I've Gone Ten Rounds With a Psychiatrist and I'm Still Standing!

If you read this sign posted on the door of your hospital ward, wouldn't you think you were free to take a walk in the grounds?  But you would be wrong: according to the staff, patients are not ever actually allowed out, whatever the sign says, not even escorted by close family. Julie was having trouble getting her head around this Looking Glass World where signs did not mean what they said.  I agreed to try and find out what was going on but my questions quickly landed me in hot water.

"If you disagree with me then we won't be able to work together, and if we can't work together then we will have to terminate your daughter's admission." said the psychiatrist, furiously.

I was astonished by her reaction and genuinely puzzled. What had I done to upset her so much?  Why should asking questions mean disagreement and why should disagreement make working together impossible?  And could she really refuse to treat my (adult) daughter because she had fallen out with her mother?

Even by the standards of most of the meetings I've had with psychiatric consultants, this one did reach a  new low.  A roomful of people, none of whom I knew before I walked in, all staring at me in owl like silence, while I was harangued by their boss.  I was just glad that for once Julie had been sent out while I was done over.

Julie's stay on this hospital ward has been complicated by a series of misunderstandings, one after the other - what medication she was on, and whether or not she could take trips out of the ward (something psychiatric patients know as "leave").  Like most misunderstandings they could have - and should have - been easily avoided by clearer communication and focusing on the needs of the patient.  Just writing things down would have been a start.  Feeling wretched, Julie appealed to me to speak to staff on her behalf.

Legally, wards do not have the right to detain patients who have chosen to be there voluntarily, but many wards do still lock all the patients in, regardless of circumstances.  On this ward, despite the sign on the door, staff always refuse to let you out; the real ward policy is that there is no leave.  I think this is wrong, and I think it betrays a ward where safety culture is put before an interest in helping patients get better.

I don't have a problem with agreeing restrictions on when a patient comes and goes, how long for or who with - I want my daughter to be safe, after all.  But I would have liked to accompany her on a walk in the grounds one afternoon, to give her a break from a ward which was, at times, quite restive and where she had little privacy.  I have seen Julie held in both high and low control environments, and high control environments have less successful outcomes.  With control taken away from her, Julie withdraws into herself, and quickly becomes disturbed and disoriented; there are problems when she is discharged from a high control environment as she struggles to re-adapt to normal life.  If she is encouraged to carry on engaging with the world outside - exercising, seeing friends, visiting shops - and the emphasis is on managing her own safety, she does much better and is more likely to manage well on discharge.

I tried hard to present this argument clearly and calmly to the consultant, but it was obvious that the mere fact of my disagreement marked me as a troublemaker.  As well as threatening to send Julie home, she instructed her staff to start researching how Julie could move out of the family home into her own accommodation.  Then she turned to me and told me that I was over-controlling Julie and needed to be less involved in her life.  Julie is a sixth form student; she is 18 years old.  How many sixth formers successfully live on their own, let alone one as confused and vulnerable as Julie?

Using everything I had learned in the past, I just took a deep breath and smiled at her.  I know this woman's powers outside the confines of her ward are not as great as she thinks.  I know that she is doing a difficult job and needs to appear to be the strong woman in front of her team.  I also know that we are going to have to carry on working together for some time to come, and that I needed to be able to carry on visiting Julie while she was on her ward.