During my first admission, I was bored. Really bored. Most of the time I sat around talking to other patients. In the absence of communal seating areas not dominated by a blaring TV, we sat on the floor in the corridor. We talked about anything and nothing, watching the micro dramas that played out as ward colleagues vented their frustrations at being refused a smoke or a pair of earbuds, at finding that their phone had not been on charge after all, at being asked to provide a urine sample. I quickly learned that the only way of alleviating the boredom for even a short time was to participate in any and all activities on offer, no matter how much I might usually scorn them.
I went to music group and experimented with percussion instruments I had never seen before. I went to craft sessions, which was like primary school except we weren’t allowed scissors. On Mondays I went to a gentle cardio class, and on Fridays I went to yoga. Once I was allowed to go to another ward for Tai Chi. I swallowed my hatred of the term and went to “recovery group” (I say group, no one else turned up). When it ran, I went to “healthy snacks” which had somehow, much to everyone’s delight, morphed into decorating cookies and making milkshakes. I did try to go to creative writing but it only happened once. All of these activities were organised by the tireless Activities Coordinator because the ward was “between” Occupational Therapists.
I didn’t know much about OT as a profession before I first went to hospital. Occupation in this sense has nothing to do with paid work, but with occupying time in a purposeful, meaningful way. According to the Royal College of Occupational Therapists, OT “provides practical support to empower people to facilitate recovery and overcome barriers preventing them from doing the activities (or occupations) that matter to them. This support increases people’s independence and satisfaction in all aspects of life.”
I appreciated that there was an effort to give us some purpose, but still I was bored. I did not feel that there was enough happening to occupy us to the degree that we would be helped to recover. Mostly there was only one activity for perhaps an hour a day, although if we were super lucky there might be two; sometimes, especially’ at the weekends, there was nothing. In my view, in order to be “occupationally theraped” we needed structure and purpose of something each morning and something each afternoon. For two weeks out of the five that I was there we had almost no activities because the Coordinator was on leave. I moaned about it to Tom and at the ward forum meeting attended by the Consultant and Ward Manager.
When I was in my next unit, I felt vindicated because there I found the structure I was looking for. During my couple of weeks as an inpatient I took part in more, and more imaginative, activities:
- Singing group (twice a week)
- Spirituality group
- Card making
- Time at the gym (which was actually pretty decent)
- “Nail bar”
- Music appreciation group
- Breakfast group (where we cooked bacon and eggs for ourselves)
- Baking group
- “Giant” games (Jenga, Connect 4, etc)
- Relaxation group
I was still bored a lot of the time, but overall I felt both more occupied and more “theraped”. I went out of my way at ward forum meeting to let the OT and his assistant know how much I appreciated the range of the activities. He seemed really gratified.
When I was admitted to my current unit a week and a half ago one of the few things I was cogent enough to ask was, “What sort of activities do you have here?” “Oh, all sorts!” said the nurse checking me in. “Anything you like.” I was really pleased to hear this; I didn’t know how long I’d be in, and I knew how important it was to my recovery from a crisis to have that structure and purpose. The next day, there was no announcement or sign about activities, so I asked a nurse and was told that an OT would let patients know what was happening.
It was a short and easy message to convey. What was happening was: next to nothing. There was an OT room which was not always staffed, and I made sure that I got in there as soon as it was open. I met the OT and her assistant, and asked what there was to do. I was invited to contribute to a mosaic started by prior patients, although the OT explained apologetically that they didn’t have many mosaic tiles any more, so I might want to do some grouting (um, not really) or use some beads. It was hard to get the beads to stick in the adhesive; mosaic tiles are specially designed to adhere. I just about managed to use some alphabet beads to spell out “Quirky is cool”, which was the only vaguely meaningful thing I could think to make out of the letters I had.
I asked what else there was to do, and there were a lot of art materials, but everything was self-directed. There was no organising expertise or suggested theme to motivate the user. I grabbed some brightly coloured strips of Plasticine thinking to model some animals, but despite trying to moisten it, it was too old and too prone to cracking to be useable. I drifted away.
I did appreciate that the OTs were doing rehabilitative activities with individual patients, helping people shower, cook, etc, acquire or reacquire important living skills. They did assessments at people’s homes to see how those skills would be used in practice. A friend of mine could not wear her shoes because her feet were too swollen, and the OT assistant kindly went to her house to find her slippers for her. They were doing good work, but all with individuals.
So what did the rest of us do? Those that could, read – one good thing about the ward was the range of books. There was a surprising amount of classic Russian literature. I can’t help wondering who left that behind when they were discharged. Some people watched telly, but mostly it talked to itself, it was too difficult to find something that everybody wanted to watch. I did watch Love Island a few times, because that won the most number of votes.
In general, people were talking to each other. Yes, that’s a good thing, but it was very inconsequential because people’s stays were short and meaningful relationships were hard to achieve. The activity most commonly engaged in to alleviate the dullness was smoking. Two patients told me that they had been non-smokers when they were admitted but had taken up smoking because of the boredom. I’m pretty sure this isn’t the kind of physical health outcome the Health Board are looking for.
Without meaningful activity designed to produce a therapeutic environment, what is the purpose of a ward? It becomes nothing but a warehouse, a place to contain people until they are no longer a risk to themselves or others. That’s it. Beds instead of shelves, but otherwise just a storage facility. By day three of my admission I was desperate to leave. Not because it was nasty, the staff were lovely, with very few exceptions the patients were nice to be around, there was a lovely garden (for smoking, of course). The food was bad, but it wasn’t dire, and you got a choice. But it was so boring. I didn’t want to be warehoused. I wanted to be occupied at a time when I found it hard to occupy myself until the danger had fully passed.
I know now that when I was complaining on the first unit, I had no idea that I was actually lucky. Since tweeting about the total lack of structure on my last ward, quite a few people have come back to me along the lines of, “Sounds like the ward I was on.” This is a widespread problem. I’m going to write to the Health Board expressing my concerns that any ward should be used as a warehouse and giving my perspective on what it is like to be in a non-therapeutic ward environment. I announced this plan to my Community Psychiatric Nurse, who I think was slightly amused, but I’m very serious about sharing my views. We’re vulnerable people, we’re not boxes, and we deserve better.