I was arrested and forcibly detained in Pond Ward, an acute psychiatric ward in Central Middlesex Hospital on 8 May 2006. I was examined by an independent psychiatrist who found there was nothing wrong with me, and on 7 June a Mental Health Tribunal released me from detention. I have already written in detail about the dubious events that led to me being detained and wrongly diagnosed mentally ill in the first place (see www.lyme-rage.info). Here I would like to describe some of the shocking conditions that I and my fellow patients had to put up with.
Patients are expected to recover in a “therapeutic environment” where they may be injured or attacked at any moment. There are very few single rooms, so most patients on Pond Ward are forced to sleep in four-bedded single-sex dormitories. There are a large number of violent and/or deeply disturbed patients on the ward at any given time, so if you are in a dorm, chances are you will be sharing with at least one of them, if not more. During the night there is little or no supervision, and many hours go by between the brief look-ins by staff. What this means is that patients, some of them suicidal or otherwise very distressed, are expected to close their eyes and sleep not knowing if they will be physically or sexually attacked in the night. Attacks like that happen on a regular basis.
I myself had to share a bedroom with a woman who tried to attack me twice, as well as another woman who was not violent but would stay up all night shouting at imaginary figures, and who had a habit of smearing faeces all over the dorm after she had been to the toilet. Eventually I refused to sleep in the room, and was allowed to sleep on the settee in a small lounge instead. The settee is not much more than 3 foot long; I am about 5 foot five.. However, I was lucky to be allowed this. The day after I was released, a 60-year old female patient in the dorm was attacked by the patient who had tried to attack me.
Like most patients, I found it impossible to sleep, even when not sharing with anyone who posed a threat , due to the constant noise. Also, because those who caused disturbance at night would often sleep during the day, it was impossible to take a nap in daytime either, as you never knew when they would wake up and attack you, dump cigarette ash or rubbish on you as you slept, etc.. After a few days on 0 – 2 hours sleep per night I felt like a physical and nervous wreck. There was simply no place to relax either day or night. Some patients cope by begging for sleeping tablets to knock them out, in a kind of desperate hope that if they are attacked in the night, they won’t remember too much of it.
Violent incidents are constantly occurring during the day too . I found myself having to intervene more than once to stop someone being physically attacked because there were no staff present, or not near enough to the scene of action, to do anything. Some rooms are almost never entered by staff and one, the “smoking room”, is constantly a site of violence. I heard a number of stories of women who had been sexually assaulted while on the ward.
Some patients can become sexually disinhibited because of their illness and will walk around without clothes on etc.. When this happens, often they are not protected by staff. One woman who was doing this during my stay ended up with a male patient climbing into her bed (despite the fact that her dorm was in the so-called “female-only area”) . The other female patients in the dorm were terrified he would attack them, and no one came to protect the girl. In the morning I heard a member of staff who had just come on shift tell the girl off for her behaviour, saying “I heard about your carryings-on last night, and frankly I’m shocked”. I was shocked too, not at the fact that a confused girl who regularly walked the ward naked had let a man in her bed, but at the fact that none of the staff had protected her, but were blaming her instead. She could easily have become pregnant , caught HIV, hepatitis etc as a result of their negligence.
The majority of staff in Pond Ward seemed to see their role as prison officers, and their patients as criminals in need of punishment. As a former (general) nurse myself I find it hard to describe some of them as “nurses” at all. For some of the staff, any request by a patient, even for the most simple basic necessities, is too much, and has to be met with a hostile or sarcastic response. I saw patients shouted at or ridiculed because of their symptoms or the side effects of the medications they were on. An elderly lady who suffered from incontinence was scolded for it, regularly left with her bed unchanged all day and had no proper aids or help to shower. On one rare occasion where she actually did receive help, the nursing assistant made fun of her body, pointing to her and saying, “Look at her, look at her!”
I saw a number of occasions where unnecessary force was used and some where patients were dragged off to the “seclusion room” by several male nurses and forcibly injected, just because they had expressed frustration at being refused some trivial request, like a cup of tea when they were thirsty. Skilled psychiatric staff should know how to calm agitated patients and de-escalate potentially violent situations. Instead, I saw the opposite happening – staff would wind up patients by shouting at them or being unnecessarily rude to them, until an incident occurred.
