Service Users’ Experiences of Involuntary Hospital Admission Under the Mental Health Act 2001 in the Republic of Ireland
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Results
Participants’ Demographic Profile
Characteristic | N | % |
---|---|---|
Sex | ||
Men | 29 | 58 |
Women | 21 | 42 |
Age | ||
Men | ||
18–24 | 2 | 4 |
25–34 | 6 | 12 |
35–44 | 10 | 20 |
45–54 | 6 | 12 |
55–64 | 5 | 10 |
>65 | 0 | — |
Women | ||
18–24 | 2 | 4 |
25–34 | 4 | 8 |
35–44 | 7 | 14 |
45–54 | 3 | 6 |
55–64 | 2 | 4 |
>65 | 3 | 6 |
Type of involuntary admission | ||
From the community and detained (Section 14 Form 6 completed) | 37 | 74 |
Originally a voluntary admission (Section 23/24 Form 13 completed) | 7 | 14 |
Held in the approved center for 24 hours but not found to meet criteria for detention | 6 | 12 |
N of previous detentions under the MHA 2001 | ||
0 | 24 | 48 |
1 | 9 | 18 |
2 or 3 | 7 | 14 |
4 or 5 | 5 | 10 |
6 or 7 | 2 | 4 |
8 or 9 | 1 | 2 |
10–15 | 0 | — |
16 or 17 | 1 | 2 |
Diagnosis | ||
Nonaffective psychotic disordera | 26 | 52 |
Affective psychotic disorderb | 16 | 32 |
Alcohol use disorderc | 3 | 6 |
Otherd | 2 | 4 |
No diagnosed disorder | 2 | 4 |
Diagnosis not available (no permission to access clinical notes) | 1 | 2 |
Themes
Quote # | Quote |
---|---|
A1 | So, and then for me to have the arrival of these people [admission team] at your door to take you off is very hard. . . . Like you can't even control your own house any more. (Female, age 41, ID3) |
A2 | It’s [being detained] very bizarre. It’s very frightening. . . . You’re very confused, and you want to sort of stand up and try to defend yourself, but you know that it’s pointless, because you’re surrounded. They [admission team] had me ambushed, surrounded [in own home]. (Female, age 46, ID44) |
A3 | I went to the door with the phone still to me ear, opened the door. [Name] was standing there, my ex, and there was, I don’t know, maybe three men and a lady, maybe four. I don’t know. . . . So, I said to my mother on the phone, “Oh my God, I said, the cavalry is here.” (Male, age 47, ID14) |
A4 | He [the general practitioner] was basically telling me to go to hospital. He didn’t give me any choice. He didn’t say anything about medication, about counseling. He just said, “I think you should go to hospital.” I just went along with that. I don’t know why I did. I was in shock. I’m still in shock in a way. (Female, age 36, ID41) |
A5 | They [admission team] came into my garden where I was working. I heard my dog barking. I came in, three of them and this woman and I didn't know [if they were] politicians or what they wanted, and they showed me the cards [ID] and said they were from [the National Admission Team] whatever and they had to bring me into the unit [hospital], and I said to them I had responsibilities, that I couldn't just go like that, but they didn't . . . they weren't interested. (Male, age 56, ID23) |
A6 | There was one [police] who came into the restaurant but there was another two accompanying him and then they brought me in the car back to the station. [Interviewer: And what did they say to you? Can you remember?] Response: Just that I had to come with them, and I knew if I didn’t they were going to get assertive. So, I left with them, and when they got me in the [police] car they kind of put their two hands on both my arms so I was kind of held down so I knew I had to go with them. (Female, age 46, ID44) |
A7 | I came in by the Guards [Irish police], yes. They came into the pub and took me out. (Male, age 49, ID2) |
A8 | Suddenly a woman called [name] came into my room, and then a few men followed her, and they just dragged me. Like, they took my wrists and ankles and just pulled me down. (Female, age 30, ID19) |
A9 | At that stage, I almost felt like I was violated. I think that was one of the words I used, that I was basically, like, taken. Someone [admission team] came to my house, came into the house, and then said, “You’re coming with us. We want you to come,” but [pause] it’s always that “but” and that sort of silent threat, that sort of coercion. (Male, age 47, ID14) |
A10 | They [admission team] come in and say, “If you don't come with us, we'll get the Guards [Irish police] involved and we'll put handcuffs on you and bring you.” This kind of thing, and they actually did that once. (Female, age 41, ID3) |
A11 | I suppose when you're involuntary, having that sort of label on you and knowing that you're trapped there [in the hospital]. . . . feel very much like you've had your human rights taken away, you feel imprisoned, and you kind of feel, as I said before, a second-class citizen (Female, age 33, ID24) |
A12 | I just wasn't respected, and I was in prison, and I was forced to do whatever they asked me to do, and if I don't, then they would take my light away or they would take my mobile phone away. (Female, age 26, ID48) |
A13 | I just felt I hadn’t any control of what was going to happen with me, how long I was going to stay in [the hospital] or anything. I think they [treatment team] had the decision made up already beforehand and that was it. Even if I was progressing in my health as the days went on, they wouldn’t release me. (Female, age 24, ID9) |
