As restrictions are put into place across the UK to prevent the spread of Covid-19, what’s happening in mental health hospitals?
According to The Royal College of Psychiatrists, these spaces have taken important steps to ensure their patients’ safety.
They state: ‘There is no doubt that providing even basic treatment for patients’ mental health needs is compromised in the present crisis. The provision of specialist services such as occupational therapy, psychology or pharmacology is secondary to maintaining their physical health in the present situation.
‘However, given the nature of wards, patients will still require basic mental healthcare.
‘Wards should exercise the principles of social distancing across the ward community. This means minimal contact and an advised distance of two metres. The need to limit contact between individuals should be clearly communicated to patients and staff.’
Those are the rules and regulations on paper, but what are psychiatric wards like in reality?
We spoke to three women who have all been admitted to a mental health hospital amid the coronavirus pandemic to find out.
Warning: This article contains frank discussion of self-harm and suicide that some may find triggering.
Pip, 23, Warwickshire
Pip Rudge was admitted to a hospital in Coventry, from 5 May to 25 May 2020. She has borderline personality disorder, and was diagnosed at the age of 19.
Pip has been ‘in and out of hospital’ since 2016.
She tells Metro.co.uk: ‘BPD can be erratic and unstable, with massive lows and some highs.
‘I was struggling a lot with my mood, and after my granny’s death in April I struggled with self-harm and suicide attempts – which led me to be an inpatient.
‘I was admitted to an acute ward, then moved to the psychiatric intensive care unit a week later. That lasted a week, and then I was moved back to the acute ward for another week.’
Pip says being admitted during the pandemic was ‘the hardest’ of all of her admissions.
‘Nobody was allowed visitors,’ she said.
‘I didn’t see my family or friends for the hardest three weeks of my life, where I really could’ve used their support.
‘I had a Covid-19 swab taken at the start of my acute admission. I had to wear a mask around the ward for the first two days until my swab came back [negative], and most staff wore masks.
‘I was allowed my phone during the day to stay in contact with people, and we were allowed to smoke in the garden. Nobody was allowed off the hospital grounds.’
Though Pip knows that being in hospital was necessary to keep her safe, she says it was ‘so, so difficult’, as during her previous admissions she relied on her family and friends visiting her to help keep her going. Not having that support during such an awful time was heartbreaking.
19-year-old Aoifa, from the south west, has been in a mental health hospital for over a year, since May 2019.
She was admitted due to anorexia and emotionally unstable personality disorder. She says her moods are very up and down, and she struggles with suicidal ideation and self-harm, as well as black and white thinking, feeling empty and numb and having turbulent relationships.
At first, she was classed as an informal patient, and then ended up being sectioned twice – the difference being that informal patients agree to come into hospital for treatment, while those detained under a section, do not have a choice. She is now back to being an informal patient.
Aoifa was admitted to a specialist personality disorder unit in the south east.
She tells us: ‘[The hospital] has changed a lot in the time I’ve been here. There haven’t been any cases on my ward, but now when patients have a temperature over 37.8 degrees we have to isolate in our rooms. This happened to me for eight days while waiting for a Covid-19 test during lockdown.
‘We are all informal patients, but we weren’t allowed home leave up until a few weeks ago, and were threatened with discharge if we did go on home leave.
‘Staff now wear scrubs and masks all the time, when normally they would wear their own clothes. This can make communicating with staff a lot more difficult as it feels weird, and obviously so much of their job is about speaking to people.
‘The masks make it feel less natural and personal.’
Aoifa adds that at dinner time, staff wear masks and gloves and patients are not allowed in the kitchen.
Recently, with the outside world starting to relax, home leave has just been allowed again – and Aoifa got to go to her sister’s house for two weeks. However when she went back to the hospital she had to isolate in her room for three days, waiting for a Covid-19 test to come back.
She said: ‘The isolation is very distressing. Luckily some patients are now getting their swabs back in 24 hours, but I found it very isolating and lonely, which definitely made my mental health worse.
‘Luckily, family and friends can now have socially distanced visits – but they’re not allowed inside the building, only on the grounds.
‘I’ve only had one visit on the ward as my family and friends are three-and-a-half hours away, but I had a visit with my brother and his girlfriend.
‘It was hard as we couldn’t hug and had to sit outside. We played card games but I didn’t feel as close to them as I usually would.