Shouting and abusive language by staff are routine, everyday occurrences. Some of the staff seem incapable of relating to their patients in any other way. I heard one disturbed patient who was spitting on the corridor told that if he did it again, he would have his neck broken. Another man, who was never violent towards anyone on the ward, but who had some obsessive-compulsive behaviour that made him continually break plastic cutlery, was pushed around by male nurses, and on one occasion told that he would be made to eat the sharp broken pieces.
I heard about one young man, whom we all knew was not at all violent, who was beaten by a member of staff. He had woken hungry in the night and asked for a piece of bread. A male nurse dragged him up the corridor and hit him. When I saw him the next morning, one side of his face was very swollen, and there were angry red marks all down his arm. He told me his story and I also spoke to other witnesses, separately, who corroborated it. I told the Ward Manager what had happened and made a written statement on his behalf, as he was terrified to make a formal complaint. He was sure that staff would take revenge on him. I think his fears had a good foundation. After I left, I heard that the male nurse concerned had been suspended, and a hearing had been held. I later heard that the nurse/prison warder was exonerated of all blame and is back on the ward. The teenager’s injuries were seen by several dozen people including nurses, two police officers and two doctors, one of whom I know prescribed painkillers for him during the night. And of course there were the patient witnesses to the assault, some of whom told me how they heard the male nurse make fun of him saying “What are you going to do, call the police?” I am very sad that this incident was dealt with in this way. This will send a signal to the rest of the staff that they are free to assault patients at will.
If a patient raised his/her voice, or complained about something, however justified, their behaviour might well be interpreted as mental illness and treated accordingly. On one occasion a patient offered to bring another patient a cup of soup from the trolley. She became upset and lost her temper when staff told her she was not allowed to give him any. On the basis of that one incident she was put on powerful mood stabilisers which she said made her feel awful.
During my stay my mother became terminally ill. The doctors said they would allow me to visit her in hospital, but ordered that I be escorted in case I tried to escape. After all, as a person who disagrees with the UK Lyme disease expert, and prefers the view of an opposing school of doctors, I am clearly a major threat to society. I had to beg for the right to see my mother in her last few days , and on one occasion was shouted at and told “You can’t expect us to facilitate this everyday!”
As far as I could see drugs were dispensed by one nurse acting alone. I was quite shocked at this, as when I was nursing we would not have dreamt of commencing a drug round without the (legally required) two nurses. This is necessary to safeguard against errors, as the law of averages says that one person, no matter how careful, dispensing hundreds of drugs per week, sooner or later, will make a mistake. And of course, drug errors can be fatal.
In fact while I was there I heard many stories of drug errors, which were covered up or treated in a trivial manner. For example, a patient with a serious mental illness , but who was well at the time I met him, told me how one day he was surprised to be given a tablet of a different colour to the one he had been taking for several years. He brought this to the attention of the nurse who said, “Oh sorry, that’s not yours, that’s so-n-so’s, give it to him.” And she proceeded to finish the round as if nothing had happened.
Staff should monitor the effects of the drugs they dispense, but in fact as far as I could see there was very little monitoring going on. As an example, one patient was obviously over-sedated, falling asleep every morning into his breakfast bowl and with speech so slurred he could not make himself understood. I told a student nurse who mentioned it to staff, but nothing was done for days. One day I found him in the smoking room so drowsy he was unable to wake up, despite the attempts of myself and another patient to rouse him. When we eventually did manage to rouse him, we found that he had fallen asleep with his lit cigarette between his fingers. It had burned an area about an inch or so long on his finger , yet still had not woken up. Had that happened while he was in bed he would have likely set himself – and the ward – on fire.
Many staff on the ward are working double shifts (14 hours) or even longer in order to earn extra money. This throws up some serious issues . After working 14 hours solid no one is likely to be able to maintain the level of alertness to patients’ , colleagues’, or their own safety needed in a place like Pond Ward. With the number of violent and unpredictable patients there, staff cannot afford not to be alert.
