Restraint and solitary confinement used with mentally ill patients have been discussed in some detail in Australia, particularly recently. It has a lot of resonance for me. Each and every time I have been admitted initially as an involuntary patient to the hospital.
My experience was that I usually wanted to be in hospital and now I’m grateful that I wasn’t able to run around the highway naked. That was my aim at one point, to strip naked and walk to a local beach and join its hippy commune. (To my knowledge there is no alternative community at this beach or its surrounds).
I think we had a tribunal every two weeks for the doctors to get their decision to extend hospitalisation rubber stamped. One day I was discussing with fellow patients the tribunal and they advised me to wear colour coordinated clothes, including underwear, and that would influence the decision. I obediently donned the clothes of my ward friend (underwear remained mine) and some boots considered important.
I was laughed at during one trial by officials because I wanted to vote in the federal election. No one expected the ramblings of mad patients to challenge the clinical knowledge of the medical profession. It would be good to find out of those who challenge their involuntary status or hospitalisation how many win. Of course, we had someone representing us if we chose to but they were part of a structure that made no sense in my mad mind.
We also were provided with turgid legalese about our rights and responsibilities and an explanation of involuntary and voluntary patients. I immediately poured over the sheet for days trying to decipher the code, the hidden meaning.
Being in a locked ward (for those patients either a serious threat to themselves or others) the solitary room – the empty padded cell – seemed always to have someone in it. I remember one guy was in there for days and he hollered and slammed and banged the door so hard I’m amazed he didn’t break his way out. He kept it up hours. But he’d still beat the door and scream “let me out!” when anyone walked past.
Eventually, I experienced physical and chemical restraint and isolation in addition to being involuntary. Getting out of hospital becomes a real yearning, to eat something other than hospital food, seeing the same walls, hearing yells or code blue and stamping feet of tough burly nurses to deal with some misdemeanour. It’s overwhelming at times, at others long, quiet and boring. I heard about a couple that got out or nearly got out and I thought I’d give it a try to make a run at the front door despite the locked door and security guard. The aim was to sneak out as someone else was granted exit or entry.
Of course, I was crash tackled immediately and caused a drama for those entering and leaving, for while I was pinned in the entry way, the door remained locked. Someone brought a medical bag with an injection, my pants were rolled down to expose my buttocks to the assembled crowd, and I felt the rough jab on my naked cheek. The nurses helped me to my bed because they knew I wouldn’t make it alone. I was out for hours and awoke to feel drugged and tired.
Another time I was crash-tackled because I was chasing my boyfriend. I didn’t want him to leave. I made a dive at him and caught him by the legs as the nurses caught me. The use of pressure points and my face jammed into the ground had me letting go subdued and crying.
Another incident particularly stays with me. A nurse was in my room telling me I had to have a tablet. I didn’t want it. I felt I was in a kind of a game where I was expected to resist. One of the tablets had gone on the bed and the nurse, who I liked, put her hand down to get the tablet. I put my knee on her hand – to my shame – and the code blue sounded and I was pinned on the bed. While they continued to pin me down one of the huge nurses told me they nearly broken my leg, the one that I placed on the nurse’s hand. I have often wondered if that was a mistake or payback. I was put in solitary until I agreed to have the medication. Later I apologised to the nurse realising by this stage it was no game.
Was this all necessary to show me the error of my ways? Or could there be more gentle methods of dealing with “non-compliance”? I was asserting my power to decide what to ingest and they showed I had no such right and no power. It was incredibly frightening although I condemn my actions.
I don’t think there is any black or white answer. The safety of nurses doing their job, many of whom are dedicated and kind, should be a priority. But where does the patient’s right of self-determination fit into this?
How can the tribunal be less of a rubber stamp and take patients more seriously?
Did the regular physical interactions that I saw between staff and patients desensitise and normalise that behaviour in my deranged mind? My experience was minor but the force I felt that I have never felt elsewhere was intimidating and made me feel I had no rights. A weak and painful knee is a lasting reminder of the time I overstepped the mark.