I have been sleeping badly lately; I should pay attention to it. It is always a warning sign. I wake maybe two or three in the morning and feel both relief and dismay at the sound of the BBC world service on the radio. It reminds me of those times when my world goes haywire. It reminds me that I will have another tribunal soon when my lack of control and autonomy is bluntly thrust into my face again; that in a few weeks, I will enter a room where I feel that I have no dignity and look on my existence with shame.
It is only relatively recently that I have learnt that the basics of all human rights legislation are to assert and respect the basic dignity we all have as people, whatever our actions and whatever we, the system, or our illness may have done to remove that sense of dignity.
My experience of in-patient mental health services
It has been some time since I was last in hospital. But despite that, I would like to describe my perceptions of my rights at that time when I was alone, lost, and desperate.
I will try to explain. I last went into hospital a year after I had left my wife. I had naively thought leaving her might be the start of a better relationship. I could visit, we could be civil for once and learn to treat each other with respect and learn how to behave in each other’s company. Instead, I found myself in a maelstrom of anger and bitterness, which I could not cope with.
I found new friends, carried on working, but somehow forgot to look after myself. Whisky became very attractive, washing and caring for myself arbitrary. Sleep became erratic, so erratic and confused that my dream life merged in some ways with my waking life. My eyes became red raw, my hair rank and my skin itchy. The absence of my son weighed terribly on me. Taking medication seemed a waste of time.
The more I thought of it, the more I considered myself a failure, not only as a father, but as a friend or even a human and, as is the way with people with my diagnosis, the power of my beliefs gained a new significance. Those beliefs: all about being a devil and evil, put my life in danger.
Within a short time, I was on a psychiatric ward at night time; still clutching my work laptop but with very little else, the clothes I stood in and maybe twenty pounds in cash. There were two nurses besides me all the time to prevent me from harming myself.
I insisted on leaving; the psychiatrist said I couldn’t. I said I was not under a section, and he said he would see about that in the morning, but for the moment, I was to be on constant obs and would remain where I was.
The out of mind experience of being section: why we still need information on our section
In the morning, the promised mental health officer turned up (for most of you; think of ‘approved social worker.’) I can’t remember much of it. I had not lost it completely. I still knew what a section was; I knew from the past what would likely happen. However, all I really remember was that she seemed to be a kind person.
I remember she said she agreed with the need for me to stay there and that she needed to tell me what my rights were, and she did. She also gave me lots of leaflets. I had no interest. These words and these papers? Why was I being told them? What did they have to do with me? What on earth was the point of them. My world was focused almost entirely on harming myself and becoming a spirit in the sky. Ordinary conversation had become almost impossible, convention and normal behaviour an alien realm I had fled from. Informing me of my rights seemed to be of as much use as offering someone a cup of tea while their boat is sinking underneath them.
Being charged with informing people like me of our rights when we are exhausted, distressed, confused and probably angry sometimes feels like a hiding to nothing. It certainly was for me. My leaflets went into my bedside cabinet and in due course were joined by my section papers and my tribunal papers and, in the months I was there, I rarely, if ever, looked at them, certainly not in the seven weeks I was on constant obs.
Of course, we need these papers, and on occasion, I am very glad of this information. So many of us, when sectioned, arrive in ignorance; not too sure what a section is, not sure what a hospital will be like, unclear what a CPN or Psychiatrist is about, so, yes, we need this information. When we realise that people like me cannot or are uninterested in taking it all in, we often say explain such things when we are in a position to listen and discuss but sometimes we never get to that stage; we can remain inconveniently uninterested in the mechanisms of our detention.
- See also: 'The mental health pay gap: is it a thing, like the gender pay gap?'
- See also: 'Scotland's MHA review: "I don’t think trauma-informed care will stop all the suffering we go through"'
We are in a new world, and from that world, I will give a glimpse of some of the things that really made a difference to me. For me, these are the most essential things of all; do your duties but go back and back to that basis of all rights legislation: the preservation and protection of our dignity.
In those first few hours, when I first harmed myself while on Constant Obs and the alarms blared, and the staff rushed to my room. The nurse dealing with my injury poured cold liquid over my arm; it was soothing. He concentrated on mending me. He did not judge. He was present for me. I felt cared for and, for a very brief time, safe.
Another night: 3 am, and I am in the dining area typing. A nurse comes and sits by me, and I tell her how wonderful it will be when the world is rid of my evil and how my son will be so much better off without me. In the silence of the night, under the bright lights, she tells me gently that her mum has bipolar disorder. She talked of her childhood when her mum was suicidal. She speaks to me from the truth. She tells me that the very saddest thing I could ever do to my son is harm myself, and she says it in such a way that I listen and feel a connection and know that she cares deeply about what happens to me and though I do not change my mind, I feel something very precious and very important has happened.
Restoring dignity through the language of kindness
I have a visit from friends and their children. I am not saying much at all, but I am delighted at the laughter and chaos. My mental health officer walks into the room to do something she needs to do; I am not sure what. When she sees us all, she says I should enjoy the company I have and will not disturb my happiness and that she will return the next day. She will have driven an hour to see me. The same mental health officer goes to the trouble of finding my notes from when I lived in Edinburgh, and for the first time, I find out that I was sectioned twice when I was first psychotic all those years ago but never informed of it. I am so impressed that she made the effort and cared enough to find this out.
I cannot speak to anyone, but every time my named nurse is on shift, she comes and sits on my bed; the weight of her beside me is reassuring. She talks with me for half an hour, and I find sometimes I can talk back. I feel that she also wants the very best for me. A nurse manages to observe me going to the toilet in such a way that I don’t feel as terribly exposed and shamed as I sometimes do, a simple but hugely important thing. I take my first food in three weeks, and the nurse who is trying to get me to eat does it in such a way that there is no shame, no event, no moment, somehow, without hassle, I am able to eat again.
Why it is important to remember the value of human rights legislation in mental health services
It is a very trite point to make, but each of those people treated me as a human. They cared for and wanted to help. I was not an irritation or a thing or someone alien. I was not a case or just a patient. I was someone they wanted the very best for. They gave me dignity when I had lost almost every vestige of dignity.
The trite bit is to say yes, of course, I need to know my right to appeal my section or to advocacy or legal representation, but underlying all that is the fundamental dignity every human being has a right to.
I remember with gratitude those people who remembered that and who preserved that for me. That is my lesson. Get the basics right; remember the reason for human rights legislation and the values that underpin them. When my world is in another dimension, I may never ever read a leaflet or pay attention to the list of solicitors I can contact. Still, those times I felt respected and valued and regained some dignity, those I will never forget.