Some nurses will be dispensing drugs after working these kinds of shifts too. One man, to my horror, seemed to be doing a 24 hour shift . At night-time he pulled up a chair outside the room of a patient whom he was supposed to keep under one-to-one continuous observation. Pretty soon, I noticed that he had , not surprisingly, fallen fast asleep. The patient on “close obs” was wide awake, observing him closely instead.
One of the worst problems in Pond Ward is hygiene. There isn't any. In the first ten days or so that I was there there was not a single toilet that was not blocked and flooded. There was no other choice but to wade through it every time you wanted to use the toilets. After ten days my shoes disintegrated from having to wash them so often.
The bath and shower facilities were filthy and were not cleaned between patients. We were not allowed access to the cleaning cupboard and had no choice but to walk through the last person’s puddles of dirty water. There was no disinfectant available to us and at least half the time I was there, there was no hot water either.
The dining tables are often filthy and patients who are late or have to leave the room for any reason often just don’t eat. One man who was just ten minutes late was refused a meal. At night a cup of tea and bread and butter is served. No plates are provided and you are expected to eat your bread off the table – no matter how dirty it is.
Towards the end of my stay the warm weather arrived and ants invaded the dining area. Patients had to beg for a piece of tissue paper to put their bread on, and even then most nurses only gave paper to those who asked for it.
I know the cleaning staff work very hard and would not like to see them blamed for the situation. There are simply too few of them. Cleaning is managed by a private company which probably won the contract by bidding competitively. Of course the job can be done very cheaply when a ward full of disturbed people is left for hours without a cleaner. But most people would not keep their dog in the conditions that I saw on Pond Ward.
Tea and coffee are served at set times from a self-dispensing machine, but between those times patients have nothing to drink apart from water from the drinking fountain, which regularly goes out of order. This is a very serious issue as many of the patients are on powerful drugs which become toxic in their bodies under conditions of dehydration.
On one occasion I reported the drinking fountain out of order . The pressure had been lost and the water could only just trickle over the metal spout. The nurse who inspected it said she could not see why we could not use it anyway. I had to explain to her that if we all had to put our mouths on the same piece of metal to drink then Pond Ward would soon be down with an outbreak of food poisoning. Then she did agree to report it to the maintenance department, but why did she need me to explain to her what should have been obvious to anyone, nurse or not? I think it was not so much a lack of knowledge as the fact that there is a general culture on the ward that psychiatric patients do not matter – they are not people..
Although some patients were allowed to attend occupational therapy during the day, there were no activities at all available in the evenings and all weekend. On a ward full of patients who are prone to violence this enforced boredom will always be a recipe for disaster.
Other than occupational therapy, patients were almost never offered any therapy, as far as I could make out..Just drugs, drugs, and more drugs. Even those who were severely depressed or suicidal did not seem to be receiving any counselling. Their fellow patients were doing the counselling instead. Worse, patients who were very openly suicidal were not being supervised properly, and were left on their own for hours a day.Patients have certain legal rights regarding the ward round and meetings they are asked to attend, but they are not told them. I was lucky because an occupational therapist eventually made me aware of my rights at the ward wounds; otherwise I would never have found out. None of my fellow patients knew of these rights either. Patients do have a right to have an advocate or friend sit in with them on most meetings with their consultant psychiatrist, but when I asked for this, especially as my consultant was bullying me, she reported this to the Tribunal as a symptom! (ie patient is paranoid, constantly requesting for her advocate to be present in meetings). There is nothing more absurd than being granted legal rights, then , when you try to exercise them, being labelled paranoid for doing so.
Patients generally had nowhere safe to store their belongings and theft of money, clothes and personal effects was an everyday experience. There were large safes present but no one knew the combination, including the staff, so they could not be opened. Further, there is a question that if picked up and hurled by a confused patient, they could probably kill, as they were very heavy. Some kind of built-in safe would seem much more sensible – preferably one that could be opened by the user!
