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.
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And at this stage I had taken the tablets already, but I didn’t say that to her. She goes, “Oh, do you want me to come around?” And I said, “No, no, no, I’ll be fine”. “Have you got somebody to talk to?” I said, “Yeah, yes, of course, you know”. And she said, “Okay then”.
And then I just slept all day. And then my daughter rang me at about seven and I’m, you know, sort of drifting in and out of consciousness. I heard the phone ring. I said, “Hello?” And she goes, “Hi, Mum, it’s [daughter]”. And I said, “Yeah?” And she goes, “You all right?” I said, “Yeah, yeah, yeah, I’m fine, love”. I said, “I’m just tired. I’m – you know, you’ve woken me up”. And she goes, “Are you sure?” And I said, “Yes, I’m fine, [daughter], don’t worry”.
And, anyway, finished the conversation and within five – 10 minutes get a phone call from my friend. And she goes, “Helen, [daughter]’s just rang me. She’s worried about you”. Because [daughter] was on the other side of town at this stage. And she goes, “You all right?” And I just burst out crying. She goes, “What’s wrong, Helen? You okay?” And I said, “No”. And she goes, “What’s wrong? ” And I said, “I’ve done something stupid”. And she goes, “What?” And I said, “I’ve taken an overdose”. And she goes, “Helen”. So she came round within a few minutes and called an ambulance and I was rushed to hospital, of course.
And I was in there, in the ward for about a week and then they put me in the psychiatric unit at the hospital. And the nurse came and put me in a wheelchair and then we were escorted by a security guard. And he had a gun as well, if I remember rightly. I’m not sure whether I was seeing things or can’t remember. But I sat there and I bawled my eyes out, you know. And I thought – and the nurse tried to calm me down. She said, “Helen, it’s not as bad as you’re thinking”, you know, because I’m thinking of all the terrible movies that I’ve seen on TV where people have been locked up and banging on the doors, wanting to get out and that. And that’s all that was going through my head. And she said, “Get the bad thoughts out of your mind. It’s really okay”.
So once I was wheeled in, you know, and I saw, you know, everything was sort of quite open and friendly and that, I calmed down. And I must have been in there for about a month. Did it do me any good? No, not really. I don’t think I achieved anything of being in there, because I just felt like I was a number and, you know, you just had this routine.
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.
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And then I got – continued on. I went to – when I was in a place called [ward name] I think it is, it was the old psychiatric ward at [unclear]. I went there and I was diagnosed by a doctor as being schizophrenic and I then come into the system. I was placed in [prison] from one year and it was discovered that I was too sick – too unwell to stay in in the prison and I got moved over to the hospital system which I’ve got nothing but praise for.
That’s so interesting. Mmm, so then six months’ time – I’m digressing – then you became very unwell and then they actually – were you in the psychiatric prison system after that or was it an external psychiatric…?
I was. I spent three months in [psychosocial unit]. I think it was, a psychiatric ward there. That was all right but I still wasn’t getting the proper treatment then. I was just treated there like a bit of a number, you know. But which I didn’t get that in the psych system at all.
Could you talk a bit about what you mean by that and what that was like?
Just like I mean, I was still unwell. I was throwing billiard balls around the room at the [psychosocial unit]. I was yelling out for help and I didn’t get any help. I still didn’t – that still sticks in my mind.
So then how would that – so they’d react to that by restraint or…?
No, just ignored me. Yeah. So in the end, I started getting a bit disillusioned with how things were going and, oh God. God it was an experience though when I look back on it. Yeah.
I was so unwell. They changed their mind and I went down to [prison] for a day. And I got held in secluded accommodation and in the end they said – I still don’t know to this day whether it was recorded because I was talking to myself like there was no tomorrow. And they said, “Look we’ve decided we’re not going to put you out on the ward, or out into the gaol system. We’re going to take you to the hospital”. So then drove me up to [prison assessment centre], you know, assessment prison and a couple of days later they moved me out to [mental health hospital]. And that’s where I stayed for nine years I think it was.
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.
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Yeah. So it was when I was living in [city] and I had met [social worker] and she was tormenting me and driving me crazy. And, one day I was really distressed and I went to [medical centre] which I lived not far from there. And, I asked them, I said, “I’ve got to be admitted, you know. I’ve got this terrible – this [social worker] voice in my head. It’s driving me crazy”. I don’t think I said I was going to hurt myself, but, anyway they wouldn’t admit me.
So I went to the toilet and I just sat in there and I just screamed and cried and screamed and that. And they locked off the toilet. Wouldn’t let anyone else in the toilet and they eventually they got someone to talk to me. She said she was a social worker and she talked to me for about half an hour and I talked about [social worker] and how she was driving me crazy and I couldn’t cope with it any longer, and I needed to be admitted. But they wouldn’t admit me. And, I just had to go off and, you know, and then [social worker’s] voice came and said, “Now – now come and see me”. So I went to her office and spoke to [social worker]. [Laughs].
Wow.
Mm. So, it was hard, but, – yes.
Do you know why they wouldn’t have accepted you?
Well, I think – no, they didn’t really say. They didn’t say, you know, that they had no beds or – they didn’t give me any reason. They just refused to admit me. Yeah, I don’t know. They didn’t give me any insight at all. It was as if they didn’t have a psychiatric unit, you know [laughs]. And I was terrified of going to hospital, because I was terrified I was going to get electric shock therapy and I was terrified of electric shock therapy.
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.
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Next thing I know I’m just sitting in the family room watching TV in a track suit. And six policemen entered the home and saying they wanted me, they say, “Well are you going to come with us?” And I say, “No” and try to get away. They grabbed me, you know, they forced handcuffs on me. So I was handcuffed against my will in my own home. I was taken away by car to [mental health unit] as a 16, 17 year old. And I think I spent the next three months at [mental health unit] heavily against my will and compliant with virtually no activities in a very unhappy stay there and I just wanted to get away. And I ran away at least twice or three times.
