Stuck or About to be stuck in a UK Psych Ward and Feel You’re There Unfairly? Find out the Real Routes.

First, before you are admitted…

• Learn about the Mental Health Act 1983 and 2007 (MHA), Mental Capacity Act 2005 (MCA), The Human Medicines Regulations Act 2012, Regulation of Investigatory Powers Act 2000, and Housing Act 2004, Human Rights Act 1998
• Also, the following International laws, which are required to be implimented in domestic legislation by the UN (mental health is international): CRPD 2006, UDHR 1948, Vienna Convention Law of Treaties 1969
• Contact Crisis Resolution Team or out-of-hours AMHP (via 111) preemptively
• Persist with short, focused communications to manage concentration issues
• Ask 111 and any existing care providers what the problem is
• Prepare tools to keep a log of actions and collect as much evidence as possible (like a phone, or notepad, and postage stamps) there is no need to make this obvious
• Prepare clean clothes and a suitcase with snacks and hospital safe essentials and have this ready if they attempt to enact a warrant (it will be searched, and valuables can sometimes go missing)
• If they enact a warrant, do not panic, you are required to open the door, but not to comply, they will most often force you if you don’t comply, and this can be sudden and physical
• You should be allowed time to pack (it is much easier if you can carry it yourself easily)
• You should be allowed to see the warrant, and know the risks they used to obtain it, otherwise simply ask their reasons
• Ask the police to record the visit (you can request this video under GDPR)
• You might want to just go with them (sometimes they will assume you are paranoid if you insist on your right to confirm their identity)
• If you have a recall notice, make sure you request the actual risks it is based on, generic symptoms are not always risks

Immediately upon arrival…

• Do not be alarmed by the unusual architecture
• Challenge the Section or CTO Revocation grounds in writing to hospital managers immediately (email form T111 to [email protected] to invoke a tribunal yourself or use a solicitor)
• Explain why your life is viable as an independent individual
• Explain that you meet all legally required social needs
• Try not to become desperate or stressed (this can be difficult because of their culture, you are not required to agree with them, and they cannot define how you feel about what they think)
• Make certain that the doctors and staff know that you would leave if you could
• Attempt to get HCAs, Nurses, and Doctors on your side (start by introducing yourself)
• Attempt to keep close family and friends outside the hospital on side
• Demand written confirmation of Section or CTO Recall from your Responsible Clinician (RC) or Approved Mental Health Professional (AMHP)
• Request a full list of all symptoms and risks they claim you present at the time of detainment, require an accessible explanation for each symptom or risk
• Get these lists on paper or digitally so that you can easily save it, photograph them and back them up, paperwork can go missing
• Request an urgent meeting with the RC/AMHP to contest any entrapment or misleading actions
• Use your mobile or the ward phone to contact your family and friends, ask if they would like to visit if you want them to (too many people visiting can be unusual in a ward environment)
• Ask for a pen and plenty of paper if you don’t have these
• Ask if you can keep using your phone and laptop, or start using these again ASAP if they attempt to prevent access to them
• Do not show them unimportant threats you have received or “weird” things
• Read all the literature on the displays on the wall
• Be aware many hospitals have emergency medical helicopters that land on helipads sometimes near mental health units, and this can be loud

• Notify the doctors about work commitments and request Section 17 Leave if required to attend work
• Sleep and enjoy the free food if you can, talk with others for context, and make sure you are comfy

