‘Plenty of biffo, I’d reckon,’ quipped the otherwise helpful bloke in Mitre 10 recently when I’d told him where I worked. ‘Actually there isn’t,’ I’d retorted, feeling obligated to yet again debunk the long-held misperception about psych wards.
Mental illness is hardly a rare occurrence. One in three or four people will experience an episode of psychiatric illness during their lives. The actual figure is a bit rubbery but the vast majority, for a variety of reasons won’t ever get to see the inside walls of a psych ward.
A scant two decades or so ago our most severely mentally ill were locked away in large asylums. These loony bins, crammed with lunatics or inmates as they were dubbed, were located well away from public view. The asylum in Kew, Melbourne where I worked in the early 1980s had its own pharmacy, engineering and carpentry workshops and even a mortuary. For many, the mortuary was to be the last stop before their interrment. So many patients spent many decades silently staring out the large bay windows at the peacocks ambling through its sprawling grounds. Few were released. Few were visited.
Every capital city and regional town had its loony bin. With the decommissioning of these facilities,the task of treating our acutely unwell defaulted to psychwards in mainstream hospitals.The long term chronically unwell were farmed out to special accommodations and boarding houses, often to live out the rest of their days in drab and near squalid confines.
Psych wards where the acutely mentally ill aretreated can sometimes come up short. After all psychiatry still defaults to age-old practices; pills and more pills with their side-effects and courses of electro convulsive therapy for cases of treatment resistant depression. At times, these places are chaotic and scary. But they’ve come a long way from what was depicted in the film One Flew over the Cuckoo’s Nest, director Milos Forman’s 1975 confronting interpretation of Ken Kesey’s 1962 book of the same name.
Their scariness is hardly surprising given that these places are where you’ll find some of society’s sickest and most vulnerable. Manic patients do rub shoulders with the profoundly depressed or psychotic or drug-affected; but most of the time, they are low key places where apathy and the dross of daytime TV prevails. And, surprisingly, patients are sometimes loath to leave. For many, their reality beyond the psych ward isn’t a welcome alternative.
Psychiatry seems destined to be the poor cousin of medicine in the public’s mind. When was the last time you saw a grateful psych patient on TV thanking their psychiatrist for the treatment they had received? Yet, psych wards get results – though rarely do they get credit for their work. On any given day, right across Australia, thousands of acutely unwell people are getting their lives back on track, thanks to the unheralded efforts of mental health professionals.
Some practices can appear draconian to an uninformed public. Like seclusion – where an acutely person is locked in a room, sometimes for up to several hours. It’s not an unusual occurrence. It may sound Guantanamo Bay-like but the reality is much different. A decision to seclude a patient is often a reluctant last resort. Staff are expected to try de-escalating techniques. Approval must be granted by an authorised psychiatric nurse. A log of the records and checks is kept in the patient’s file. Checks at 15 minute intervals must be undertaken. A combination of antipsychotic medication and seclusion is often the only way to manage people who are floridly psychotic and assaultive.
When therapy and antipsychotic medication fails, more drastic interventions are deployed. ECT is still widely used to tackle severe depression and otherwise treatment resistant illnesses. These days the procedure occurs under a general anaesthetic and it is a surprisingly effective treatment. With up to 15% of severely depressed people at risk of killing themselves, psychiatrists often don’t have any option but to go down this ECT path.
Tremendous pressure is exerted on psych wards to admit every disturbed person who presents atemergency departments. It’s almost as if there is an expectation that psychwards will turn people’s lives around. Occasionally they may. Mostly they won’t. And then there are those who, cannot obtain, for myriad of reasons, obtain any positive outcome from the psychiatric system. For many, an involuntary stay in a psych ward is but a brief, albeit difficult period of their lives;and for others, arevolving door syndrome, where multiple admissions are their painful reality.
We have moved on from the era of those large loony bins and long term incarceration. But it’s also time to move beyond stigmatising our psychiatric system and, implicitly, our mentally ill.
I am a psychiatric nurse.