Richard McLean spent time working on a psychiatric ward as a Consumer Consultant. As a mental health service user, he shares his unique viewpoint.
It was my first day on the job as a Consumer Consultant. My autobiographical book, ‘Recovered, Not Cured, a journey through schizophrenia’, (Allen and Unwin, 2002), changed my life, and was the biggest job application I’d ever written.
I remember first walking down a long lino corridor. It led to the psychiatric inpatient unit, when I was fortunate enough to have the experience of being a ‘consumer consultant’ for a time, within the psychiatric service.
Hearing testing, eye care, the dentist, the doctors, and even the palliative ward where people go to pass over, are all located together in the hospital. However, in a seemingly symbolic way of representing the theme in society, the mental health ward was separate, isolated and distanced.
A new colleague pointed out the Electro Shock therapy rooms as went through locked door after locked door, to which I now have the key, or more accurately, an electronic swipe card. I had presumed that shock therapy had ended around the time of ‘One flew over the Cuckoos Nest’. There was a lot to learn.
Walking inside, I felt a pang of guilt. I was intruding, I had never been in a psychiatric ward. A lot of the people I met there however, did not seem as ‘sick’ as I remember being.
I spent a lot of time in that place, yet I’ll never forget my first impressions.
It was a pleasant warm day, yet I had a long sleeved shirt on, to impress. It was the kind Mum would refer to when she would always suggest, ‘Wear one of your NICE shirts’, to family functions. They made a change from the art-school-black-pop-punk-style I usually wore.
The most obvious thing about the psychiatric ward was what was referred to as the ‘Fishbowl’, or nurses and doctors station. It was a long, central room located behind locked doors and huge panes of glass.
It’s where the computers were, where the doctors and nurse hung out, where the cigarettes were rationed out (one an hour to some). It was the place where I painfully witnessed person upon discordant person crave for attention through the thick glass, often in futility.
There were long corridors which lead to tiny rooms, each with a bolted down single bed and a small window. There was no décor or decorations. Just plain walls and a place to store some clothes.
Outside in the courtyard, there were a few plastic chairs and two tables. This is where most people sat and endlessly smoked what cigarettes they could muster, (or afford). They would pendulate between this environment that looked into the fishbowl, and the free-of-stimuli lounge, that only made an exception for a television.
Meals were on time, and everyone lined up with plastic plates and utensils. There was an increasing amount of art from arts therapy on the walls, which I thought needed to be budgeted for much more.
Everything was bolted down, secured, or too heavy to pick up, so nothing could be used as a weapon. The carpet was fairly grim, and the chairs tainted with piss. But oh, the wonderful conversations I had in that place. The term ‘acutely empathic’ comes to mind.
The people working in the field, from psychiatrists, to clinicians, to social workers, and consumer consultants, worked hard, with limited resources-and the beds were almost always full. It sat ill at ease with me though, when I would sit in on staff meetings, and the ‘in and out’ of people would be recorded and monitored, as if by a machine like entity.
Although the psychiatric drugs are used to treat the symptoms of ‘mental illness,’ they are also used to make the person more manageable. Time spent there for a person varied, yet it was supposed to quite short-from five days, up to two weeks.
This time in the ward was enough time for the clinicians to drug the person so that their symptoms would recede or disappear. It was just enough time to place people into a frame of mind, where they would fit into society with more grace and less burden. Drug company reps would regularly visit the staff, with all amount of pens, post it notes, and food, discussing the benefits of the latest anti-psychotic medication.
Any epoch of time in that place would make you feel discordant. Sometimes I left there walking up the long lino corridor back to my office with tears in my eyes and anger in my heart, and a feeling of relief I didn’t ever have to endure that environment whilst I was ‘psychotic’.
