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 Staying Out Of Trouble During A Stay On An Acute Psychiatric Ward

A friend of ours in the United Kingdom suffers from a form of bipolarism. Putting it mildly, she hates it. The chemical imbalances in her brain regularly drags her life into chaos.

On several occasions her bipolar disorder resulted in her checking herself into a psychiatric hospital. During these times she encountered a wide range of people. Some of whom tended to hinder other people's recovery through their behaviors. Most of these weren't acting maliciously or out of spite, but as point#3 talks about, they often have a combination of being extremely sensitive and not reacting well to stress. Like in everyday life, this is a source of a lot of what we call 'trauma drama.' Still there are a few who were apparently less interested in recovery than they were in creating problems, strife and trauma drama.

She wrote this guide, Staying Out Of Trouble During A Stay On An Acute Psychiatric Ward to help people avoid the problems these people can cause you while hospitalized. Mostly it's about knowing what to do and what not to do in order to avoid potential conflict. Other than the part about the smoking area, the information applies to wards throughout the Western world. Still, smoking area translates into TV area or some other popular gathering area.

Our goal at No Nonsense Self-Defense is to help people avoid conflict and fighting. While no one ever needs these kind of crisis's, you really don't need them when you're trying to manage mental illnesses. We present this guide to help people who are going into such a ward or who has a loved one in a hospital.

Donna can be contacted through Facebook. A friend who wished to remain anonymous also contributed to the article.

Staying Out Of Trouble During A Stay On An Acute Psychiatric Ward By DeeDee Ramona

Here's a little guide I wrote to how to stay out of trouble during your stay on a a general adult acute psychiatric ward in the UK. Despite what you might think from the TV, such places are, in general, not particularly dangerous. You will likely get on just fine with the majority of your fellow patients and the worst they are likely to do is sneak one of your chocolates.

However, there are some problems that can arise when a group of vulnerable people with reduced ability to deal with stress is subjected to the stresses of communal living on an acute ward. The problem is that you are, effectively, shut into a set of rooms smaller than the Big Brother house, with twice as many people, none of whom really want to be there and with whom you have nothing in common except ill-health. All of you have had your social skills drastically compromised by mental illness. A small number of the other patients may live a very rough existence, due to past and present social exclusion, and you will need to get on with them too.

Here are 10 tips to help you have a trouble-free admission.

1. Secure Your Possessions You should not bring anything into a psychiatric ward that you would mind losing. Everything, including your socks, can and does get stolen. The staff will probably give you a key to a locked drawer in your bedspace in which you should place any valuables such as cellphone, money or cigarettes. Carry the key on your person. If no such drawer is provided, then you need to leave your high-value items with staff, or keep them on your person at all times. You will need clothing with secure pockets to keep this key safe.

Anything else - expect it to walk. Have a friend come in and collect your dirty laundry. If the hospital has a laundromat, make sure you keep your belongings in line of sight throughout the wash and dry cycle. If you can't do this, or there isn't a member of staff overseeing matters, don't use it.

2. Smoking Area Drama The vast majority of psychiatric patients smoke. I don't know why (I don't), but they do. You will find the corridors of the ward completely empty during the day as the 30 or so patients squeeze into one tiny balcony area or ventilated room to get on with the essential business of getting through 40 Marlboro Lights a day.

Stay out of the smoking area.

With everyone crammed in there, you get endless drama. A thinks B is looking at him funny, because A is paranoid. B gets really aggressive about this because he isn't able to control his emotions well due to illness. C starts shouting at them both to can it, because he can't hear the TV (there is no TV). D and E get stressed out by the noise and start screaming at everyone... (Mental Health Blogger Seaneen Molloy (www.mentallyinteresting.org) refers to the above as the game of "Mentally Ill Dominoes"). Or there will be schoolboy and schoolgirl bitchery, as one patient decides he or she wants a clique, and passes comment on everyone else....

The smoking area is the source of 90% of all ward drama. If you have a falling out with someone in there, you have to cope with being in the presence of that person constantly, perhaps for a number of weeks, until you are discharged. They may decide to make their distaste at your existence abundantly clear on a daily basis, shouting at you whenever they see you so you find it impossible to go sit in any of the common areas without being yelled at. Avoiding the smoking room cuts the probability of having this happen to you right down.

