June 27, 2020

What it’s Actually Like Working in a Mental Health Hospital.

On the eve before my internship, my fiancé and I sat down for dinner.

I pulled out my phone and checked my bus route to the hospital for the 10th time, making extra sure I got it right.

My fiancé glanced down at my phone and then looked out the window, “Wait a minute, I think that building over there is your hospital. Here, let me see the map.” I handed it over and sure enough, the massive building in perfect view of us was the hospital I would be interning at. Ever since we moved into our apartment four months prior, we wondered what that building was. It was so large, secluded, and surrounded by trees, we assumed it was some elite private boarding school. What a strange coincidence, I thought.

The next morning, I arrived at the hospital exactly as planned. I’d only ever spoken to my mentor over the phone and wasn’t sure what she looked like. I pictured someone artsy and eccentric, my idea of a stereotypical Art Therapist. I wandered around the cafeteria until I saw an unsuspecting woman sitting beside a trolley of art supplies. That must be her, I thought. She had short jaw-length hair, black-rimmed glasses, and a collared work shirt. I took a seat at her table and we chatted briefly about my bus ride in. She checked her wristwatch and informed me that we had exactly 12 minutes before we needed to head upstairs for the staff meeting.

She looked at me and spoke decisively, “For the next two or three days you’re going to be my shadow, so just watch and observe. You need to understand that you’re not here to fix, save, or solve anyone. Your job is to help facilitate a small section of their therapeutic care program. Once you leave the doors of this hospital, these patients are no longer in your care.”

I followed her as she used her keys to unlock a maze of hospital doors. Each room had two steel doors that had to be locked behind us before the others would open so I literally was stuck to her side. We entered in a boardroom with the psychologists, social workers, dieticians, and counsellors. The head of the department sat at one end of the table holding a sheet of paper with a list of patients and their conditions. She read them out and then proceeded to give out orders to each person like it was an army drill. One by one, everyone rushed out the door.

That day did not go according to plan, not for anyone in that entire hospital. Of all worst-case scenarios I could’ve imagined, this was so much worse—and that says a lot. We had just finished lunch and were on our way to the public ward. My mentor asked me to wait outside with the trolley while she went to the bathroom. The middle of the hospital is a large empty space like an atrium. No matter which floor you’re on, you can look down into this huge empty space. The first thought that strangely entered my mind was how easy it could be to jump off. I then noticed a bunch of people on the floor below me gathered around near the ledge. This was the maternity ward, and I figured there was a complex pregnancy, maybe the nurses wanted to debrief outside the room to protect the mother.

I walked closer to the ledge, peeked my head down, and saw a white cloth with police circling the area. They were looking up at me with walkie-talkies in their hand. Hm, that’s odd, I thought. Just then my mentor stepped out of the bathroom, and we started walking to the public ward. As we were about to open the door a receptionist came running toward us looking panicked, “Did you guys hear?! Some guy jumped from oncology!”

What I’d seen moments earlier was in fact a man’s deceased body being covered by police. I cringed, how could this be? Before we entered the public ward, my mentor turned and looked at me. “Look, we need to let that go now. I know it’s terrible but we need to be of service to the people we are seeing, so try to release that out of your mind.”

I was in a state of shock but I wanted to prove to her that I was capable. My mind kept spinning with thoughts, “Is he actually dead? Did I just see a dead body? Is this actually happening?” We entered the ward, and I helped set up the space with essential oil, music, and art supplies around the table. I opened the door and a woman with missing teeth and dishevelled hair came in. She knew my mentor as she’d been through the ward a few times before. They spoke briefly, asking how things were since they last saw each other. We encouraged her to do some art so she picked up a pastel and spent a few minutes wildly scribbling on a piece of paper.

When she was done, she held it up like a little kid with a big, toothless smile. My mentor asked what it was about, and she explained that it was Adam and Eve, they had reincarnated on planet earth. She continued talking about how and why this was true as my mind broke off from the moment and began obsessively thinking about this man who had jumped. I was no longer in the room with them, my body was there but my mind was gone.

