By Blogger, posted on 10th November 2013
The 2nd episode of Bedlam, channel 4’s fly-on-the-wall documentary series, follows the work of Lambeth Hospital in South London, a vital A&E triage service for mentally ill patients in crisis. South London and Maudsley NHS Trust (SLaM) has pioneered the use of short-stay emergency wards for patients in crisis.
Before reading this blog article about the programme, if you haven’t yet seen the episode, you can view it on channel 4’s catch up service 4oD (note this article contains spoilers): http://www.channel4.com/programmes/bedlam/4od
One of the patients featured in the episode is 45-year-old Dominic, a creative director of an IT company and father of four who was found at home by his family after taking an overdose. Dominic represents one of the most high risk groups in the UK for suicide risk (middle-aged men), and so the programme gives unprecedented insight, as we get to witness Dominic’s harrowing time in crisis following being admitted to the ward and we are provided with the opportunity to gain further understanding about mental illness.
I think one of the things which is particularly ground-breaking about the programme is we see Dominic at various points during his crisis as it unfolds: his reaction to trying to make sense of the turmoil in his mind, his feelings of anger at the threat of sectioning after he later admits himself voluntarily back on to the ward, the extremely difficult dilemma the staff are faced with when deciding whether or not he can be discharged, and not forgetting the devastating impact his illness and suicide attempts have on his family.
We also get to see the impact of the ward environment. Dominic is able to interact with Rupert, another patient on the ward who suffers from Bipolar affective disorder, whose behaviour can sometimes be challenging and threatening. In this case, Dominic and Rupert form a heart-warming friendship, but it is clear to see how anxiety-provoking such an environment can be. Following admission, patients have to try and make sense of, and come to terms with their own illness, its impact, and how they ended up in hospital, which must be difficult in itself, let alone to find themselves in such an alien and sometimes visibly distressing environment, where they may witness staff needing to restrain patients and where they may also encounter patients who are aggressive or display other threatening behaviour.
The staff have to deal with incredibly difficult and challenging situations on a daily basis, with “beds at a premium”. Dr Baggaley, who is a consultant psychiatrist and also Medical Director of the Trust, regularly assesses patients: “Here there is a particularly high level of decision-making. We have 18 beds, there’s a fast turn-over. We might be making 50-100 important decisions a week and they affect people’s liberty, they affect people’s safety, they affect public safety.”
In relation to the agonising decision as to whether or not to discharge Dominic following his admission, Dr Baggaley says, “Sooner or later you have to make a decision and you don’t always get it right. You have to trust people. If you never trusted people, you’d never let them out. We haven’t got space for them. And ultimately, what I always say is, if you really want to kill yourself, you will kill yourself”. There’s no doubt that Dr Baggaley would not take a decision to discharge a patient lightly and that the decision-making process itself, is not straightforward, but I can’t help but consider the apparent contradiction of the statement.
I would argue that the majority of people who kill themselves or attempt suicide are desperately trying to escape the unbearable suffering they are experiencing rather than actually wanting to kill themselves; their judgement is clouded/impeded by mental illness in such a way that they are convinced it would be better for all concerned if they are no longer alive, or they simply cannot see a future. Suicide ultimately goes completely against the grain of human nature; our innate instinct for survival. That is why intervention is so powerful and arguably, essential as it can be life-saving. By assessing patients and providing a safe environment, it buys the patient critical time and provides the opportunity to start treatment. I think we need to crush the belief of thinking that ultimately people who are suicidal will kill themselves if they really want to, because with the right intervention and help, recovery is always possible, with which the programme helps demonstrate.
I think what Dr Baggaley’s statement does raise, however, and most likely what is intended, is that sadly you can’t always foresee what will happen next, and therefore, it’s not always possible to prevent tragedies from unfolding, particularly if a patient is particularly determined to take a cause of action, which reinforces the enormity of the extremely difficult decisions the staff face and that they have to do everything in their power to minimise risk and act in the patient’s best interests to provide a duty of care with the means in which they are able. As voiced in the programme, risk assessment is not an exact science. To complicate things further, just as Dr Baggaley talks about the need to trust the patient, that trust needs to work both ways, which is highlighted by Dominic’s anger and fear following the threat of a section 5(2) to keep him in hospital following his voluntarily admission: “I had that dream, about being trapped in here, indefinitely; at which point I woke up gripping the blankets, sweating and shaking.” It’s hard not to ask the haunting question as to whether what happens next in the programme is avoidable? Would Dominic have felt able to re-admit himself voluntarily prior to the overdose as he had done previously if he hadn’t been confronted with the fear of being sectioned? Or is that too many ifs? They are certainly difficult questions to ponder.
In addition to the programme challenging stereotypes, and raising further awareness about mental illness, I think the programme also goes some way to challenging the stigma surrounding personality disorders, as we later discover Dominic has been diagnosed with one. It makes you wonder what viewers’ reactions would be if that was the first thing that was disclosed in the programme. The personality disorder label is another issue altogether as there is still so much controversy that exists, as they are seen as an entirely different classification to mental disorders. The personality disorder label is also often seen as a diagnosis given to patients who are difficult to treat or those considered particularly complex. Regardless of one’s beliefs about Dominic’s diagnosis, I think what was so enlightening about the programme is the way it attempts to capture patients’ journeys from crisis to recovery. As Dr Baggeley’s movingly comments on the programme series in an interview in the Guardian:
It follows people on a journey to recovery, which is something that we don’t see nearly enough of in the media. People can be reluctant to seek help for a mental health problem, or even to talk about it with their family and friends, because of the stigma and discrimination that is sadly still too prevalent in society.
With the impact that mental illness has on society and high suicide rates, it is vital that people suffering from mental illness get the help and support and timely intervention they need, including access to a safe and therapeutic environment and therapy services to give the patient the best chance of recovery.
Find out why Dominic decided to share his story and more information about the programme: