the PICU is different likewise everyone’s reasons for needing more intensive care. I guess I wanted to dispel the myths from people trying to dispel the myths. People think that restraint, injections and restrictions are a thing of the past in mental health hospitals, when in actual fact, they’re still very much a part of it. I guess that’s why they’re unreported. Lets stick to learning about the isolated tribes in the Amazon and the bottom of the ocean. It makes better television.
definedisorder 