What surprised me most about this event was that I somehow survived the terror of it. It felt like some sort of conspiracy against me, like the universe was saying, “You think you can handle working in a mental ward? Here, take that!” Every detail about that man’s death stuck to my mind for about a month. It was all I could think about. But through more therapy and self-care, I did eventually recover.

As much as I’d like to say this was the worst experience and it was smooth sailing from then on out, there were several more than shook me to my core. Nothing was as dramatic and shocking as my first day, thankfully. But it was painful to experience these triggers that have laid dormant for many years. It forced me to uncover deeper areas of my mind and heart that still need healing.

The patients I saw ranged in ages from 13 to 80 years old. The most common mental health conditions were borderline personality disorder, major depression, bipolar disorder, and a range of anxiety disorders. Most of the people I met appeared completely healthy and well-functioning that I sometimes forgot we were in a mental ward. I’d often have to look for their wristbands to see if they were a patient and not a visitor.

It surprised me how insidious a mental illness really is, it can fool everyone around them into believing they are completely fine.

During my first week of shadowing, we visited the private ward. This ward usually holds people for a longer period of time and has more strict requirements of patients. For example, in order to leave for a smoke break, they must take part in one or two group therapy exercises per day (mindfulness training, dialectical behaviour therapy, creative therapies, etc.). Essentially, it’s the only group in the ward where we can do a full three-hour art therapy program that dives deeper than colouring and drawing together.

One day while setting up, I noticed an older man in his late 60s who was diagnosed with major depressive disorder. It was unbelievable to see how physical this mental illness had become. The depression wore him like a heavy cloak, his whole body visibly sunk under the weight it. With a group of about 10 other patients, my mentor and I did an art exercise around a boat at sea. We led them through a visualisation meditation and then asked them to draw what came up. One by one, everyone shared an image that was as different and unique as they all were. This man had drawn a realistic fishing boat sinking in a stormy ocean underneath a black, stormy sky. When it was his turn to speak, he shrugged and said he didn’t have much to say about it. He didn’t need to, so much was already said.

I spent a few shifts at the start of my placement working in the elderly ward. During this time, I met a woman who was notorious for her detailed monologues. As soon as we opened the door, she’d plonk herself down and go straight into a story about her life as if she was presenting to an audience. It would start off innocuous and then quickly delve into the details of a traumatic experience. In group work, I learned it’s important to harness people in so they don’t describe horrific memories that vicariously traumatise others in the group. It’s difficult to balance creating a space for nonjudgement, openness, and refuge, but to also gently divert when things go too far.

The first time it happened, I noticed the rest of the group members cast their eyes down while others left the room. Despite what felt like complete chaos, I noticed another older woman in the room sitting alone completely unfazed by everything going on. My heart felt tender as I watched her arthritis-ridden fingers try to clasp the paintbrush and move it across the paper.

As my mentor tended to the other woman, I walked over and sat beside her. Her picture was a beautiful abstract painting with bright, happy colours. I genuinely loved what she did; it surprised me how good it was. I wondered if I should say anything but was afraid to say to the wrong thing. We sat silently until eventually, I spoke, “I love the colours you’ve chosen; it makes me feel happy looking at it.”

She looked up at me and smiled, “I always seem to paint joyful, bright things,” her smile fading, “I don’t know why, really.” She told me she used to be an artist, but ever since her husband died, she stopped painting. I’d learned in her case notes that her husband died suddenly in a car crash and her only son was a drug addict.

She was alone at home for a few weeks, overcome with grief, and admitted herself into the hospital. She had long, silver hair, which was partly tied up in a bun, the rest cascaded down her bony shoulders. She was soft-spoken and had these beautiful big brown eyes that held depth and warmth.

On one of our last times together she revealed to me that she used to be a mental health nurse. I wondered how that must be, to be on the other side. She smiled and said, “I remember being there for all these people, and now here I am, just another crazy patient in a mental ward.”

