Hospitalisation: Being admitted and leaving

Almost all the people we spoke to had been in hospital in relation to severe mental health problems. Although many had only been hospitalised once or twice, some had been hospitalised many times (six to eight times; Anna recounted having been hospitalised 24 times). A few people couldn’t remember how many times they had been in hospital.

People may enter hospital on a voluntary or involuntary basis. Involuntary treatment can be given providing certain criteria in the Mental Health Act are met: for example, a psychiatrist confirms the person has a mental illness that requires immediate treatment because they are a serious and immediate risk to themselves or to others and there is no less restrictive alternative. Some of the people we spoke to began as voluntary patients in a private or public hospital but were then made involuntary and moved to a public hospital. The situation of all involuntary patients is reviewed regularly by an independent Mental Health Review Board or Tribunal. In Victoria this is the Mental Health Tribunal (MHT) (formerly the Mental Health Review Board (MHRB)). Before 2014, the MHRB had the responsibility to continue or revoke involuntary treatment orders. Since 2014 the MHT has had responsibility to make Extended Involuntary Treatment Orders after an application is made by a mental health service. The Tribunal also hears appeals from patients about their involuntary status.

Being admitted

Most people remembered being admitted to hospital, even if they said they had been very ill at the time. Some were referred after going to see their GP or as a result of seeing a psychiatrist. A few admitted themselves by going directly to the hospital, and some were admitted as a matter of emergency after an attempted suicide (e.g. by ambulance). A few told us they were taken to hospital by force. When Maria ‘threw all of the doctor’s paperwork on the ground’ halfway through a consultation the police were called and she was taken to a psychiatric ward.

Helen was ‘rushed to hospital’ after a suicide attempt when her daughter spotted she was not quite right. She was there for a month and doesn’t think it helped her.

Brian and Charlie were admitted to hospital while they were in prison. Charlie ‘got into trouble’ with the police and spent time in a women’s prison and a suicide cell before going to a forensic hospital in seclusion.

Brian had committed a serious crime and was diagnosed with schizophrenia. After six months to a year it was decided he was too unwell to be in prison and he was eventually transferred to a hospital.

A few people talked about the difficulty of actually getting referred to hospital when they were feeling very unwell. Lisa described becoming ‘more and more ill’ until ‘eventually’ her psychiatrist referred her to a private psychiatric ward. Delay in going to hospital could be upsetting. Before Carlo could go into a private hospital he was given an appointment to see a psychiatrist. When the appointment was cancelled Carlo said no alternative was made and he was left to wait, which ‘freaked’ him out.

Jenny felt ‘tormented’ when she had the voice of her social worker in her head. She went to a medical centre to ask to be admitted but recalled that her request was rejected with no clear explanation.

On first arriving at hospital, some remembered going through a process of admission. Sarah felt the assessment process was too ‘administrative’ and she felt someone should have tried to calm her down and listen to her story. Carlo said he felt as though ‘they were trying to interrogate’ him and when they asked to take his photo it made him feel like ‘a criminal’. Lisa remembered being searched and having her belongings searched for anything that could be used for self-harm. She remembers hospital staff confiscating razors, hair dryers and straighteners, which could only be used under supervision.

Less than half the people we spoke to had experienced involuntary admission at some point. Some people entered hospital voluntarily but their status was changed while they were there. Gurvinder thought the decision to make him an involuntary patient on the second day of his stay when mental health professionals hadn’t really heard about or understood his symptoms ‘wasn’t really an informed decision’. He appealed the decision and lost but now understands ‘where they [were] coming from’ as he had attempted to end his life and was ‘very paranoid’.

Although being taken to hospital by force was very difficult for Allen the first time, when he went to hospital the second time as an involuntary patient he ‘accepted’ he was unwell.

Quite a few people spoke about direct or indirect pressure to agree to go to hospital voluntarily on the basis that otherwise they would be admitted involuntarily anyway. This could be very subtle pressure or more direct; Ann was told by the admitting nurse at a private hospital that because she was at risk of self-harm and suicide, if she didn’t ‘follow the guidelines’ they would make her an involuntary patient at a public hospital. When Alice was admitted to the emergency ward of a hospital she was worried about how this might affect her career. She recalled the psychiatrist telling her if she agreed to go in voluntarily it would be less likely to have a negative effect. However, she was made an involuntary patient and the next day the Mental Health Review Board decided to continue her involuntary status.

Susana went into hospital because she ‘didn’t want to get into trouble with anyone’.

A few people went voluntarily to a private hospital where they described conditions as being better than in public hospitals. Chris said he now has private health insurance after having experienced both public and private hospitals. He said if he had to go to hospital again, he would go to a private psychiatric hospital because he doesn’t want to ‘go through’ staying in a public hospital again. He described the benefits of private hospital as ‘discretion, personal choice, personal hospital, personal doctor, personal medication’. Michelle described going to a private hospital as a place of ‘respite’ where she could just rest.

A few people mentioned that when they were admitted to hospital they weren’t told how long they would be there for. Although Lisa found it ‘bizarre’ to be in hospital ‘for an indefinite period of time’, because she wanted to make plans to go back to university, she also accepted that she would have to stay until the treatment was finished.

Leaving hospital

Some people didn’t remember leaving hospital or just remembered that they ‘became well’ and went back home. Others remember being surprised when they were told to leave, including Brendan who said, ‘I didn’t think anything had been fixed’. Some people chose to leave and others were allowed to leave either because they were assessed to be well enough or the hospital couldn’t help them anymore. At the end of her second stay in hospital, which lasted 18 months, Michelle remembers being told, ‘you can’t stay here forever’. Lisa said ‘I’d like to think that I got well enough to leave but also, in retrospect I think I [was] just sick of being there’.

The first time he was in hospital Allen didn’t want to be there. He said he was discharged because he wasn’t taking the medication or other treatments and kept running away.

For some, leaving hospital was a gradual process. Tanai had ‘lots of interviews’. Helen was allowed to go home with her family for the day on several occasions and when she could ‘cope with that’ she was discharged.

Brian was given extended leave, and he had to appear before a judge who considered his case.

The Mental Health Review Board met three times before they agreed Bernadette could leave hospital. She struggled to find accommodation for her and her children.