I think everybody’s experience of involuntary treatment is negative otherwise it would be voluntary treatment. You know, I mean, there’s not a single person alive that doesn’t hate the system and hate everyone in it for involuntary treatment. I mean some people get really bitter and they’ll never let that go which I think is a mistake. But even like, you know, 10, 15 years down the track they still can’t let go of that anger, that hatred. I don’t know I just – I encourage them to reconsider. But, you know, I mean, when I went in, when I was an involuntary patient the second time in 1998, I accepted when I was in there after I was medicated quite heavily to be brought down to ground level. I accepted that, you know, I think particularly – I accepted that I 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’.
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Yeah at that [coughs], on that particular day and that – I haven’t, wasn’t sleeping, I had a bad night sleep as well.
And were your family members around at this time? Or were you kind of doing this all on your own?
Oh no, my parents were home. I was too, I was just not aware they were going to come, but they had called me and I, from what I can remember, yeah I kind of didn’t want them to come in the house. Not the house, but just I didn’t want to see them, but eventually they found out I was home and that’s when the problems started, yeah.
Yeah okay, so then, and then you and, so then you end up in hospital?
Yeah, I didn’t want to go but I had no choice. Yeah I wasn’t happy but I didn’t want to make any more, anything more difficult, so I kind of, I had to, it was a very traumatic experience but I just had to accept it and agree with whatever was, whatever they wanted to do, yeah.
When you say now you just had to kind of suck it up and go in, can you say why that might have been?
Oh, because I didn’t want to get into trouble with anyone so, so yeah I just did what I thought was right.
Yeah so then was it, you mentioned before that it was a traumatic experience kind of being forced to go to…
Yeah it was, yeah stressful yeah.
…hospital. Well you, but you made the decision to go.
Yeah.
Could you talk a bit more about that and what happened when you were in hospital?
Oh yeah, in hospital, I was sleeping very badly, like I’ve had very bad, prior to that I had months and months of sleeping on and off really, sometimes well, sometimes unwell, really short hours and stuff like that. The hospital experience wasn’t easy, but I guess they put me on some sleeping tablets and it helped me sleep for a little bit, and then after that I kind of, when I got home I thought, ‘Oh I’d better start sleeping better because I don’t want to come back to hospital again, I don’t want to return, you know’. But I didn’t like being in hospital because you don’t have freedom, you can’t do what you want.
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.
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I think they tried to reason with me but I wasn’t to be reasoned with. I was not in a good state to be dealing with what I saw as a major imposition on my life which I didn’t ask for or invite into my life. And I just wanted to be home and sort out myself in my own sweet time. I liked home because it was like a safe place to be. But I didn’t like – I wasn’t ready to be sort of stripped naked and put in that adolescent unit at that time. Also with a lot of kids that many were sort of from backgrounds and geographic areas that I knew nothing about. Going to the school that I went to. So I had to be at odds with the cultural change of that situation and that was difficult. And yeah but anyway I eventually got out of there. Out of [mental health unit].
How did you, how do you know how that was…
Well they just discharged me after three months because they said like, “”If you’re not willing to take part in the activities and you’re not going to consent to treatment and you keep on running away there’s nothing much we can do with you””. So they just discharged me home again. So I mean I think they eventually said, “”You’ve got to take part in what we offer for you. If you’re not going to take part in that then you’ll have to leave””, and I said, “”Well, it’s obvious that I want to leave””. So they said, “Okay”.
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.
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In terms of leaving, I guess I’m interested – because obviously you’re tapped into different support networks.
Yeah. Yeah.
Could you just talk a little bit about, I guess what that – because I imagine that that could be also…
Stressful.
Yeah. Big transition.
Well as I said, I’ve never actually hit anyone, but I used to get urges to strike out and punch people and I had a doctor – there was a psychiatrist said, “Look I want to put you up for extended leave”. Are you familiar with extended leave?
Yeah, but if you could talk about it.
Yeah. So in the psychiatric system, extended leave is basically like your parole. You’ve got to be approved by all the doctors and it’s got to go to a Supreme Court judge. And – what was I going to say?
So one of the doctors said, “I want to put you up on extended leave”.
Oh okay, yeah, but they said, “I’m going to let you know that if you have any urges to strike out, might be a problem come the court day”. But it was never a problem. The judge – they put their case forward, said, “Look he gets these thoughts, these impulses but he’s never actually,” – so I’ve hit people in prison but I’ve never hit anyone in the psych hospital. And that was pretty well good. The system come through pretty well there.
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.
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And then I was out of seclusion on the normal ward and I had two more Mental Health Review Board hearings. The second one was a split decision. The legal member and the chair said that she thought I should be made – I don’t know if she said voluntary but I should be released anyway and the other two members disagreed and so I was kept in. And then finally on the third one, I’d got released. But I had to work obviously with the social workers and things to try and find accommodation.
Excuse me [sneezes] and for me I was trying to get accommodation that I would be able to have my children in. And they were saying to me, “Well, we don’t know that you’re actually capable of looking after your children and we’re never going to be able to find you that sort of housing and blah-blah-blah-blah-blah”. And they offered me one – a share house at some point in time and I said, “No I don’t [laughs], I don’t want that”. So I eventually just made the decision that I was going to have to come back to [city] and get accommodation wherever I could and go and stay with an aunt of mine while I tried to sort that out.
And I got released on the third time. And I came back and I had to rent an apartment that was really expensive like, I don’t know, you know, a weekly, fully-furnished apartment week-by-week. But I had arranged for that to happen so that I was able to be released and I was eventually released.
