LIVED EXPERIENCE
Contrasting settings and their differing impact
Katharine Lazenby has extensive ‘lived experience’ as a mental health service-user, having, in her 20s, been admitted to inpatient facilities 10 times over a 13-year period. Now firmly on the path to recovery, she works to help others with mental ill health get better, feel more ‘in control’, and regain their equilibrium. In the first half of a two-part article, The Network’s editor, Jonathan Baillie, discusses with her some of her own service-user experiences, and how they have informed her views on ‘what can be done better’.
Katharine Lazenby, who gave an impassioned and highly memorable address at last year’s Design in Mental Health conference, vividly recounting some of her experiences as a service-user, and how they made her feel, met up with me recently in London for an interesting hour’s chat. During our discussion we focused both on her own various periods in mental health inpatient facilities – in her 20s one psychiatrist noted that she had spent more time in such care than at home – and on some of the positive work that she is now doing to help others with mental ill health recover.
Growing up in Hackney in East London, she had, she said, ‘probably been a pretty anxious, and at times depressive, person for as long as I can remember’. She explained: “My mental health started becoming more of a problem when I was studying for an English degree at Cambridge University. After two years of a three-year BA Honours course, I had a breakdown. I think a mixture of factors – including being away from home, and the pressure of study – were too much, and I was first admitted to a psychiatric hospital in north London aged 19; I was there just over a year.” She was subsequently admitted to the same hospital and ward 10 times over the next 13 years. “My experience there was pretty mixed,” she explained. “Initially, you just go with what is there; you don’t know any different. The hospital was a pretty old and dilapidated hospital site in north London. My 15-bed unit was on a long corridor with single rooms, shared bathrooms and dining rooms, and a communal lounge. The rooms were ‘OK’, but the place was very institutional. I saw it change considerably over the years. “
Ever-more stringent guidelines She continued: “Ever-more stringent CQC and other regulations increasingly shaped the design there, with anti-ligature furniture replacing the previous soft furnishings. If anything, this made the hospital feel more institutional, but to be honest, these
THE NETWORK | JANUARY 2020
Katharine Lazenby explained that her mental health ‘started becoming more of a problem’ while she was studying for an English degree at Cambridge University.
inpatient facilities always do. Although the design in many mental health inpatient facilities has significantly improved in recent years, the institutional feel has, if anything, increased, because – for example – everything is now ‘wipe-clean’, the furniture is nailed to the floor and ‘tank- like’, the wardrobes have sloping roofs, and the mirrors are all plasticky. The windows will barely open, and feature a strange mesh, which dilutes the sunlight.” Katharine Lazenby described her first inpatient spell as ‘pretty traumatic’. She said: “Effectively having your liberty taken away is very difficult to deal with. You’re in an enclosed environment, with all your autonomy removed; you even have to ask to use the toilet. Indeed, you need permission to do anything. Something as simple as that can become a real point of conflict; no one would have a key, or you couldn’t find a staff member with the right one. All the negotiation about access becomes a battleground. The ward doors are locked. There is constant debate as to when you can go out.”
Very limited access to the outdoors In fact, there were just two points in the day when one could go outside for walks. Katharine Lazenby said: “Outside those points – 10.30 am or 3.30 pm – you couldn’t go out. There were some views, but we only had small windows, and yellowing walls. The bedrooms were a decent size, but you could only open the windows a tiny crack, due to their restrictors.” At the north London hospital, the service-users were aged ‘from around 18 to over 60’. She said: “At times the noise of other patients having a really hard time could be difficult; you tended to lock yourself in your room to try to block it out, but you also wanted to know what was happening.” I wondered how respectful the staff had been of the service-users. Katharine Lazenby said: “It was a real mixture, but there was sometimes a bit of an ‘us and them’ feeling. I got on enormously well with many of the staff though. Many of the female nurses were very motherly and warm, and my consultant psychiatrist was great. I think, however, that a number of staff were not very well equipped to deal with our frustrations, were a bit ‘worn out’, and wouldn’t now be considered very forward-thinking.
‘Quite defensive’ in approach “They were often quite defensive when conflicts occurred,” she added. “If somebody mentally unwell becomes frustrated, confrontational, and aggressive, because they can’t get outside, surely responding in kind is not the answer? Instead, have some compassion for them perhaps needing a breath of fresh air, maybe bend the rules, and let them have five minutes outside. I think much of the conflict and tension could have been avoided with a bit more flexibility and understanding. If you’re caged in, you behave uncharacteristically, because it’s an unnatural setting. Inpatient spaces need to be healing places, where people return to ‘’normality’ and stability, but actually they can be places which force us into a very extreme and unnatural situation, and bring out unnatural behaviour. I behaved in ways
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