A14 | Well, I preferred the [name of a drug] over two weeks, but then when it was changed I went through every drug on the market, and now we finally found [name of another drug] which Dr. [name] wanted me on in the first place and wouldn't let me leave hospital without me going on it. So, I was beaten into it in the end. (Female, age 41, ID3) |
A15 | Hospitals grind you down. You're just ground down into nothing until the doctor feels that you're supplicant or whatever the word is. . . . Until you're nothing, until you agree with them. So, the doctors will keep you here until you agree with them. They break you down like that. (Male, age 32, ID12) |
Quote # | Quote |
---|---|
B1 | No, nothing was explained to me. . . . No, no one even said where my family had gone to, you know, why was I even in there [hospital]? . . . I didn’t realize until I was, I suppose, in the vehicle on the way going down there [to the hospital] and even at that stage I wasn’t even sure where I was going. (Female, age 20, ID40) |
B2 | No [response to question about being provided with information], not really. I did. I knew I was in hospital. I had done the interview [with the psychiatrist]. I wasn’t quite sure why I was there. I was saying, “Why am I here?” You know, because I believed I was fine at the time. I wasn’t quite sure why I was there. (Female, age 46, ID44) |
B3 | My dignity and respect weren't, if you like. . . . They were only interested in doing their own work. They didn't take my considerations into account at all, or they had no interest. I told them that I had my animals, my feed, and all this. They weren't interested. They didn't want to hear it. (Male, age 56, ID23) |
B4 | He [psychiatrist] spoke down to me. I said, “I’m going home full-stop.” He said, “Oh no you're not.” I needed compassion at that time. I needed him to say we're just going to try and help you. Let's see how it goes. “Oh no you’re not. I can tell you you're not.” [emphasizing the demand of the doctor] In that tone of voice. (Female, age 56, ID20) |
B5 | I was given no notice of anything and told nothing. Not prepared [for the tribunal], didn’t even know the solicitor was coming. . . . I was just sitting down on the chair beside the bed relaxing, when in comes this man and he said, “I’m your solicitor. I’m going to represent you at the tribunal,” and I said fine. He introduced himself. Sure I didn’t know what was happening, [name] about tribunals. . . . the day that the independent psychiatrist arrived, I never knew he was coming either. Never told, had no time to prepare. Went inside to this doctor, never saw him in my life before. He told me he was from Dublin and that he was the independent psychiatrist, and I asked him would he be present at my tribunal and he said he didn’t know. (Female, age 60, ID30) |
B6 | I don't know. I think I was told what it [the tribunal] was for. I was never asked to go to the tribunal or whatever. I don't understand what the tribunal was anyway. (Male, age 23, ID37) |
B7 | I kind of got the feeling that, you know, sort of medics [doctors] stick with medics, as it were, and in tribunal situations . . . you kind of get the feeling that they would take the medics' view over the patients' view, because they are medics and it's a medical situation. Maybe you know they’re not really listening to the patient. (Female, age 33, ID24). |
B8 | I don’t really get to say anything in there. So if I go to say anything, Dr. [consultant’s name] will butt in and . . . and you felt like you didn’t get a chance to say anything only what the solicitor said. (Female, age 68, ID4) |
B9 | I was sure that someone I knew would come and help me. Trying to find a voice, like, I remember lying down on the floor, all the men [members of the assisted admission team] pushing me down, and I was trying to find a voice I could recognize, someone I knew to say, “Please, help me. I haven't done anything wrong.” (Female, age 30, ID19) |
B10 | So, I kept getting these letters [about the tribunal] then, all the time getting these letters. I’d come back from lunch, and there would be a letter on my pillow, which was very annoying because there was no one to talk to about it. (Female, age 60, ID30) |
B11 | They could at least have someone there to explain things a bit better because you don't get a good explanation about it [role of the tribunal]. You get told that you’re going involuntary and that’s it. You've no opinion like. In this day and age, I just felt that was wrong. . . . Just to have someone there to explain things a bit better really. At least that way then you know what's going on. (Male, age 23, ID37) |
Quote # | Quote |
---|---|
C1 | Leaving the hospital . . . that's even worse, because that's when the trauma comes in and the fear comes into your normal life. You have to go to work and keep living this like big trauma caused by these people [involved in involuntary admission experience], and this trauma is the one that's going to cause more severe and more problems. (Female, age 30, ID19) |
