What is it like to be committed to a psychiatric hospital
against your will? This is surely one of the most frightening
experiences anyone could endure? Claire was placed under a variety
of sections of the Mental Health Act and as a result found herself
committed on several occasions to various psychiatric institutions.
Raj Persaud talks to her to get her story out to the world on what
it's like to be 'sectioned'. The interview was organised
thanks to assistance from Mind - the mental health
charity. Many thanks to Aimee Gee of Mind for assisting in
making this interview possible.
A related article which may be of interest first published in
The Huffington Post by Raj Persaud and David James
An investigation by BBC News and Community Care magazine into 53 of
England's Mental Health Trusts reveals that 1,711 mental health
beds have been closed since April 2011, including 277 between April
and August 2013, representing a 9% reduction in the total number of
mental health beds available in 2011/12.
The BBC News website reports possible consequences including the
tragic case of 39-year-old Mandy Peck who told clinicians she was
feeling suicidal, but her local mental health service centre
initially claimed no beds were vacant. She jumped to her death from
a multi-storey car park shortly afterwards.
As psychiatrists who have worked in the NHS, we have both
experienced the chaos of trying to find a bed for a patient who
needs one urgently.
The enormous pressure on the staff to find a bed means that the
modern NHS becomes a constant fight for beds, creating stressful
conflict with other clinicians. Even if you (eventually) secure an
admission for your patient, this is at the expense of the patient
who was previously in that bed, who, in order to accommodate the
new admission, gets moved to another part of the country, or is
discharged, or sent on leave prematurely.
Providing any kind of therapy in this frenzied environment is not
possible. Admitting someone in a fragile mental state into this
siege atmosphere means you are only arranging an admittance to
prevent suicide or harm to others, rather than offering help to the
mentally ill in need of care. You have become a form of warder, not
The National Confidential Inquiry into Suicide and Homicide by
People with Mental Illness at the University of Manchester,
published in July 1013, reports that during 2001-2011, in England,
13,469 deaths (28% of general population suicides) were patient
suicides. These are persons who had been in contact with mental
health services in the 12 months prior to death.
There has been a projected rise in 2011 (the last year for which
data is available). In 2001 there were 1261 suicides by people in
contact with mental health services and this figure had risen to a
projected number of 1333 by 2011, during a period when it now looks
like more beds were being lost.
Patrick Keown, Gavin Mercer and Jan Scott published a recent
analysis in the British Medical Journal, finding that between 1996
and 2006 in England the number of NHS psychiatric beds decreased by
29%. Entitled Retrospective
analysis of hospital episode statistics, involuntary admissions
under the Mental Health Act 1983, and number of psychiatric beds in
England 1996-2006, their investigation found involuntary
patients occupied 23% of NHS psychiatric beds in 1996, but 36% in
The authors conclude that inpatient care transformed considerably
in the decade from 1996 to 2006; more involuntary admissions to
fewer NHS beds. The case mix shifted further towards psychotic and
substance misuse disorders, altering the atmosphere of inpatient
One interpretation of this data, and our personal experience
supports this, is that the ambience on wards has changed, and for
the worse, in terms of providing a therapeutic environment.
Psychiatric in-patient units are now much more likely to be
precarious containment areas for the extremely seriously mentally
ill, not a haven, nor asylum from stress for those who need
For these reasons, being admitted to a psychiatric ward today may
in fact be an added source of stress - not a therapeutic experience
Some evidence for this comes from a recent investigation of a
consecutive series of individuals aged 18 to 65 who died by suicide
between the 1 January 2001 and 31 December 2006 in England, the
date of death being within seven days of the date of admission to a
The study entitled, Suicide
in recently admitted psychiatric in-patients: A case-control
study, found around a quarter of all in-patient suicides
occurred within the ﬁrst week of admission to psychiatric
in-patient care. 46% of cases died on the ward itself; the majority
by hanging. 40% of suicide cases died within the ﬁrst three days of
admission. A ﬁfth of all suicides were on authorised leave at the
time of death, but 34% were off the ward without staff agreement,
compared to only 1% of controls.
The authors, Isabelle Hunt, Harriet Bickley, Kirsten Windfuhr,
Jenny Shaw, Louis Appleby and Nav Kapur, conclude that contrary to
previous relevant research, this investigation examining wards in
England found a short length of illness (less than 12 months
duration) was independently predictive of suicide in the immediate
The study, published in the 'Journal of Affective Disorders' in
2013, contends that it may be that receiving a psychiatric
diagnosis requiring in-patient treatment is particularly stressful,
plus the experience of entering an environment that patients have
described as ''frightening'' and ''intimidating' probably
increases, rather than diminishes, suicidal feelings.
The authors considered there could also be an association between
being admitted to a psychiatric ward and a heightened sense of
Given that those on authorised and unauthorised leave account for
such a large proportion of in-patient suicides from their data, the
authors of this study point to two recent court cases in England
after the suicide of a detained patient who absconded (Savage v.
South Essex Partnership NHS Foundation Trust, 2008) and a voluntary
patient who died by suicide whilst on leave (Rabone v. Pennine Care
NHS Trust, 2012).
The authors of the study point out that these cases were viewed as
a breach of Article 2 of the European Convention on Human Rights
(which safeguards the right to life), resulting in a new obligation
for health authorities and hospital staff to protect patients where
there is a ''real and immediate'' risk of suicide.
The danger of the current headlines over fewer beds is that it's
not just the numbers that are important - the quality of the bed,
as it were, is vital. What is the point of offering a bed if the
quality of the experience is so poor, aspects of it contribute to
The NHS neglects quality of care, which has been sacrificed on the
altar of numbers, because numbers are so political.
Numbers of beds dominates the debate - and numbers are important
because we have had too few beds for the system to be safe for some
time now. And the decline in bed numbers appears to continue
inexorably. But we should be looking beyond numbers to human
beings, focusing as well on the quality of what patients get, when
they actually get anything at all.
Raj Persaud is a Consultant Psychiatrist in Private Practice in
Harley Street, London UK and author of several best-selling books
including ‘The Mind: A Users Guide’ published by Bantam Press. Dr
David James is an eminent Forensic Psychiatrist.
Raj Persaud is joint podcast editor for the Royal College of
Psychiatrists and also now has a free app on iTunes and google play
store entitled ‘Raj Persaud in conversation’, which includes a lot
of free information on the latest research findings in mental
health, plus interviews with top experts from around the world.