17yo sectioned in all male adult unit

[scotsheather]

www.bbc.co.uk/news/uk-scotland-49447655

This was on the news. Just makes me so angry. A vulnerable young woman in a confined space with men.

"She said the men looked at her daughter in sexually inappropriate ways and followed her around the unit."

As if being moved to an adult unit at 17 isn't bad enough. What does it take to get vulnerable women the option of male free spaces when at their darkest place?

From the little I know it seems like people with autism and mental health needs just get warehouses in whatever secure space is available even if it's inappropriate or miles away from home.

I am an ex MH nurse. And also a MH service user. Whilst I agree with some of the points that minibroncs makes, I do also think that it misses a huge part of the overall situation.

Ideally, no female should be nursed on a male ward. The times when this is not possible is if there is only one ward for (e.g.) PICU. You won't find many staff disagreeing that this is unacceptable, and the trust I worked for spent lots of money in building additional wards so that we could segregate by sex.

Prior to that, it isn't that cut and dried. If a person is, for example, at a very high risk of harming themselves or others, then they are likely to face a higher risk of harm by not being in hospital, than being admitted but with 24 hour 1:1 care from a person of the same sex.

That's obviously not ideal, by any stretch of the imagination, but if the alternative is that person's possible suicide or harm to others, then it can sometimes feel to the AMHP and Drs sectionning that there is little choice.

With regards to sectionning of individuals who have capacity: capacity often fluctuates, and in its legal sense, has to be ascertained by two doctors. This means that in order for capacity to be fully assessed, a patient would likely need to be admitted anyway. I always tried to avoid any patient being sectioned if I could somehow persuade them to stay informally. Sometimes, that just isn't going to work, and the person needs to be detained for the safety of themselves and others. When I have instigated sectionning, I have never had a patient tell me, once they are well, that they didn't need to be sectioned. Though at the time, they will always deny it. I have always had the patient understand exactly why we had to. Maybe it is about explaining to the patient fully, I don't know, but there are occasions where we would have been doing the patient a great disservice if we hadn't sectioned.

Forcibly medicating is a bloody awful thing to have to do. I have done it many times, often with tears in my eyes, but only after I have answered the question of "would I agree this needed to be done to my family member". I agree that there are some MH professionals who are utter bastards and are in the job for some kind of power trip. The rest of us know the massive responsibility, and privilege it is, and I promise you we don't do these things lightly. Other patients should always be moved out of the way so the person has privacy, and same sex members of staff should deal with the underwear and injection, to.maximise dignity. To be fair to male colleagues in that situation, I have never known one not avert their eyes, even when the patient would not have been able to tell whether they were doing so or not.

"we remove them from their social support, we deny access to all their usual coping mechanisms, we take them away from anything that was good in their lives, we remove all their choices and control over their own life and environment, we give them crap inedible food, we deny them fresh air and access to outside spaces, we deny them exercise, we deny them meaningful stimulating activity"

This paragraph I do not recognise from the wards I worked on, though I appreciate they are all different. We WANTED their social supporters to phone and visit the patients, they had lots of choices of activities - we employed activity facilitators specifically for that, there was a wide choice of food, there was access to outside exercise, fresh air, a gym, a pool, physio, occupational therapy. People were encouraged to make choices and retain as much autonomy as possible.

Maybe it depends on the particular Trust - I worked for a specialise mental health trust. They do tend to have better provision than mixed Trusts.

My only reason for posting all this, is that I would hate someone to read a series of negative posts about mental health wards, and be terrified of ever being cared for in one. I can't speak for all, but I was proud to work where I did, and would be happy to be cared for there myself. Or have family members cared for.

They aren't perfect, but the patients don't see the vast amount of risk profiling that we do to try to keep all the patients safe and as well as possible. We broke our own bodies and mental health to provide the care that vulnerable females needed. And we took complaints very seriously. E.g. a colleague was accused of rape by a patient. This was alleged to have taken place with 7 female members of staff also in the room. Despite all the staff saying "this did not happen", we suspended the staff member, called the police in and the room was a crime scene. The colleague's ex wife heard what happened and refused him.access to their daughter (he had to spend £1000s through the courts to get access back), so he personally suffered.