C2 | If I didn’t have those [outpatient appointments and group sessions], I would have been a hell of a lot worse, because, as I said, when I came out of here [hospital] I felt I needed more therapy than when I came in. You know what I mean, I felt there were more issues because it was something that, you know, it [experience of detention] was like a nightmare. (Male, age 47, ID14) |
C3 | So, when I came home into my own environment, it was like then I had to go through posttraumatic stress of being in the hospital, and within a few days I did bring terrible anxiety over me. . . . I just went through a period of horrendous anxiety. (Female, age 56, ID20) |
C4 | It was really traumatic. I have nightmares about it [being restrained]. . . . Then sometimes I wake up in the middle of the night screaming. It was the most traumatic and stressful experience, so it's like it left a scar in my past, and it's now sometimes I get repeated thoughts about it, and then it's like flashbacks. (Female, age 26, ID48) |
C5 | Well, then I started going back to my room trying to sleep and that was this place where people [admissions team] handcuffed me, treated me with so much aggression. I couldn’t sleep. I had lots of fear in my own room because of them. . . . I just kept remembering all that happened and all they did to me, and I just couldn't feel safe. I couldn't feel safe in my room. I couldn't feel safe in the world. Because you have to feel maybe they can come in again. I mean you just don't feel safe like. Like, if that happened one time, it could happen another one. Like, fear of something could happen. (Female, age 30, ID19) |
C6 | I suppose it’s the fear of the reoccurrence of it [involuntary admission]. The fear of the fact that this abuse or whatever can happen again. That other people can decide how well I am without me expressing it. Other people can take charge, you know. (Female, age 40, ID22) |
C7 | So, I seen this van [similar to the vehicle used for transporting the person to hospital] turning down the drive, and I’m thinking to myself, I’m actually trembling inside. I froze thinking hang on, this van is coming to take me away. That’s just the way I felt. I still wasn’t inside my door, and all of a sudden there was a van turning down toward the house. It didn’t come into my place. It went next door, but it was just that feeling, you know? I remember feeling that cold feeling of hang on, you’re still not out [of the hospital]. (Male, age 47, ID14) |
C8 | I felt I couldn’t actually say anything ever again without it being taken the wrong way. (Male, age 47, ID14) |
C9 | My husband thinks I should be back in here after a weekend out because I was quiet. . . . I didn't want to say anything and be back there [hospital] again, you know. (Female, age 42, ID16) |
C10 | I don’t trust my own thinking. I don’t feel capable of making decisions because I’m unsure of whether it’s right or wrong now, as where before I trusted my own gut instinct. . . . That for me has gone now. I’m uneasy most of the time. (Female, age 40, ID22) |
Quote # | Quote |
---|---|
D1 | I suppose it started off with the Gardaí [Irish police], and they took a very caring attitude. They seemed concerned. . . . When I got here [hospital] then, it was the nurse that actually brought me in, that kind of ran me through everything that kind of signed me in to the ward. It was caring as well. She was actually talking to me. . . . I just think that engagement in itself helped relax me. (Male, age 37, ID5) |
D2 | To be honest, it was just like me walking in myself. That’s how it felt. It didn’t feel bad. It really didn’t, in fairness. I was treated just like any other person that would walk in off the street, I’d say. They weren’t bad-minded to me or talk down to me or, they just treated me like a normal person, which was good, you know. (Female, age 44, ID50) |
D3 | And then she said, “If you ever need to talk, just get the nurses to get me, and I’ll talk to you.” . . . She’s very down-to-earth. Very civil and everything. . . . Because she’d talk to you like she was a friend of yours. (Male, age 47, ID33) |
D4 | And they’re willing to listen, and even though they go by the book as well, they’re willing to adjust. (Male, age 39, ID29) |
D5 | No, I was given plenty of information [about detention]. I had somebody come to me and talk to me. They gave me the mental health booklet. Somebody talked to me about the tribunal. Nurses came over to me regularly and asked me what was going on. They were very insightful at the time, I found, regarding what was happening to me and what would possibly happen next. (Male, age 37, ID5) |
Feeling trapped and coerced.
Lack of informational and emotional support.
Admission-induced trauma.
Person-centered encounters.
Discussion
Conclusions
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Cover: Still Life of Fruit, anonymous, circa 1865. Gift of Edgar William and Bernice Chrysler Garbisch, National Gallery of Art, Washington, D.C.
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