‘Psychiatric wards are a collective national shame’

While I was working in homelessness, a client was sexually assaulted by his neighbour when he was a boy. The day he was admitted to a psychiatric ward, he had attacked someone on the street due to paranoid voices in his head telling him he was under threat. The previous day, he had left my office smiling, only to go to his room and slash his arms because his voices had told him to. The day after being admitted, still a threat to himself and others, he returned to our hostel. He had been deemed ready for discharge. 

I also worked in mental health with a father who experienced an episode of psychosis. He had never previously had mental health issues beyond anxiety. During the episode, he tried to take his own life; his child was lucky enough to stop him before he came to harm. The ambulance brought him to a ward that his family could only describe as a living nightmare. An old Victorian, clinically lit hospital, with patients expressing acute distress scattered through the ward and an overwhelmed staff. The family told me that, even though their father was a risk to himself, they thought carefully about returning him home and staying on 24/7 watch over him. 

Case studies like this are common across Britain. Involuntary psychiatric inpatient admissions in England rose by 38% following the implementation of austerity measures after 2012. 

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Psychiatric wards in the United Kingdom are a national disgrace and should account for a collective shame. We place people in these settings during some of the most frightening and overwhelming periods of their lives. Consider how you would feel if you had constant bullying voices, hallucinations and paranoia. Now, imagine being at your most severely unwell and being forced to remain in the environment I will now describe, sometimes for a 28-day or longer sectioning process. 

The TV in the wards I have been to plays the news on repeat, patients are allowed out twice a day, and screams echo in the corridor day and night. There are locked doors, restrictions and restraints – and patients have little meaningful choice. The environment in wards can seem punitive, like we are criminalising mental health issues. 

The hospital staff are not to blame; they are among the heroes of our society. They are underfunded, undertrained and underpaid. They experience vicarious trauma daily. If I were religious, I would say this is not how we should be treating those who are doing God’s work. 

The economic benefits of getting this right are clear. Mental health issues cost an estimated £119 billion per year. It is estimated that £1 invested in mental health promotion and prevention yields an average return of £5.

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The Prime Minister has demonstrated outstanding values and courage in his commitment to advancing social care. His lived experience of his father’s Alzheimer’s is clearly helping to inform him and us. I know he holds similarly strong views on mental health provision. Under Keir Starmer, the government made a positive start on this issue, attempting to reverse the implications of the previous government’s indifference to the sector. Efforts include an annual funding boost of £2.5 billion, 59 new dedicated mental health emergency departments and 100 new community mental health centres for those with severe mental health needs. 

When we look for solutions and exemplary practice to push us further, Dr Jacqui Dillon leads the way. She is an activist, writer and trainer and a longstanding figure in the Hearing Voices Movement. Her work explores how such experiences can become more understandable in the context of trauma and adversity, relationships, social circumstances, power and meaning. It provides peer-support spaces where people can talk openly about voices, other unusual experiences and much more. 

The Psychosis Therapy Project, founded by Dorothée Bonnigal-Katz, is the opposite of the all-too-common thought process in psychiatric wards, which holds that clients are too difficult to manage or too complex to make progress with – so we medicate and contain them. The service actively engages with clients’ psychotic thoughts, delusions and voices. 

The Nightingale is a ‘money is no object’ private mental health ward. Funding concerns detailed above do not occur here. The staff told me that if a patient gets three good nights’ sleep after admission, they’ll see drastic progress in their wellbeing – and they were right. The Nightingale can offer this peace to patients. Largely, we don’t give that respite to those who can’t pay and end up in NHS psychiatric wards. 

Mental health services can be a place where light can be seen from the darkest depths of human experience. We must reach out to lift our family member, friend, or neighbour rather than dismissing them in their time of need. In return, our society and economy will benefit.

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