The police investigated - it was a false claim made by a lady who was very unwell and it was part of her delusions. We knew that from the start. And still escalated it anyway. It is untrue to say complaints aren't taken seriously. They are. They are sometimes unfounded though. When they aren't unfounded, the shit hits the fan internally and there are major investigations.

I say all this NOT to defend a 17 year old being on a mixed sex ward. But to give the other side of MH treatment that the patients don't always see or even know about.

“we remove them from their social support, we deny access to all their usual coping mechanisms, we take them away from anything that was good in their lives, we remove all their choices and control over their own life and environment, we give them crap inedible food, we deny them fresh air and access to outside spaces, we deny them exercise, we deny them meaningful stimulating activity”
This could not be more true. People who haven’t been inpatient in ~certain~ institutions cannot begin to imagine the level of archaic, dehumanising evil inflicted behind locked doors in the 21st century

People who haven’t been inpatient in ~certain~ institutions cannot begin to imagine the level of archaic, dehumanising evil inflicted behind locked doors in the 21st century

My perspective is that of someone who has a family member currently held under section at the National Hospital, Carstairs. That is the maximum security mental health facility in Scotland, our equivalent of Broadmoor. He is being held there because he was charged with and acquitted of due to mental illness, attempted murder.

My family member has suffered paranoid schizophrenia for a quarter of a century. He has been sectioned before, he will probably be sectioned again. On this occasion our family had spent months pleading to have him sectioned prior to the incident that led to his arrest.

I am very well aware that mental health facilities are not perfect and that in the past many people were institutionalised in them when they should not have been. I am also very well aware that 'care in the community' does, and has since the beginning, lacked proper funding, adequate staffing and sensible prioritisation.

Sectioning is not something that happens lightly. You have to fight tooth and nail to get your loved ones sectioned even when they are a clear danger to others, never mind themselves. If we want to see fewer patients held under section we, as a society, need to invest much more heavily in mental health services than we currently do. That means higher taxes, or money taken from somewhere else. The reality is we, as a society, aren't going to do that in the foreseeable because we, as a society, don't want to think about these people. They aren't 'stunning and brave', they are awkward, and difficult, and sometimes downright scary. They get little sympathy.

The vast majority of people who work in mental health institutions are decent people doing their best in extremely difficult circumstances. The patients they deal with are all in extreme crisis, because it takes extreme crisis to be given space in these wards and institutions at all. We would do better to intervene before it gets to that stage, but we won't. I've been waiting my whole adult life for anything to improve on this front and no longer believe it will. Sorry to be blunt but the bottom line is no one gives a shit about mental illness, at least not anyone that matters.

So no, this girl should not be on a mixed sex ward. She quite likely should never have been on a ward at all, but the powers that be don't care. They'll do what they always do, pay lip service to the damning headline then tomorrow forget about it and move onto something the more palatable and nothing will change. Again.

I don't recognise the wards you say you worked on, Joanna, though as you say specialist trusts night be different. A pool?!

Personally I recommend to others that they avoid secondary services unless they feel they absolutely need medications a GP is unable to initiate, and if the possibility of hospital comes up, to do anything they can to avoid admission, even if they're suicidal.

(Obviously, this is to people who are considering it as something potentially positive and helpful for their deep distress or depression or whatever, not for those who e.g. are extremely manic and psychotic and wouldn't be considering it as something they might want to do anyway.)

The whole sectioning system is a fucking disaster. For all the times that it helps people who are very unwell, there are people who are in desperate need whilst fuck all is done, and also those who are sectioned for spurious reasons by doctors practising defensively. I fell into the latter category, and the things which were done to me as a result have, despite my best efforts, ruined my life. I shouldn’t have to fucking accept being collateral damage caused by a system which helps some people, sometimes.

This is somewhat closer to a recognisable picture of an adolescent psychiatric ward… adolescent units are far, far worse than adult wards in my experience, and that of many other people I've spoken to. So perhaps I was too rash in saying they should put her in an English adolescent PICU. If she's on 1:1 she's likely safer from assault in the adult male unit, sadly.

