As someone with more than seven years of lived experience on acute wards, PICUs (Psychiatric Intensive Care Units) and a rehabilitation unit, I believe I have the relevant experience to make suggestions on how to make improvements to the UK mental health service.
I have been unwell for 13 years and was diagnosed with paranoid schizophrenia. When I fall ill I become paranoid and erratic, mainly due to aggressive and threatening voices which I have constantly heard for more than 12 years.
Prior to my first admission I was studying for an MA in journalism and was working part-time to fund myself, but my first episode scuppered my plans and I ended up sectioned and detained in a psychiatric hospital. It is important for mental health professionals to realise how traumatic it is to be detained for the first time on locked units where constant observations take place and there is a new regime to get used to.
Throughout the past 13 years I have been in and out of hospital with many long admissions. I have lived at the step-down rehabilitation unit for more than three years.
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Recommendations for patient treatment and support
Firstly, I feel that patients need to be approached holistically and not just viewed as another report written by nursing staff. In psychiatry there is a general adherence to the ‘chemical imbalance’ theory which has resulted in an approach towards mental health based ‘mainly’ on medications that affect the brain.
Personally, I am on two different anti-psychotics and have started taking a mood stabiliser, which is usually used to treat epilepsy and bipolar disorder. There are other possible causes of psychosis including genetics, childhood trauma and, as a Muslim, I also believe in spiritual causes, such as Jinn possession.
Also, I think that newly diagnosed patients should be notified, in clear terms, about all the potential side effects such as weight gain, drowsiness, and numerous other side effects when they are started on anti-psychotic medication.
On a personal note, I gained weight and developed diabetes and tachycardia as a result of taking Clozapine, which is touted as a ‘wonder drug.’ I must add however, that Clozapine has helped me.
I also recommend that patients on mental health units should be encouraged to carry out light exercise such as 10 press ups a day and a brisk 10 minute walk, even if it is on the ward corridor. I have noticed so many mental health sufferers who are overweight and unhealthy. Exercise should be a part of the patient’s care plan.
Thus I suggest that healthy eating should be enforced on psychiatric units and smoking should be completely banned. I started smoking at a PICU during my first admission because smoking used to be allowed on wards at the time. A smoking ban would be hard to enforce as people smoke to relieve stress, but the ultimate health benefits outweigh the distress that would be caused by a smoking ban.
Take away food should be restricted and healthy options should be recommended by nursing staff by discussing potential health problems that can arise due to being overweight.
The Mental Health Act and patient rights
Furthermore, patients need to be notified and educated about the Mental Health Act, regarding the frequently used Section 2 and Section 3 interventions. Mainly about the fact that a person can be held by force under these sections and patients can be medicated voluntarily or otherwise. Also, patients should be notified that they can be detained for up to 28 days under a Section 2 for assessment and up to six months under a Section 3 for treatment. I have been sectioned and detained for more than seven years in total in various hospitals.
I understand strongly that it is imperative that family members of patients should be educated about mental health, particularly about the diagnoses of the patient. Family should also be more involved in the sectioning process as they know the patient better than a doctor or social worker. They should also be made aware of their rights under the Mental Health Act.
My family have supported me so much over the years, emotionally and financially, by visiting me in hospital, taking care of me when I was living at home, by helping with my medication, and going for appointments.
Tailoring support to the patient and their personalised needs
I also recommend culturally sensitive therapy and treatment. It is up to mental health professionals to learn about the culture and religion of the patient. In my case, they could learn more about my faith- Islam. If members of the nursing team and mental health professionals knew about the Islamic rulings concerning mental health and the importance of the Quran it would help to build trust and rapport and will ultimately contribute to recovery. Therefore, it is necessary that mental health professionals have a grounding on the basics of Islam by possibly reading a translation of the Quran and a biography of the Prophet Muhammad (PBUH). On a positive note, my dietary needs have always been met in every hospital I have been held in.
I believe it is very important for nurses, psychologists, and psychiatrists to interact more with patients, and to get to know them rather than just speak to them at ward rounds. Recently, I was challenged to a game of chess by the unit consultant psychiatrist, which was welcome and surprising.
Psychiatrists have so much power over patients, so at the very least they need to understand and empathise with patients by getting to know them well. I know they have a heavy workload, but where there is a will there is a way.
Education and therapy courses within the rehabilitation unit
I firmly think that there is a need to have regular educational courses offered, such as basic Maths and English, so the time a patient spends at a unit won’t be completely wasted. Courses and activities should be held which will help people to be productive once they leave hospital after a long period. There is a culture on units where the patients only eat, sleep, watch TV and take medication.
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- See also: 'Working as a journalist and living with schizophrenia'
I was offered psychological support at the rehabilitation unit which I found to be beneficial. I learned many coping techniques, Cognitive Behavioural Therapy, and Compassion Focused Therapy. However, I hold the opinion that it is important to have psychological therapies on acute wards and PICUs too.
Although I have made many suggestions, I admit that mental health treatment has come on leaps and bounds over the past few decades, and I have been treated with dignity and respect by nursing staff on various wards. The UK system is still better than many other countries in the world in how the mentally unwell are treated.