One consumer had lived in the inpatient unit for nearly two years. She has a dual disability I am told-she has a mental illness accompanied by an intellectual disability. At that point in time, there was simply no-where for her to go. So there she stayed, watching the affected and often familiar people come and go over the months, and walking up to the fish bowl, pleading for cigarettes. I wish I had a dollar for every time she asked to see her case manager, or to be allowed to walk to the shops.
Seclusion was a room with a mattress. It was supposed to be used in the context of ‘least restriction’, and only when the patient was uncontrollable, actively suicidal, or as a last resort to treatment. It was a small room, with no clock or chair, just a bed with restraints.
To control aforementioned patient, she is threatened with seclusion. “If you don’t behave-you’ll go in there”, the manager said. To be honest, the worker is trying to run a ward with limited resources, not enough funding, and also attempting to look after all the other patients. She had no choice. Still, it made me sad that the threat of seclusion would make her fall back into line, just like that.
So she obeyed. She was a solidly built European heritaged woman with huge googly eyes, always fondly calling people ‘Daahling’, and kissing and hugging everyone. I had seen and heard her being dragged to that seclusion room, and she could pack a lungful. An animalistic purge so raw, and powerful, it made you think twice about not paying her the attention she direly needed, when she asks to see her case manager.
It seemed her dream to be married, and she was fond of me. Another client whom must have been familiar with her, told me to tell her I was married to avoid the flirting and adoration. I did-and she rarely called me ‘Daahling’ again.
I always felt awkward when she asked me to see her case manager-that futile lament-the correct answer would have been: ‘The outside world doesn’t care about you. You are forgotten. Trying to reach a nurse, or your doctor, to get you out of here or even take you for a walk to the milk bar, will be futile. Just accept that you will be locked up forever, because in actual fact, I am as helpless as you are. My hands are tied, we are helpless, and the staff are too. The staff did all they could but there were simply not enough resources. But a person’s home should not be an inpatient unit.
One day she appeared in the courtyard, carrying a Bible and ripping the pages out. I asked her to stop. Destroying books, in my mind, was an abomination. She insisted everyone take a page. She was making noises and invading peoples space as she violently thrust them pages.
Quickly, she moulded into something else altogether by saying, “The people here need to be more spiritual.”
Months after the bible incident the most beautiful piano music, a classical piece, emanated from the coffee and art room. “Who’s playing that piano?” was the discussion in that moment. After walking up – there she was, passionately belting out quite a complicated concerto.
This was a person, who was part of the character of the ward, and I will never, ever forget her.
Nor will I forget the first person I met on the ward, who was a character unto himself.
I only met him once. I wonder, as I do of a lot of people, where he is now-if he is even alive, and was he ever validated to find contentment?
I had walked out onto the grass in the sunshine, and saw a young bloke sitting looking out to the suburban landscape of Melbourne. He was the first psychiatric patient I spoke to, the first of thousands in my short lived career in that particular role.
“Hi!”, I said, “Mind if I sit down?” He looked away after seeing the photo identification around my neck. I could tell he was thinking I was a clinician, in my ‘nice’ shirt.
‘I’m the new consumer consultant’, I said. He asked me what that meant. The moment I told him I have Schizophrenia and am here to listen to him, he had an instant rapport. This was usually the response from clients.
He had tattooed the words ‘Pain’, and ‘Misery’ on his forearms, and I was shocked to see the state of his wrists and forearms. They had deep wounds all across them, from years of self-harm. I didn’t look twice.
We chat about a cream he has heard of that reduces scar tissue, “You should see how people look at me on the train,” he said with disdain.
He originally went to another hospital because he decided, and believed, he was going to kill himself. After one look at his violent and uncooperative past however, the staff denied him access to the hospital and literally threw this meth-amphetamine addicted young man onto the streets.
He retold how he crossed the road, and walked straight to the shops, found the first sharp thing he came across, a fluorescent light, and began to slice up his arms, once more.
With no more money to satisfy his addiction, and years of being in and out of psychiatric inpatient units with no relief, I’d imagine he looked at the deep futile blood clotting wounds up his arms, and cursed his bodies durability.