@ScrewLiterature - yes, a hydrotherapy pool for people to engage in physical activity again.

It was a specialist trust and had absolutely amazing facilities. I know I was lucky to work there.

I would NEVER dissuade someone from hospital admission if they were suicidal. Largely because when you end up with people committing suicide, it is horrendous. The Trust I worked for did its best to nurse people at home, with the crisis team going in 4 x daily to monitor people. But some really do need to be in hospital. And sometimes, family simply cannot keep a suicidal person safe as they will need to sleep or nip to the loo, and then a person can take that opportunity to harm themselves.

If someone needs 1:1 observations, or even arms length nursing, then it can only be done in hospital.

I would hate to think of patients being put off an informal admission due to the advice given online causing fear, and then end up being detained as a result, when many units have come on in leaps and bounds over the years.

Nurses are also trained very differently now. As the baby boomers retire, practice is changing - for the better, I would argue. It means few people who work on modern wards ever worked in the old asylums. And so don't have that culture of being "key swingers" who do things TO patients rather than WITH patients.

I suspect I was lucky in where I worked. It is a centre for excellence. I would have hated to work on some wards in London which were apparently much less therapeutic.

I just don't want people to be scared of admission if it is suggested to them, when I would have been perfectly happy to have had myself or any of my family nursed on the wards I worked on.

We take away people's freedom on the say so of people with next to no legal training, we lock them up, we take them away from their homes and everything familiar, we remove them from their social support, we deny access to all their usual coping mechanisms, we take them away from anything that was good in their lives, we remove all their choices and control over their own life and environment, we give them crap inedible food, we deny them fresh air and access to outside spaces, we deny them exercise, we deny them meaningful stimulating activity, we forcibly restrain them and forcibly medicate them

And for some people this saves their lives, and gives them a chance to be on the road to an acceptable standard of living. Not in all cases, and I have no doubt that there are (too) many cases where someone is sectioned when this is not the best course of action; but from experience, sometimes it is needed. Sometimes support in the community and at home is not enough, sometimes the illness makes the thought of taking medication impossible, sometimes seemingly extreme intervention is needed. I would have certainly lost a close family member if not.

The wards I have worked in have all been mixed sex, but with washing facilities in each individual room. It must be scary for the girl though, and extremely glad she is being moved.

Last time I was in hospital, a young and very unwell man stabbed another patient, an older, blind man. The young man was placed on 1:1 line-of-sight with lazy nurses/HCAs who would focus on their magazine or newspaper and ignore the fact that their (disgustingly heavily-drugged) charge was wandering off round the corner, acting most put-out if another patient mentioned this and suggested following him. When other patients expressed concern about being locked in with someone who was (through no fault of his own, as he was a lovely chap when he was well) clearly dangerous, we were told not to be discriminatory and that he was unwell like us. We knew that. We didn't blame him (well, the guy who was stabbed blamed him, but that's understandable), we just wanted to be safe. The staff didn't give a fuck.

Most of the time, there were no therapies or activities; we all just sat around being mental. A volunteer took some of us once a week to the beautiful occy therapy room from back when it used to be a traditional mental hospital, full of art and craft materials that nobody knew how to use, and we did colouring-in. There was a small gym with a couple of exercise machines, that most of us weren't allowed to use. No pool. Some people were allowed to go to the weekly group relaxation session with a psychologist. And a dietitian came in and lectured us once, which was a laugh because the food was dire and they couldn't accommodate my dietary needs so I subsisted mostly on jars of peanut butter brought in by my partner, eaten with a purloined teaspoon.

There were also plenty of places I could've hanged myself in there. And surely we all know that lots of people just top themselves shortly after they get out anyway?

And that was a good hospital experience, compared to some. Nobody showed me their genitals, nobody made me eat hash, and nobody held me on the floor for an hour while repeatedly injecting me with sedatives for daring to struggle against the restraint in order to breathe.

