Sunday, 11 August 2013

Forced Drugging is SOMETIMES Needed!

Wow, my opinion has caused quite a stir on Twitter. People saying, "No it's never needed," or "Staff aren't doing their job right if they have to fall back on it," or "It's against human rights." I've tried to explain as best as possible that yes, sometimes it IS necessary, but 140 characters isn't a lot to get a long story out. So here it is in more detail.

WARNING: Possible Triggers.

First the bad. My first forced injection was in hospital one. For those who haven't read my blog, I've been in three psych units during two psych stays. The first stay was in an awful English hospital, the second stay was in a good Welsh hospital, then a Welsh specialist unit. That first injection still gives me nightmares to this day. Three men, three women surrounding my bed, the indignity of having my bottom half of clothing halfway to my knees, the animalisation of the way they were talking about their Christmas holidays whilst doing it, then the laughing about the 'wonky' plaster.

When writing about it for my currently unreleased memoir, it took me three attempts to start, because I became so stressed by it twice that I had to stop. It was an awful experience, and you could argue whether or not it was needed too. On one hand, I wasn't very anxious or anything that night, but on the other hand, I hadn't eaten anything for over two weeks, had only had one cup of water in four days, and was refusing all forms of medication. I nearly had forced ECT because they were so concerned that I would die if I kept on refusing everything. After that forced injection of olanzapine (Zyprexa), I started with liquid nourishment, including Ensure Plus, and complied with medication. I didn't find the medication helpful, but I'm pretty sure the liquid nourishment was more than useful!

Now the good. In the second hospital, I had more forced injections that I care to count. There's only one time that I felt it wasn't good - the time where I COULD have been talked out of my fear and then a HCA heard me screaming, walked in and asked the three members of staff trying to inject me if they needed a hand. But that aside, there was one night in particular where I know that forced drugging was definitely needed, and possibly even saved my life.

I'd had a really bad visual hallucination, where I could 'see' hundreds of what I called demons. I don't know how long I'd been hallucinating for, but I lost five hours of time that night. When I finally stopped hallucinating around midnight, I didn't even know up from down, never mind what had just happened to me. I was sat on the floor, with my back to my bed, when three nurses came into my bedroom. They tried to get me onto the bed, but I fought back, unsure of whether they really were nurses or demons in disguise. I know they were talking to me, but even looking back now, I've no idea what was said. I was so confused, psychotic, just not in this world, that talking to me for hours would have done nothing. Plus, my heart rate was so high and my blood pressure was undoubtedly very high too, that I would have been in real physical danger if something wasn't done quickly. So they did something. The only thing that would have helped me at that time.

When they realised they couldn't get me on the bed, the three of them sat around me. Two either side of me, one in front of me. I'll add here that the three nurses were female. The nurse on my left put her arm around me as if giving me a hug, so that she could gently hold my arms whilst whispering something in a comforting tone. The nurse in front of me held my legs very gently, so much so that I wouldn't have realised what she was doing had I not seen her. I think her hands were only there in case I did start kicking, I don't think she was really holding my legs per se. The third nurse lowered my trousers a tiny bit and I barely felt the needle going in.

The nurse in front of me then took the empty syringe and whatnot away, and went back to the ward she was normally based in. The other two, who were the only two members of staff in the ward of ten patients, then sat with me for a while (I don't know how long) as the drug started working. As I started calming down, they were able to talk to me, and I could talk to them. I was terrified of the 'demons' coming back, but one of them told me that they wouldn't be able to get in, and even if they did, they would have to go through her first. She told me that there was no way she was going to let any demon get anywhere near me, and it calmed me down enough that I was able to be left on my own. I fell asleep very quickly after they left, and I am grateful for the few hours of peace I had that night.

Waking up later, I started feeling anxious again, and thankfully the nurses were able to check on me so often that they noticed very quickly. They brought a lorazepam tablet, and convinced me that I needed it. I was able to take it orally, without another injection, but because it was tablet form, it took longer to work and wasn't as strong. As a result of that, it took longer to calm down, and one nurse had to stay with me for over an hour until the day staff came on, when I could feel the sedation kicking in and could fall asleep. It was a welcome release from all that was going on in my head.

