Indefinite isolation is anything but a ‘new normal’ for the thousands of patients diagnosed with mental illnesses cooped up in 60 medium-secure mental health hospitals dotted across England and Wales. The majority know neither when they will be discharged, nor what specifically they need to demonstrate in order to regain their liberty. Mental Health Today spent time with a handful of patients just prior to the wider world falling under a desperate lockdown of its own. This interview is the third in our In Secure series. 

“Half the staff agree with some of the patients here that it’s excessive how long we're kept locked up,” I’m told. “It doesn’t take years to get better.” Adam is 6’2” but speaks softly. His morale is fragile after enduring four years of unbroken supervision in the medium-secure hospital where we meet.

‘They came to the conclusion that I didn't have the capacity to be tried because I wasn't pleading guilty. If I’d pleaded guilty, I would have spent five months in prison; I’ve been in hospital for four years [instead].’

Adam becomes enthused however when discussing his life ‘outside’. Previously he had been working semi-professionally as a landscape artist. He has been painting since he was eight-years-old, when he practised tentative brushstrokes at his grandmother’s watercolouring society.

“For about five years we used to go to this big manor house. There were people painting in oils and other mediums. I spent a lot of time when I was younger there, with my grandma, painting. Fond memories…”

It feels the lifetime ago that it was. But every experience on the outside does. “I've had various jobs: Vodafone, doing building work, working in pubs, bars and stuff. But I've always tried to make money from artwork.”

“I'm approaching four years [in hospital] and it's all off the back of what I'm accused of, assaulting a police officer.” Adam says he went to court five times, consistently pleading innocent to the charge. He maintains that his medical record, which included hospitalisations for psychosis [experiencing things that those around him were not able to see or hear], influenced the way he was treated by the criminal justice system and not for the betterment of his mental health.

Everyone Adam lives with on his ward has had one run-in or another with the criminal justice system. By definition, that is the profile of patient his hospital – unlike most other psychiatric units – is there to treat (and contain). The mental health professionals working here hold a spectrum of views as to how they interpret their roles, whether the individual or wider society are the priority of their work.

“I think half the staff are of the same opinion as some of the patients, whereby they think it's excessive how long that we're kept locked up and the other half think it's necessary,” Adam says, dispiritedly. “There's a conflict of opinion there.”

“My solicitor said ‘look, I know you believe you think you're innocent [but] you're better off just saying you're guilty and you'll get five months in prison and get out. So I should have taken her advice.”

Diagnostic overshadowing

Adam feels this way because he would have had his liberty restored by now, enabling him to see his daughter grow up. More than that though, he feels that pleading guilty to something “I definitely didn’t fucking do” would have spared him more of the diagnostic overshadowing [being judged on the basis of his mental health condition more than his actions] he says has been imposed on him perpetually since his arrest.

“I did eight months on remand in prison, which is longer than the sentence I would have got had I pleaded guilty. They then moved me to Farm Field* [a private mental health hospital run by Elysium Healthcare] and a doctor who I spoke to there for three minute went to court for my last appearance. They took the stand and said: ‘We believe he's very ill. He has a history of mental illness and we'd like to put him under section 37 / 41’ [a particular detention for treatment in hospital]. They came to the conclusion that I didn't have the capacity [to be tried] because I wasn't pleading guilty and I've ended up doing a long time here.”

“I prefer prisons to be honest,” Adam continues, reflecting on the fleeting time he spent being assessed at Farm Field, where he wasn’t under section, and in his current hospital, where he has resided without a single unescorted walk around the grounds' secure woodlands for four years. “When you're in prison, your state of mind isn't being questioned.”

“What I'm trying to say is… I'm not just complaining about my situation, but sometimes these places don't get it right. They get it totally tits-up and it just doesn't make any sense.”

'Ambivalence hangs in the air'

Adam references Hospital Rooms, an arts charity offering creative outlets for patients, as the one therapeutic experience he’s experienced since being transferred from prison to hospital. “Things like Hospital Rooms are amazing. It gives the place a lot of hope. But at the same time, I think there are a lot of people locked up that don't need. It doesn't take years to get better.”

Adam acknowledge his own historic battles his psychosis but insists that “lots of people end up in this situation and there's nothing wrong with them. I think... I don't know… Do you believe that?” he asks his support worker.

"I think it depends on the person," flashes back the sincerely sensitive, though diplomatic, reply.

Adam initially seems to feel validated, but then swiftly becomes regretful at opening up.

“It depends on the person, yeah. Everyone's different. Sorry…! I'm banging on about... I'm bringing it up, aren't I? What I've brought up, I'm trying to forget that, so apologies. Yeah, maybe I shouldn't bring it up. I don't know. I bring it up sometimes, don't I? I'll try not to. I need to move on. Move past that, sort of, yeah.”

His support worker encourages: “I think you're working through it.”

“You need to get it off your chest,” I say.

“Yeah, I know. I didn't need to say that, to be honest. I don't know…” Adam turns to his friend, another patient.

“What do you think, man? Honestly, these places, do they help?”

“From what I've sort of seen and from what’s happened to me through experience... as you said, it doesn't take years to get well. You can get someone who's unstable or someone who has just done something unusual and that's just a blip in their life and then they are locked up all this time.”

“They get well because they are here, or they get unwell, again. So it can be problematic, to be honest, being in this sort of situation, this environment, it can be very problematic. A lot of people can become institutionalised, but at the same time, for a lot of people, it can be a positive thing.”

The ambivalence hangs in the air and it is clearly felt heavily by the patients and the support worker they share.

“I've been in hospital quite a few times in the past on section threes,” Adam adds. “I had a few psychotic episodes when I was younger [and] recovered within months. In the latter years of being in hospital it, hospital, feels very unnecessary.”

Adam thinks a lot about his family: his grandmother, his daughter, his parents. He continues to enter his artwork for competitions while waiting indefinitely for progress towards discharge. Prizes are forwarded on to his mother and father for safekeeping. A bottle of Champagne awarded by the global law firm Dentons, for his watercolour depiction of “three camels walking towards a desert oasis”, is among those being stored at his parents’ house for future reunification.

Names have been changes for the anonymity of all involved.

* Views expressed by the interviewee, including those related to Fresh Farm, are those of the interviewee alone and are non-verifiable. No accusation is made or implied by Mental Health Today of any wrongdoing.