I've given an Advance Statement to my mental health team requesting that I not be admitted to hospital (or given antipsychotics) unless necessary for the safety of other people. Unfortunately, if you're sectioned under the Mental Health Act, even if you have capacity or have made a previous decision when fully capacitous, you can't refuse whatever treatment they fancy giving you, so unlike everyone else, for whom an Advance Decision legally must be followed, it's pointless for you to make an actual Advance Decision, as it'll just be treated like an Advance Statement (i.e. they don't have to stick to it as it's just considered your preference and can be ignored). But my Nearest Relative has promised to do what they can to get me off section if it happens in future, and if they can't, to "break me out" (as it were) and take me somewhere they can't get to me.

These places can be truly horrendous, and I would do whatever I could to persuade family members to stay out of them, if it's only been suggested. Of course, most of those who would be given a choice aren't offered it…

@ScrewLiterature That sounds like an absolutely horrific experience. What I will say, is that, awful as they are, they are the experiences of those people who stayed on that ward, with those staff, at that hospital.

I had a terrible experience in hospital following the c section birth of my DD. The staff and ward was dreadful. What I would not do, is discourage anyone who needs a c section from having one, even if it meant staying on that crappy ward.

The reason being, dreadful and dehumanizing though the experience was, that ward and awful staff saved mine and my DD's life. I am alive to be traumatized by it.

Ideally, no-one should be traumatised at all. But I would rather be traumatised and alive, than too dead to complain about it and try to get things changed for others.

So please don't tell people to refuse informal admission. They are far more likely to end up sectioned, with all the implications of that.

And if you are "busted out" of hospital whilst on a Section, the police will look for you, find you and prosecute your loved one. Is that REALLY what you want to put a loved one through, because it isn't very nice of you if so? You would most likely be fine due to being on a Section. They would be the ones taking the rap for it.

How do you mean "those people"? Apart from the stabbing/being stabbed, those things all happened to me, all at different hospitals (well, two of them were the same hospital ten years apart where the only staff member who remembered me was a lovely HCA who must have been about 112). Although the one I never really recovered from was the first one, the adolescent ward, with all the restraints..

There are many people on here who muse about going into or trying to get a family member into hospital who think it's a very different thing from what it is. If they're being given an option about it, I'd try to dissuade them because I know too many people, especially women, who've been broken by mental hospitals and many more not helped at all. I do know some who were helped by it but that tended to be those where there was very obviously no other option than hospitalisation and they were given no choice in the matter. And there are some people who seem to want to go in there again and again, but I think they have other issues. Those who are given a true choice should be allowed to do so knowing what a mental hospital is, or can be, like. And much as nurses etc. like to tell you that if you don't agree to go in, they'll "get you sectioned", that's the AMHP's decision, not theirs (depending on the section, obviously). But I fundamentally disagree with the "if you don't go in voluntarily we'll make you go in" technique. It's hardly voluntary, you just end up locked up against your will but without the protections and entitlements of the MHA, when the AMHP may very well have chosen not to section you anyway.

I haven't asked my Nearest Relative to do that. He's seen what those places have done to me, and told me that if I don't want to be there, that's what he'll do if necessary. As a matter of fact the last time I was in I chose to readmit myself, a few days after having been allowed to leave and despite the stabbing incident, for his sake, as he was barely sleeping for watching me. Please don't try to guilt-trip me; it won't work.

I do understand why these things are difficult, but mental hospitals can and regularly do ruin lives. It's not the same thing as needing a c-section at all.

Actually I wouldn't have expected any of them to have remembered me, but I didn't remember any of them either (including her), and as far as I know she was the only person there who was the same. Was very surprised she remembered me but I guess she remembered specialling a 17 year old girl on an adult ward.

I really have no interest in 'trying to guilt trip you'. I just feel for your relative.

It is the AMHP who makes the decision, but who do you think they talk to to make their decision, in addition to the patient?

I have never had an AHMP refuse to section a patient who I thought was unwell enough to need it. Nor a Doctor. Because we are the ones with the patients the longest, who often know the patients through various admissions, and know their risks etc.

'Those people' were the people on the ward you described. You, obviously, and the person who was stabbed, the person who stabbed someone. There was more than just you in your description.

