Night Time Confinement

This is a blog posting from a patient that was very passionate about the negative effects of night time confinement.  This was written as a letter and under an alias, it was thought that the blog would be the best way to let the patient express his thoughts and concerns.

Article for Patient Opinion blog regarding Night-time confinement

This is my personal view of a very worrying development in the care of patients in forensic units across Nottinghamshire Healthcare and what this development represents.

Rampton High Security Special Hospital has already implemented a programme of night-time confinement. In plain English this means that all of the patients in this forensic psychiatric Hospital are locked in their rooms from 8pm, through the night, until 8am, every night. It is unlikely that; having paid for the improvements to facilitate night-time confinement, and crucially, having made large cost savings through having to employ less night staff, night-time confinement will stop anytime soon. However, Nottinghamshire Healthcare NHS Trust is commencing a pilot scheme of night-time confinement at Arnold Lodge Medium Secure Forensic Psychiatric Hospital in Leicester, with a view to rolling it out across the Trust. It will, undoubtedly bring a cost saving, and so you can be sure that it will be rolled out across Britain. As a mentally ill service-user I am deeply opposed to night-time confinement, here are the reasons;

1.    The stigma that is attached to mental illness will be increased, decades hard work undone almost overnight. Myths of the mentally ill being dangerous are reinforced by locking the mentally ill up at night. Children will come to learn that the mentally ill are locked up at night and so the stigma will be grown amongst future generations. People will think of psychiatric hospitals as de facto prisons, rather than places of respite where mental illness is treated and the patient recovers. 

2.    Night-time confinement is obviously a cost-cutting venture. But if you look closer, and with more insight, then yes the money spent on the mentally ill decreases, but the cost per mentally ill person being treated actually increases. And so the efficacy of each pound spent on mental health decreases. From an economic point of view, the target surely has to be to get the largest amount of successfully treated patients who do not relapse for every pound spent. For a change, this target actually concurs with the medical model. We should all know that there is a finite pot to spend in the NHS, and despite promises from the government that the NHS would not suffer from cuts, we know that many NHS budgets have been cut. Statistics say that one in four people will suffer from mental illness in their lifetime, with the pace of modern life expected to increase that statistic. So it is crucial, that we make the most effective use of each and every pound. We do not yet have the evidence, but prior understanding can tell us, that locking mentally ill people up at night will not speed up recovery times of mentally ill individuals. In actuality, it will lead to fewer people being treated within hospital for longer periods of time. This has numerous knock-on effects, beds become blocked, community services become unable to cope, more mentally ill people do not receive the care and treatment they need, and more crises occur, the public perception of the mentally ill becomes more distorted, stigma is increased and so less people come forward to receive the treatment they need to prevent a crisis. This vicious cycle gets worse with every cycle until it becomes a vortex that shatters the lives of anyone with any connection to mental health issues.

3.    Night-time confinement will lead to a penal culture within psychiatric hospitals. An aspect of the compassion which makes us part of Humanity is to look after the vulnerable and treat the ill. If we allow night-time confinement to come in then we are abandoning our own humanity, as well as our fellow humanity.

Locking people in their rooms changes the whole culture of psychiatric hospitals. Would we lock up the people with cancer at night to save money? How about those patients which fractured legs? The mentality of mental health nurses changes from caring nurses to prison guards. It makes for an antagonistic ‘Us and them’ mentality, between patients and staff which is not good for the trusting therapeutic relationship that is so crucial to therapy.

Being locked in a room feels like punishment to the person who is locked in. The mentally ill should not be punished for being mentally ill, and as anyone who has attended an anti-bullying session will know “If it feels like bullying, it is bullying” and so by the same token I would propose that “If it feels like punishment, it is punishment.” No matter how it is dressed up.

It is inhumane, and cruel to lock up vulnerable people, who are disturbed by mental illness, at night, where and during which; they may feel isolated, alone, fearful and in need of psychological intervention from nursing staff. Many mentally ill people are ill because of trauma they have experienced, and many of these will have experienced their trauma at night: To put them in a strange environment, where they know no-one, then lock them in a room at night, every night, makes them exceptionally vulnerable people. They may need help at night (caused by a cost-cutting exercise) and find that this help is not available during their most vulnerable period (again, because of a cost-cutting exercise). It’s just plain wrong. And this doesn’t go near the potential of institutional abuse.

Why not lock mentally ill up for 23 hrs a day? This would save more money. Perhaps, this is the plan? Why not stop paying for expensive therapies? Why not stop employing psychologists, nurses, occupational therapists? Why not just employ large, unqualified ‘care assistants’, with the keys to keep the mentally-ill locked in their rooms like in the ‘good old days’ before the Victorian era, when they used (and abused) the mentally ill to complete menial tasks in workhouses. This must not be allowed to happen. WE are in the privileged position to ensure that the thin edge of the wedge (night-time confinement) does not become the thick edge (work houses), and that we continue to improve services for the mentally ill, rather than let the cyclical wheel return us to a past that makes me shudder.

And so I implore all of you whom have read this article, to consider the outcomes that may result from night-time confinement, put your feedback on Patient Opinion, and TALK ABOUT IT with friends, family and others, then mobilise an opposition to night-time confinement.

Epilogue

Since writing my ‘Article for Patient Opinion regarding Night-time confinement’ I have become aware of the suicide of a patient confined at night in Rampton Hospital. This tragedy exemplifies just how vulnerable people with mental illness can be. It is with huge sadness, that I attempt to empathise with how this patient might have felt during the nights leading up to her suicide; feelings of isolation, desolation, loneliness, hopelessness and horrific guilt, all of which needed psychological intervention. However, each night all patients at Rampton, and, potentially, all people in psychiatric hospitals with mental illness, could never, in reality, access even basic mental health nursing interventions during the long dark hours, night after night.

I remember spending night after night at Rampton: Feeling scared of staff coming into my room at night, and being told in no uncertain a manner that I was not allowed to leave my room at night, being left to my own devices on how to cope with the isolation, emptiness, guilt and near-hopelessness of being a Rampton patient.

And so the questions that beg to be answered regarding this tragic death, for me, are;

1.    Did the lack of night staff that comes with night-time confinement contribute to this suicide? 

2.    Who is taking responsibility for this and will this include a review of the night time confinement?

3.    Is the death of a vulnerable person under the care of the NHS worth the cost saving made through night-time confinement?  

Remember, we have the opportunity to oppose night-time confinement.  I will repeat my ask for all who are concerned about this to make their voice heard.    

Madhatter