If you don't smoke and another patient invites you in, state that you can't, because the large number of people in a small area makes you feel "anxious". If you must smoke, go in there, stay really quiet, and if anyone says anything, mutter, "I'm not feeling well today, the walls are closing in on me" and then leave when you have finished your cigarette, citing that you feel paranoid. No-one will question this, regardless of diagnosis.

3. General Drama Remember that no-one has any social skills due to illness. This means that a normal conversation, where you discuss a mildly controversial topic in a civil manner, can result in an adult woman or man in their 50s - who would never behave like this when well - screaming blue murder at you because she doesn't agree with what you have to say, or alternatively bursting into floods of tears and complaining that you are being mean.

Therefore, be very careful about what you bring up in discussions with other patients and steer well clear of anything that could lead to disagreement or friction. The weather and your dog are good topics. The government and the state of your local football team are not. Avoiding talking about your children or asking others about theirs as many patients feel tremendously guilty that their illness takes them away from their families.

4. The "250mg of Chlorpromazine Walk" and "Can't Sit Still" Excuse If for any reason you are in one of the common areas and someone you don't want to be near comes in, or drama starts, or someone looks like they are about to start some, wait about 15 seconds and then say something like, "dammit, I can't sit still today, bloody medication", get up and leave. No-one will question you.

You then wander off doing what I call "the 250mg of chlorpromazine walk". This is where you imagine you're full of anti-psychotics, and shuffle along slowly with a blank, slightly-confused expression on your face. You sort of blend in as part of the furniture and people tend not to notice you. I'm serious, it works a treat. It's the ultimate get out of jail free as regards getting away from troublesome patient-related situations.

5. The Violent or Threatening Because of Illness (VTI) There will always be at least one other patient who is threatening, violent towards staff or overtly lecherous towards other patients because they are ill. The lecherous while manic thing is so common that many wards have a women-only section as otherwise the ladies would have to hide in the dorms all day from one hypersexual male after another.

Avoid this person. Yes, you may feel sorry for them, but they are NOT your problem. The staff are there to assist them with their recovery. You, look after yourself. If they come and sit down beside you, do the 'can't sit still' excuse followed by the 250mg of chlorpromazine walk (see above). It is not judgemental or narrow-minded of you to prioritise your personal safety and recovery in this way. If you see the VTI behaving erratically or in a threatening manner, tell the nursing staff and let them handle it. Just stay well away from them and concentrate on your own recovery.

6. The Nasty Piece of Work (NPW) There is always one. This is someone who is, outside the hospital, a social predator who spends their time scaring and intimidating others, getting involved in low-level crime, or frankly they are a violent offender who also have a severe mental illness. They tend not to control their condition very well and so end up spending quite a lot of time in hospital. They are used to the environment and have lots of practice. Therefore, they are in a position to exploit people they see as vulnerable and will go after anyone they see as a threat to their position as king/queen of the ward.

The NPW may try and see if you can be intimidated into handing over cigarettes, or, if you don't smoke, money. They will either approach you while walking around the ward, or, if they are feeling more aggressive or confident, come directly to your bedspace with their demands.

It is essential that you do not give in, regardless of how much this person may scare you. Otherwise you mark yourself as an easy victim for the duration of your stay and this person will not back off. Just flatly state, sorry, I'm not giving you anything. No matter what kind of tantrum the person throws, or how much they scream in your face, just stand there and keep repeating yourself. They are unlikely to resort to violence as this will get them in hot water with nursing staff. Once they have backed off, report them to staff immediately. With luck the staff will come running anyway if things get in any way loud, and your problem has gone away - he or she knows you are not to be picked on and so they will interest themselves in someone else.

They may just ignore you completely, in which case you should do them the same favour. Don't be tempted to become the "ward police" and report the NPW whenever they step out of line. If you do that, they may see you as a threat to their dominance of the ward and could react violently. Mind your own business if they are not directly affecting you.