You advise people how you think best. You do to your relative what you think best. To be honest, you have said nothing that I haven't heard an awful lot of times before. Mostly from patients who end up getting sectioned as they are an obvious risk of refusing admission. And they tend to be very unaware of quite how they are when they are unwell.

I wish you luck in the future and hope that any future admissions are better than the ones you have had so far.

To be honest with you, we tend to remember loads of our patients. And if we dont know them, we speak to colleagues who have looked after them in the past. All details of all admissions are there in the notes, along with the patient's personal, family, medical and risk history. It means we can get a good picture of a person pretty quickly.

I got to know hundreds of patients over the years, lots of whom still say hi if I see them in the supermarket or wherever. All patients are different, but we spend so much time observing and talking to them, that we get to know them.

You are a person with value in your own right, therefore you will have been remembered.

Take care

I asked what you meant by "those people" because I wasn't sure whether you meant the people on the ward, or if you hadn't realised I was talking about my own experience of being flashed and being given cannabis to eat (fairly mild in the scheme of things,I know; I have friends who've experienced far worse) and thought that I was talking about other people's experiences of those things.

WRT being remembered, it was ten years since my previous (and only) admission to that ward, and I'd only been in there a couple of weeks the first time — I could hardly have expected anyone to remember me! And WRT reading past admission notes allowing you to get a picture of a patient, I've read all mine, and sometimes, depending on staff member and ward culture, they can be full of lies and misrepresentation. Often they're fine, but at one hospital in particular I'm thinking of, they made a silly mistake in forgetting to remove the contemporaneous handwritten record of a serious, life-threatening incident, which contradicts the later typed-up version in several very important ways — the typed version exculpates those members of staff who would otherwise have been in serious trouble (or should've been). Most of the rest of the time they were careful in what they did or didn't allow to hang around in the notes — for example, most restraints not recorded and none of my injuries from restraints — and they sometimes added blatant lies, like, for example, that I was making myself vomit using soap as the reason they didn't medically investigate the vomiting. There's also entries in there that are actually about other patients :-/ Don't believe everything you read in notes…

If you've heard "an awful lot of times" about neglectful and abusive practice (like excessive restraint, ignoring your 1:1 walking off, coerced "voluntary" admission) then why on earth are you so blasé about it all?

BTW I've done nothing "to" my NR. I chose to return to the last place on earth I'd want to go, one that brings back deeply traumatic memories, just so he could sleep better — I think you're being a little unfair there. I don't intend to have any future admissions, and think it's unlikely as long as I'm able to stay on lithium. But thanks; I'd hope they were better than some of the admissions I've had, too.

I was told if I didn’t go into hospital as an informal patient they’d section me anyway. The only reason I agreed to go in was because they said I could leave at any time.

I was on all female ward but the majority of staff were male. Some of them were utter creeps. One, a ward supervisor, followed me around trying to chat me up, then threatening punishments when I ignored him. There was another who would unlock my door without warning, once when I was getting undressed and once when I was showering. He actually opened the bathroom door that time. Then there was mr victim blaming rape apologist, who told a group of us women that if we’d been raped we should think of what we might have done to encourage it.

The place was bloody awful. There were never enough staff for us to have our few minutes of leave each day; the food was basically sludge; and there was literally nothing to do apart from sit in the lounge and watch the telly, which a particularly senior member of staff would take control of and lock us out.

Anyway a few days before they said they’d discharge me I witnessed two male members of staff chasing a sobbing young woman to her room. She was next door to me so I heard the screams and crying as they pinned her down and injected her. The fear was palpable, you could feel it. I had a massive panic attack as a result and told them I wanted to go home. The first doctor said yes but the ward manager insisted on waiting for the night doctor to come on duty instead. The night doctor wouldn’t let me leave and threatened to section me again. Apparently the reason she knew I wasn’t ready to go home was because I was adamant I was. That was the thursday, I was discharged the following monday.

I hope that poor girl has long since been transferred into a female setting and I hope she gets well soon. No girls or women should have to share a ward with males and no female ward should have any male staff.