The crisis unit is reserved for younger patients who have harmed themselves or are at immediate risk. It’s served as a type of holding tank until a decision is made on their case to go to another ward, a specialist hospital, or get released. This was the ward I was most fearful of, especially since I’d heard of patients lunging for the art supplies to self-harm.

Before visiting any ward it’s good to have a read the case notes just to get an idea of the scene you’re entering into. But for the crisis unit, each patient’s notes needed to be thoroughly read. Depending on who was there, we’d only bring in a few pieces of paper and a handful of pastels. The crisis unit usually holds about five to six people at a time but on this occasion, there was only one person, a 13-year-old girl. I felt tense reading her case notes before seeing her. She was not as high-risk, so we decided to bring our whole art trolley.

My mentor and I arrived and set the scene as usual: putting out a tablecloth, plugging lemon myrtle essential oil, and playing relaxing music. The girl peeked out from her room, looked down at the art, and smiled at us shyly. She had long black hair and a friendly face. Her tiny waist was accentuated by a tight, plastic brace for scoliosis. She was really just a kid, and it broke my heart to see her here.

“Come join us!” My mentor welcomed, pointing toward the table. We all sat together and started doing some watercolour of clouds at sunset. Patients are often quizzed relentlessly about what they did, how, and when, that the simple act of silently painting together can be an incredible relief for them. The girl told us how she loved doing art and wondered out loud about why she doesn’t do it anymore. Her whole energy changed as she painted—it was like she opened up and bloomed before us. She started talking more and more about random things in her life and even making jokes. My mentor mentioned that she used to do calligraphy and the young girl perked up,

“Oh my God! I’ve always wanted to know how to do calligraphy! Could you show me?” With a fresh piece of paper, my mentor showed the girl how to write her name, letter by letter. I sat back and watched the two of them. It was so peaceful that for a moment, I forgot that we were in a mental ward. It felt like we were lifted away from all that, it was just us and art. I wondered if it was like that for this girl too.

When our time was over, the girl got up to leave, thanking us profusely. In one of her art pieces she had written a poem in calligraphy, so we asked if she wanted to stick it to the wall. “Okay…” she said as she taped it. “This will be a nice thing to read for the other people who come through here!” She pronounced. Indeed, it was. Long after she left, I’d find patients looking up at her art stuck to the wall.

In the public ward, I met two people who later ended up doing a longer stay in private together. These two had a great dynamic; it made me want to write a TV series about the real life inside a mental ward. Except instead of being sombre, it would be cynical, intelligent, and funny.

They both had a wicked sense of humour, and I couldn’t help but enjoy being around them. She was a short-haired, well-read feminist and he was a blonde-haired, well-travelled surfer dude. They were both in their early 20s and the only thing they really had in common was the fact that they were both in a mental ward together. I enjoyed seeing them because they were open to new ideas and genuinely wanted to get better.

On the first day I met them, we did an art session around which animal they identify with and why. The girl chose a crayfish, of all things, because she thought they were cute and used to have one as a pet. The guy chose an elephant for intelligence, strength, and for the loyalty he wished he had. I’d read in his notes that he was schizophrenic and believed his mum was a secret spy out to kill him. I had to reread the name and case notes to make sure it was the same guy; it was like he was a totally different person in front of me.

The experience of working in a mental ward caused me to look at people in a different light.

Being in that hospital was like getting a glimpse of the underbelly of human existence—the part that society hides away in fear. Yet being with people at their lowest allowed me to see them beyond all the masks and superficiality of life. They showed up in blinding vulnerability, and I couldn’t help but love them for it. Their rawness and authenticity was just so beautiful. It felt like they revealed their soul to me and it was like watching diamonds glimmering in the sun.

It’s so rare, but so wonderful to see.

The most important thing I learned was that things don’t necessarily need to be grand and extravagant in order to make an impact. Often it’s the littlest things that make a difference. I now see the value of one small moment. One pause of silence, one paint stroke across a blank page.

It’s the little moments, after all, that add up to one life. It’s those little moments that count.


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