7. The Phantom Staff Regrettably, there are still some acute wards where the staff do not have a presence on the ward at all, preferring to lurk in the nurses' office, emerging only to administer medication or if a violent incident has occurred. This is going to be a real problem if you have been targeted by the NPW - they are free to threaten you with violence and you have no backup, and they know this. It's a situation that is totally untenable and no hospital should inflict it on you - but there are still cases where this does happen, so it needs to be mentioned here.

You may be thinking about smacking them one, hard (the NPW, not the nursing staff). They may richly deserve this, but, remember, your goal is not to teach this person a lesson, it is to get to the nurses' office and pound on the door. This way, the NPW they realise that the outcome of any threat made to you will be hassle from the staff whose darts game has now been interrupted.

There is an additional problem you need to think about if you do decide to engage in violence to deal with someone like this - that of what goes on your file after the previously non-existent staff erupt from the nurses' office, find 2 patients "fighting" and give both of you haloperidol jabs to calm you down. The merest mention of "tendency to violent outbursts" in your file could change the tone of your treatment forever from working with you to find the best solution to containing the potentially violent offender at all costs. You don't want your doctor to be scared of you.

I would suggest you study carefully what Marc MacYoung has to say about bullies and how to deal with them on his excellent site No Nonsense Self Defense (http://www.nononsenseselfdefense.com/bullies.htm) Take a very detailed look at this page, and indeed at the rest of his site, before you decide what you would do in that situation.

8. Drugs and Alcohol It is commonplace for "friends" of some patients to bring illegal drugs or alcohol in to them. It was so frequent at my local hospital that there are now stern notices at the entrance threatening anyone so doing with immediate arrest.

If you suspect someone has brought in booze or drugs, my advice would be DON'T report them to staff. Mind your own business. Do not become a "snitch" on what is a criminal undertaking or you could be letting yourself in for serious trouble. The staff are not stupid, they will find out and handle it themselves - they see this every single day.

Just stay out of the common areas, especially the smoking area, for the rest of the evening, as drink and drugs on top of a major psychosis and heavy medication can turn otherwise OK patients into violent assholes.

9. Loudly saying "I don't belong in here" This goes down about as well as in the Shawshank Redemption. You may feel that you've just landed in a ward full of hard-core mentalists who have all been hearing voices since birth and have been fully "in the system" for most of their adult lives whereas you have been depressed for precisely 6 months - and this is possible. If you were on a kidney unit you'd meet all the people who have had dialysis 3 times a week since they were 6 years old even if all you needed was 2 days of treatment. Nonetheless, although these people are sicker than you, you are all mentally ill and that is why you are a patient on that ward.

Patients are very sensitive to any suggestion that someone is "too good" for them or that the severity of their illness makes them a lesser person than you and will interpret anything that remotely suggests this as such. Many have suffered years of discrimination and ill-treatment from their families and communities. So no matter how scary you think someone else is, do not express this view in conversation with other patients about them, or to staff where other patients can hear. It will not make you any friends and will probably create drama.

10. Relationship Troubles This is not the time to start any sort of romantic attachment with another patient. If you really think this person is the one for you, they will still be that 2 months after discharge. It's best to wait. It's known to be bad for your recovery, which is why your doctor will not be happy with you about it, plus you risk breaking up on the ward and this will cause further drama.

Conclusion: Relax! It is extremely unlikely that you will be threatened with violent assault while a patient on an acute ward anywhere in the UK. It is much more likely that you will find the other patients to be a source of support and you may even make lifelong friends. The most that you really risk happening is that you will have a falling out with another patient that will make your life unpleasant, that your cellphone will get stolen or that the behaviour of other patients may result in drama. I have included the more extreme scenarios mainly because they risk causing you such stress and trouble if they do occur, but remember, they are pretty rare.

The tips presented here should reduce the likelihood of these problems occurring. I hope you've found this guide to be useful and informative.

Dee Dee

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1) See Emotional Vampires: Dealing With People Who Drain You Dry by Albert Bernstein for not only a layman's explanation about the different personality disorders and their behaviors, but how to set boundaries that counter their behaviors. Return to Text