Being able to communicate with friends and loved ones is a lifeline for many people locked up in units like Park Royal , yet the one and only patients’ phone was set at such an exorbitant rate that a 5 minute call to someone who lived locally would have cost £3.00. (At the time of writing, an ordinary public phone box in London would give you two and a half hours for the same cost.) I was told the rate had been set so high in order to generate income “to buy things for the ward”. I would be interested to know what things had been bought with that money, and whether patients were involved in the decision to sacrifice their ability to communicate with the outside world for these “things”. Many patients on the ward were penniless and would not have been able to call a friend, their solicitor or advocate if they were in need.
To be fair, not everything in the unit was negative. I did see some members of staff, both qualified and unqualified, who always treated patients humanely and with empathy. Indeed some of those were in charge. The problem is that there are too few like this, and too many who are uncaring and brutal. And the good staff are turning a blind eye to the human rights abuse around them.
Granted, being a psychiatric nurse is not an easy job. Staff are constantly exposed to danger, just as patients are. However, a different outlook would make the job safer for all concerned. Only staff who are willing and able to empathise with patients with mental health problems should be allowed to work in these units, in my opinion. The aspiring “prison guard” types need to be shown the door. This is the 21st century.
I do understand that shortage of staff makes the job very hard. That is a question for management to resolve. If funds are insufficient to run a ward safely, then I believe managers need to say so, refusing, if necessary, to continue unless the required funds are delivered. Recently a psychiatrist was on television protesting over plans to save money by housing young children in the same mental health units as adults or older teenagers. He said he would resign if this plan went ahead, as he could no longer guarantee a minimum level of safety for those children. This is the spirit with which, in my opinion, doctors and managers need to raise issues such as the unavailability of single rooms. In a unit that accommodates violent patients, it is absurd to expect people to sleep in shared dormitories. And if they think otherwise, I invite them to try sleeping in those dorms themselves.
Yes. I challenge all the staff associated with Pond Ward – doctors, nurses, managers – to spend just 24 hours living in the conditions in which I had to spend a month, and in which some of these poor people have been, on and off, for years. I guarantee they would come away with a different perspective, that is - if they survived the experience.
If there is one thing that can be singled out as good in Park Royal, it is the Occupational Therapy Department. There staff, both qualified and unqualified, were the only ones who consistently treated patients with respect, took an interest in their problems, their lives, their rehabilitation. They provided sessions on art, cookery, exercise, music, poetry etc.. Often these sessions were the only place where patients could safely express their feelings. I know that for many patients these sessions were a lifeline without which they would probably have gotten much worse . or even committed suicide. Sadly some of the most severely ill patients who could have benefited from these sessions were not allowed to go. As far as I understood, they were prohibited from attending by the medical staff. These patients could, and should, receive one-to-one occupational therapy with a nurse present if necessary. It is wrong to expect any human being to hang around all day with nothing whatsoever to do.
Since my release I have been working with a patients’ organisation which is fighting to improve conditions in places like Park Royal. Sadly I think it is a very uphill fight. Without a media spotlight and public awareness of just how bad conditions are in some of these facilities, they will continue to exist in the Dark Ages. The daily human rights abuse I saw in Pond Ward will carry on unabated.
A few days ago, as I was preparing to publish this, I heard some very tragic news. It was reported that a young girl given leave from the ward took her own life while outside.
I knew this girl; I had met her when I was in Pond Ward . She was a lovely, friendly person, but had suffered the most terrible abuse throughout her childhood. It seems that a further horrific experience had triggered her admission this time round. She told us that she was very depressed, and much later I heard that she had tried to cut her wrists on the ward on previous admissions.
She was discharged before I was, but re-admitted some time after I got out. She had to cope with the same atrocious conditions we all did. If she did receive any counselling while she was in there, I was not aware of it. Most of the time I knew her, she was simply left to her own devices.
Maybe if she was in a place where she had received the care, empathy and attention she needed, to cope with the horrors she had been through, instead of having to try and survive in a filthy and dangerous environment, she might still be with us today.
Rest in peace.
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* Elena Cook is a pen name.
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