Notes on psychiatric crisis care

There's a private psychiatric hospital at the top of Harrow on the Hill.
It's in beautiful surroundings in what looks like a converted stately
home. The grounds are well tended. I never saw the rooms but I assume
they are all single room. There was a general feeling of peace in the
hospital. It was a place people might want to visit. Private psychiatric
wards rarely sectioned people however there has been a sharp trend of
increasing use of the Mental Health Act powers by private psychiatric
facilities.

I've stayed in one of the NHS psychiatric wards in the same area and the
experience is markedly different. They're places that make people more
ill, at least the one in Park Royal does. They're dirty, noisy, skanky
establishments. The environment has an oppressive feeling. Its
inorganic. Everyone is compressed into a smaller space and that makes
people worse. That ward had no access to the outdoors or green space for
sectioned patients on the top floor until the smoking ban. Any sane
person would not want to be in that NHS psychiatric ward when they were
ill.

A somewhat better facility was my displeasure to be sectioned in in
Nottingham. This may have been a teaching facility though my
recollection of the time isn't fantastic. The environment was cleaner
and the general feeling of stress was much lower. It was more relaxed.
Staff were much better motivated. It was probably one of the better
psychiatric wards. It was my first experience of full blown hypermania
and psychosis and was a lot of fun until the hospitalisation. My life
took a sharp turn for the worse upon entry to the NHS psychiatric
system. It's what my dad feared.

Before the Japanese changed their equivalent of the Mental Health Act in
the 1950s it used to stipulated that hospitalisation was done at home.
The Japanese mental healthcare system has a strong interplay with family
and culture. In practice what this meant was that a person may be tied
to a chair in a room in a house while they were going through an extreme
state. This was before the Federal Drug Adminstration approved the first
antipsychotic medication in the US.

Soteria houses and other similarly principled alternative paradigms of
crisis care offer minimal use of medication and coercion, people with
lived experience as staff and other novel features.

100 years ago lunatics were expelled from society. They were put in
converted leper houses and other buildings. Their opportunity for life
in the world was removed in an act of compassion. Their value to the
world was removed.

Confinement often seems to be the 'treatment' when all competence fails,
like violence is the resort of the incompetent or sarcasm the resort of
the witless.

In crisis trust is vital. A person may loose all trust in everything
when going through a period of severe crisis. Prolonged mild psychosis
or paranoia - schizotypy rather than schizophrenia - can also
significantly damage a person's trust in everything. Life itself usually
lends a hand in destroying trust. Maintaining trust is vital. This is
often poorly achieved in acute wards in the UK.