So those who say it isn't needed, I can say that I DID need it. And believe me, it has taken me a long time to get to a place where I could admit that. I think many of the staff who knew me from then would fall off their chair in shock if they heard me saying this. Those who say they weren't doing their job right if they had to fall back on it, you must live in a perfect world. Those two nurses from my ward, and the third from the other ward, were some of the loveliest nurses you could ever meet. They didn't just treat patients as equals, they wanted to learn from us and improve themselves so they could help others even better, and as such, they treated us as better than them. They just didn't have the time/resources to get to me any faster.

There were two members of staff on the acute wards at night, which had 10 patients in each. The locked ward had four members of staff for four patients, but as those patients were more acutely unwell, the ward needed the one-to-one ratio. On my ward, there was a patient with an eating disorder on permanent one-to-one obs until she fell asleep, for fear of her exercising. The other nurse would have to help the other nine patients alone, including doing the meds for those with nightly meds, which I didn't have at that point. That night, the patient on one-to-one obs had difficulty getting to sleep, and there was another disturbance on the ward. They didn't realise what was happening to me because they didn't have the resources to check on me. Even scarier, I've heard that the staffing levels have been cut even further since then.

As for 'against human rights', yes it is. But so is being detained against your will when you've committed no crime. However, there are times when a person is such a danger to themselves and don't realise it, that if they weren't taken in to a place of safety, their life could be lost. In a perfect world, there would be more mental health staff to help a person in the community before they hit rock bottom, but there wasn't enough BEFORE the cutbacks. We need more mental health staff in the community in the UK, and for the times when community care isn't enough, we need more mental health beds in the UK, not less. There have been around 2,000 beds cut in the past few years, even though there wasn't enough in the first place. People are being shipped all around the country so that they can have a bed. And even when a patient has a bed, the staffing level is so low that the care isn't up to standard. The nurses are sometimes doing a fantastic job, but they can't do as much as they want, because there's not enough of them. One patient kicking off can mean three or four nurses taken away from the others, which might only leave one, or even none, to help the others in the ward. What can the nurses do?

So yes, the mental health system in this country is far from perfect. But there are mental health professionals doing their best, swimming as hard as they can against the tide, but fighting a losing battle. Unless the cuts are reversed and there is MORE care in the community, MORE beds available in hospitals and MORE nurses on the wards, things are only go to remain substandard or even get worse. Nurses must surely be burning out, having to take leave for stress, or even leaving the job forever. I know of some who have become disheartened and left the job, and to be frank, I'm not surprised.

So to the good mental health professionals: Thank you for doing such a difficult job in hard times. You are doing great. I'm also sorry that there are so many bad mental health professionals that are tarnishing your reputation too. As a mental health patient who doesn't like being 'tarred with the same brush', I know that I cannot tar you good ones with the same brush as the bad ones. Please keep up your good work. My life was saved by good mental health professionals. If you keep going, you will do the same with numerous patients. You have my respect and my thanks.


  1. Yes, I agree with you: sometimes people in distress need to be medicated against their will, sometimes when no amount of talking will help because they are totally lost to the real world and they have lost the capacity of reasoning logically. Once they have recovered rational thinking though, they should always have a say in their treatment and so often that doesn't happen: then the medications do more harm than good

    1. I totally agree. Only in acute distress when there is no other way of helping should forced drugging be used. Once rationality is back, a person should have a say in their medication! For me, meds did more harm than good, but I know some who were forced into antipsychotic medication who are grateful for the intervention.

  2. The meds do not work anyway. There a waste of time. Schizophrenia should be treated from a holistic perspective. I have schizophrenia and this is the only way I could treat it.

    1. Judging by this comment, I would have to say that you didn't read this blog post fully. I have just written how a medication worked for me and possibly saved my life. This is a very generalised comment. Something that works for one doesn't work for another. Psych meds don't work for all, but they are lifesavers for others. Holistic perspective might work for some, but it won't work for all.

  3. Hello, thank you for sharing your thoughts and experiences. I am a new RN, working in a state psych facility. Last week I was involved in my first forced injection. This particular patient is very sick and very opposed to medications but still I felt quite awful about the experience. She fought hard, bit several of us, and I can understand why. I appreciate you speaking truthfully about the horrors and blessing as a patient and also being open minded enough to empathize with those who were at times orchestrating some of the horrors. I am in the USA, but it seems no one has really figured out a good system for treating mental illness and I don't think we will make good forward progress without keeping an open dialogue between the 'professionals' and the 'patients'.

    Glad you have found treatment that is working for you.