A question I’ve been asked a lot before is ‘what is life like on a psychiatric ward?’ and I don’t think there’s a description I can give that fully sums it up. It changes from ward to ward, patient group to patient group and things like ward dynamics, staff, type of ward and outside influences can change how things are dramatically. For example, the ward I’m currently on is in the process of being completely split into a male ward and a female ward so there is a lot of building work going on. This means that it’s loud, busy and often overwhelming. It has definitely impacted how this admission has been compared to when I was here 4 years ago. But I’ll try and describe what life can be like on wards – this is purely based on my experiences as a patient (and former staff member – I used to work as a HCA at a Priory hospital so I can comment based on that experience too). It’s also important to note that I am referring to acute wards (the most common type of ward) as this is the only kind of ward I have experience of – I am not talking about PICU, secure services, rehabilitation wards etc which all have very different presentations too.

Thinking about psychiatric wards can feel like you step into a world that is covered in a veil of mystery, yet also stigma. Patients are kept behind locked doors and, unless you are admitted yourself, or are visiting someone on a ward, things are neatly hidden away. That is, unless a patient absconds, but that’s a whole other kettle of fish and something I’ll leave for another day. So what is life like behind these closed doors? Psychiatric wards serve as a safe space for individuals experiencing mental health crisis and offer a degree of support and treatment for a wide range of mental health conditions. The experience of life on a ward varies hugely from patient to patient, especially as we are all so unique and are all presenting in different ways, yet there are some common threads that tie the experience together.

I think one of the biggest misconceptions about psychiatric wards is that you go in unwell and come out better. On NHS wards in particular there is a big absence of therapeutic work available to patients as this kind of long-term work typically comes in the community (or rehabilitation wards such as those that specialise in trauma therapy or DBT). It’s not that common for wards to have regular therapeutic interventions from psychologists, although in some cases this does happen. I, for example, have just been offered 4/5 weeks of weekly sessions with a psychologist to complete a formulation that will hopefully help to prepare me for discharge. However, the therapy that I really need – trauma work – will come when I am in the community and stable enough to fully engage in it. Patients will typically be discharged once they have stabilised to a degree that they are no longer in acute crisis, but this does not mean that they are well, or even that they are stable by ‘normal’ standards – they are stable enough to be discharged.

Often there is an activities programme put together by the activity coordinators and occupational therapists that work on the ward and this can provide a welcome distraction from the mundane life that patients are forced to experience. This can include things like film nights, cooking sessions, baking, playing games, having coffee mornings, having access to an art room and visits from PAT dogs (I did, of course, save the best until last!) They may also offer things like mindfulness sessions and individual sessions with OT’s to work on individual goals. Programmes like this do help as they engage patients to a degree and get them used to regularly engaging in groups, as well as mixing with other patients (something I’ll come to in a minute). Engaging in groups also shows the MDT that you are working with staff and will work in your favour when it comes to things like requesting leave and, eventually, discharge.

One of the ‘nicest’ aspects of life on a psychiatric ward is the opportunity to make connections with other patients – after all, you are spending all day, every day in the same, fairly confined, space and so you do often get to know each other quite quickly. This isn’t always the case, though, as it does depend on the patient group at the time and how well you ‘gel’ with other patients. However, when connections are forged, they are often deep and meaningful. After all, you understand the difficulties of being in crisis and what life is like with mental illness, may have similar diagnoses, and can empathise with the difficulties of being stuck on a ward, shut away from the outside world. There’s also the opportunity for peer support, as patients can share their experiences and give advice based on situations they have found themselves in – I know I find it much more reassuring when I’m hearing things from someone who truly understands what my life can be like as there is that empathy underlying the discussions.

I was actually having a discussion with a patient the other day. We are fairly similar in age which is always nice, and seem to have a good relationship despite only knowing each other for a matter of days. We were sat in the quiet lounge (trying to escape the hectic nature of the ward at the moment – building work and loud patients aren’t always the best combination for two individuals who need to have quiet time!) and got chatting about our lives and how we ended up on the ward. And as each of us spoke, we found it really easy to slip in different pieces of advice, as well as stories from our lives to hopefully encourage the other. This isn’t always how things happen on wards, however, but it’s a nice bonus when it does!

Something that I think is probably fairly common, yet also not, across wards is the sense of rigidity and routine – it can often feel like there is no routine or structure on a ward, and whilst that can be the case at times, when you take a step back and look at the day as a whole you will find that there is actually a lot of routine and structure. Medications are given at the same time (roughly) daily, meals are always at the same time, groups tend to happen at the same time each week and you have your ward round at the same time weekly as well. When you aren’t able to engage in groups or they aren’t available it definitely feels like there is no structure at all – you seem to aimlessly float around, maybe sitting in the communal area for a change of scenery, but certainly not feeling like there is any semblance of structure to your day. But some of this does give patients a feeling of predictability and order – they know their meds are coming or that lunch is coming up – in a world that can feel so unpredictable and messy.

I could probably go on and on with stories from my admissions, comparing different wards and just generally rambling, but  I’ll draw to a close here. Overall, life behind the closed doors of a psychiatric ward is a complex, interconnected web with so many different threads that draw together. It can vary so much from place to place or time to time but I think that the overall aim is for wards to be places of safety for people experiencing crisis where they can stabilise to a degree before returning to ‘normal’ life to continue their recovery. I hope that by talking about the reality of life on a psychiatric ward it can do a few things: dispel some of the myths and misconceptions that people might have, shed some light on what life is really like whilst an inpatient on an acute adult psychiatric ward, and also foster greater empathy, compassion and support for those who are struggling with their mental health. Whilst we have made great improvements in the understanding and acceptance of mental health in recent years, there is still a lot of stigma that needs to be removed and it is talking that will help to lessen this stigma even more. 

All my love,

Anna x