‘I get on really well with my siblings, and they were planning on visiting me around once a month – which hasn’t been able to happen.
‘It’s made me feel isolated, and I’ve found it harder to feel like people care. I’m so detached from them.’
Anna*, who would like to remain anonymous, was admitted to a psychiatric hospital on 29 April 2020. She had been suffering with psychosis.
She was first diagnosed with the condition in 2019, but had been suffering with recurrent episodes ever since.
A few weeks before her admission, her antipsychotic medication was changed. This led to a relapse in symptoms.
‘Specifically, I heard the voice of the devil and believed that I had been possessed,’ Anna says.
‘I was unaware that I was unwell, attempting to kill the devil inside of me, hearing the devil’s voice 24/7.
‘My care coordinator arranged for a mental health act assessment at my house. I was soon placed under a section due to concerns for my safety.’
Anna was told that when she arrived at the hospital, she would be placed in isolation on the ward until she was tested for coronavirus.
She said: ‘Being in hospital is a scary experience at first because you are acutely unwell, and aren’t entirely sure what’s happening.
‘Alarms are always going off, staff running around, patients kicking off… it’s not a nice environment.
‘Once you start to become well again you begin to make friends on the ward and start to cope a bit better with being there. I’ve made so many lifelong friends on psychiatric wards. You meet people from all walks of life.’
Anna, who has previously been admitted to psychiatric wards before the pandemic, continued: ‘Because I was admitted during the pandemic, a few things were different in this hospital admission compared to my previous visits.
‘When I arrived, I was taken to a bedroom just off the main ward, in a locked part of the corridor where I couldn’t get onto the main ward or out at all.
‘I was told that I would need to stay there until I had been tested for the virus, and that I would be allowed on the ward if the test came back negative. It was awful.
‘I was there for six days. Being alone in a single room for that long is enough to send anyone crazy, let alone someone who is already psychotic.
‘I had a buzzer I could press if I wanted staff, so I had to ask for drinks to be brought to my room. All of my meals were delivered on trays to my room and I had to eat them at the end of my bed.’
Anna adds that she wasn’t allowed to take part in any activities, which can be a vital part of improving a patient’s wellbeing, given them a sense of community and normality.
She continued: ‘When staff came to see me they were all dressed in PPE. I wasn’t even allowed out to see the doctor.’
Eventually, Anna’s test came back negative. Nobody has tested positive for coronavirus in the hospital.
When she was allowed on the ward, there were signs telling patients to stay two metres apart. All activities on the ward were split between male and female, so that the patients on the two wards never met each other.
Coronavirus also meant there were fewer activities than what is normally offered.
In this particular hospital, home leave wasn’t allowed, and nor was smoking leave. Visitors were also not allowed.
Anna is now doing better and has been discharged from the hospital.
She said: ‘Once you were in, you were stuck. It was awful. I have friends who I met there who are still in hospital, and they say that those Covid-19 rules still apply – and we are now in August.’
A doctor’s experience
Dr Ahmed Hankir, academic clinical fellow in general adult psychiatry at South London and Maudsley NHS Foundation Trust, was working in an anxiety disorder residential unit, treating conditions such as obsessive compulsive disorder, but was redeployed to a women’s mental health ward due to the pandemic.
‘I suspect there are other units and wards that had to close down,’ he tells us.
He has found the coronavirus restrictions ‘challenging’, but accept that these are in place to keep patients and staff safe.
‘It was challenging for the patients and for the workforce,’ Dr Hankir explains. ‘Doctors and nurses and other allied healthcare professionals were at increased risk of contracting Covid, but also, if patients had to self-isolate, like an entire corridor, there would be certain measures put in place like social distancing measures.
‘We know there is a shortage of psychiatric beds already and if we have to corner off a corridor of five to ten rooms and you can only use one of them because a patient has COVID-19, that is a tremendous stress and strain on mental health wards.
‘This is something you have to be mindful of, but patients can also contract COVID-19 from healthcare professionals.
‘You have to take into consideration it’s unchartered territory. We have to make these difficult decisions. We have to be mindful of the fact we haven’t done this before.
‘We’ve been utilising technology to have virtual appointments with patients which has implications, because if usually you’re delivering a talking therapy it will happen under the same conditions – which we call the integrity of the frame. This was really disruptive.
‘We don’t know whether the virus will reduce the quality of the treatment.
‘We’re doing our utmost to provide patients with the highest quality care.’
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