As for me, I’ll raise hell if they ever try to hospitalise me again. I don’t trust MH professionals and although I’m well at the moment, there’s no way I’ll be going anywhere near them if I get ill again.The community MH teams are condescending, gaslighting and straight up abusive enough, in hospital you can’t escape, so they can do what they like, and they do.

Solidarity fuckery I hope you never have to go back in.

May I just say as the mother of a young woman who was 17 and who was once quite unwell that the entire system is a disgrace. CAMHS didn't give a shit. A&E after a tiny crisis were hell bent on refusing to let her leave despite saying she was a voluntary patient. All for a CAMHS review. A&E staff were utterly horrible and insisted she had to have a 1:1 which was an absolute deprivation of liberty. The lack of transparency was mindblowing. When I insisted she could be assessed in A&E by an MH liaison nurse on premises from 8am to 2am. The A&E nurses and paed cons didn't know until I put my foot down. Paed cons told me it had all been put in place after our conversation and with my permission - funnily I later found out it was put in place at 4.15pm. They didn't contact me until 5.48 and I arrived at 6.45pm.

Because CAMHS had refused to help my dd she was being suppirted by a consultant paediatric psychiatrist and was much better than when originally assessed by CAMHS and offered nothing. CAMHS assessed again - guess what zilcho.

But A&E would have depeived her of her liberty for that and the ward sister screamed at me and accused me if harming her when I asked why her discharge that shouldn't have been necessary if she wasn't being held involuntarily. Said ward sistervalso yelled for all to hear that I was causing a safeguarding issue and she'd call the police if we left - although at no time were we informed dd was sectioned and could not leave.

Happily dd recovered - because I had £6k to spend on private care. Oh she was diagnosed too - a diagnosis CAMHS laughed at.

So finally may I ask if the hospital/ward was sobterrible why did the parents leave her alone? I'd have camped at the door of the ward to orotect my child and made myself such a pain in the arse they'd have had to orovide optimum accommodation. Care is substandard because as a nation carers are too grateful.

Jesus wept some of the staff that some of you have been nursed by have been dreadful! It makes me ashamed of my fellow MH professionals. Though I am reluctant to call them professionals.

I am not blase about what happens where I work. Largely because stuff like is beinf described here just didn't happen. I know it does in non specialist Trusts, and used to in the asylums, but doctoring paperwork to cover up fuck ups and men injecting women after chasing her.....and the pervery of the staff - that's mind blowing. I do believe you all, I just cant get my head around how it is allowed to happen.

Any one of those incidents would have resulted in staff being suspended and a major investigation where I worked. We had enough of those as it is, but never for something like the things listed here.

Oh, except for one guy who liked to try and pretend he was a prison warden and he lost his job, for being a power crazed dickhead. One girl entered the time wrong on some paperwork abd very nearly lost her job.

It sounds like the wards and staff you have experienced are truly toxic. The polar opposite of what you need to feel safe and get well.

Those Trusts which have these staff need to do some serious recruitment and "letting go" of the terrible staff.

I think food staff know that we are all trying to be as straight down tbe line as possible, so any arseholes who worked there were soon dealt with. I suppose if the culture is terrible, maybe the opposite happens.

I am so very sorry for all your experiences. It shouldn't be that way. It is the opposite of how we are trained. And an abuse of the role.

to all.

*good staff not food staff!

The food staff in mental hospitals are also super important

But I feel the most important thing is ward culture. On a ward with a good culture, the occasional person who can't help themselves when it comes to bad practice is dealt with. Though probably they just end up leaving and going to a ward with a bad culture a lot of the time. In a ward with a bad culture, it's the rare nurse who doesn't get sucked in to, at the very least, complicity. The rot spreads and nurses who could've been a great addition to a good ward end up being unprofessional, neglectful, even abusive. I don't doubt this could happen on an all-female ward with all-female staff. But there'd at least be less chance of sexual abuse, which is rife, whether patient-on-patient or staff-on-patient.

Thanks Joanna, mini and all others for this eye-opening information on what is as obviously a hugely neglected topic.