He told me he then made his way to a friend’s house, where he took a whole tray of an anti-psychotic medication prescribed to him. His mate found him when he arrived home some time later, and called an ambulance. He was unconscious. The paramedics quickly resuscitated him, and pumped his stomache, and he was then taken back to the very same hospital, where he regained consciousness. Once conscious he was whisked off to the psychiatric ward, where he ended up groggily sitting in the sun next to me that morning, on that devastatingly beautiful day.
“The cops are after me,” he said. Ahh, I knew this all too well, having been familiar with delusions in my own past. I thought to myself: I am the perfect candidate for this job. But I asked why, validating the holistic concern of any delusion he might have, as experience had taught me there is a rhyme and reason to madness.
As it turned out, he was on a Community Treatment Order, (CTO), which meant he was legally bound to take prescribed medication, because he was considered a danger to himself and/or others. He seemed to me blandly at peace, maybe for him it was a relief to be back in the familiar ward, ‘off the grid’.
Under this CTO, he had to report daily to his psychiatrist, whom then confirmed his whereabouts to police. After his three- day spree of ice, he told me that most likely the psychiatrist had reported him missing to the police. What I incorrectly assumed a delusion, yet turned out to be totally valid and real.
I tried to think of the most appropriate reaction and a solution.
“Can you give your psychiatrist a call to make sure they know where you are? That way the police wont be looking for you”. He didn’t mention any family.
He told me, that he could not.
I could empathise with this bloke, after some of my experiences with psychiatrists, I assumed dis-trust and non-compliance with his doctors. Yet I asked anyway why he couldn’t call.
“I haven’t got fifty cents.” He continued staring out into the landscape.
I took him inside to ask management for a fifty cent coin to make a phone call. Clients could only make a call from the ward phone, at a charge of fifty cents, and all mobile phones are banned.
I found myself looking for his nurse, or a doctor, or anyone to help, to no avail. I asked the kitchen lady whom I might speak to. She directed me to a nurse, darting down the corridor, avoiding the constant pleas of patients. The nurse informed me to look on the whiteboard. Every client was given a nurse under the nurse’s name. Each nurse had the responsibility to address around six people during their shift.
I had no idea who this person supposed to be helping him was, and neither did the young man. When I finally located the nurse, and told her the problem, I am directed to his doctor. When I find his doctor, I was directed to the manager.
Finally, I spoke to the manager, and explained the situation. He seems embarrassed, even ashamed, and the young man is whisked off to the fishbowl, given fifty cents, and directed to the blue pay phone on the wall. The exchange was so swift that when we get to the phone he realises he does not know the number.
I felt helpless.
The next day I stormed into my office of my boss, where I proposed writing a feature article for a major metropolitan newspaper about the appalling state of these poor people, the total lack of understanding and financial resources. She is appreciative of my enthusiasm for the role, yet informs me of the issues of confidentiality. She tells me my job is on the line, and that it would be more appropriate I praise or improve the service than slag it off. I found it hard to work under such limitations, the red tape and bureaucracy, and the hierarchies.
As the weeks went by, I was deeply traumatised by what I saw and experienced. I would take these experiences home with me, angry and sad. Sometimes I was overjoyed too, let it not be forgotten to say. I had not learnt to professionally distance myself from my day job. I guess I’m not generally clinical, yet we still need all types of people to contribute to the mental health crisis as staff.
When I got home, I battled my own illness and had great empathy for those the same as me.
I loved those people, those characters I met, and mostly understood. It was such a wealth of shared experiences from the hum drum of ‘normal’ life…that opaque and ostracised little paradise of light, dark, struggling, hope, comedy, bravery, tragedy, creativity, and individualism. I saw things from their side.
*** This is an extract from Richard McLean’s book fourth titled, “The SHRINK! …and you thought you were crazy!” ***
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Photo courtesy of the author