• Ask your nearest relative to discharge you

Within the first few days…

• Ask for verbal explanations for symptoms and risks (ask the nurse to ask the doctor, and persist in a thouorgh followup)
• Explain in appropriate detail to the doctor why you disagree with their application of medical criteria as symptoms (try to make sure appropriate depth is achieved in your explanation)
• Explain why you don’t believe the risks were applied correctly to force treatment
• Provide News and Media public sources of your views if you have them
• Provide Academic and Scientific sources of your views if you have them
• Provide Government and Military sources of your views if you have them
• Express the logic of your beliefs in a clear and coherent way
• Show reliable communities and groups that might explain why you appear to have symptoms
• Demonstrate technical viability of ideas if sensible and possible (give examples)
• Ask any family, friends, community interest representatives, academics, experts, or professional contacts that you would trust to represent you to contact the department
• Contact Mind, Mind Legal Line, Disability Together, Vocal Advocacy, Shout, Rethink, Samaritans, and any other Mental Health or Disability charities
• Keep your room organised and spotless (this will improve perception of your mental health)
• Think about acting on suggestions like taking leave for exercise (try not to argue when it isn’t important)
• Maintain healthy relationships with other patients (if they like you, it will help, you will probably often hear weird and triggering things, ask or shout for help if needed, there should be staff nearby)
• Request to speak to the Psychologist (regularly, if appropriate)

• Ask to speak to an advocate or IMHA (Independent Mental Health Advocate)
• Request a second or third opinion via Second Opinion Appointed Doctor (SOAD)
• Explain to staff the laws they are breaking (common examples will be posted in a future post)
• Request an Independent Mental Capacity Advocate (IMCA)
• Request a solicitor
• Contact local MP
• Interact with the daily staff rotations to introduce yourself (List below)
• Call, email, or write, to companies that work with the things you are claiming and ask if they can reply with a short endorsement of the validity of your work/interests if they are in question
• Ask to speak to an existing Care Coordinator or GP and attempt to get them on side

• You can replace nearest relative legally if there are fundemental disagreements about your mental health with Form N208; court fee £245 (waiver possible)
• If you are changing your nearest relative decide who this becomes very carefully
• Request an appeal via Managers’ Hearing and MHT if you fail the first time

• Use any sessions (like music or psychology group sessions) or therapeutic opportunities as unpressured time to explain or get further staff on your side

When they begin to act like medication is going to be forced (they do this to most people)…

• You can legally refuse treatment if capacitated (MCA), or even under MHA section if not urgent
• Request Dose Review
• Ask to verify paperwork such as medical documentation, capacity assessments (which might not be relevant in the first three months of your section), and/or section paperwork
• In theory they should be able to find out which specific clause of the MHA they are using to allow them to apply force
• Make it clear that they dont have permission (shouting and screaming can make you look bad, and they are generally highly prepared to sedate you to administer drugs or drug your food)
• You will most often not be prosecuted for fighting, but you will probably never win because you will be quickly outnumbered
• If overpowered, report as a safeguarding incident to your Locial Council Adult Safeguarding Team

If previous pathways fail…

• Complain to PALS
• Complain to the Police
• Email the trust’s MHA office to report issues with previous complaints or trouble complaining due to sedation
• Make a Subject Access Request under GDPR to expose incorrect data recording via a solicitor (complain directly to the Information Commissioner’s Office (ICO) if there is no response within 30 days)

• Make an official and formal complaint to the hospital via recorded mail
• Make a safeguarding complaint to the NHS itself on [email protected] or call 0300 311 2233 to raise safeguarding concerns

If you are not getting results…

• Complain to the CQC
• Complain to the Parliamentary and Health Service Ombudsman
• Complain to the IOPC
• Contact more Mental Health Solicitors

If you can prove that staff have broken rules…

• Report doctors to GMC
• Report Nurses to NMC
• Escalate team to NHS England’s Regional Team
• Report the Social Workers to Local Government and Social Care Ombudsman
• Contact AvMA (Action against Medical Accidents) for support with complaints

If you are being systematically discriminated against…

• Challenge Via Court of Protection (Form COP1, fee waiver via EX160)
• Contact Medical Negligence Solicitors
• Lodge Small Claims Court Cases against Individuals using Sections 3(28) and 3A(29M) of the Police and Criminal Evidence Act 1984 which can make both individuals and corporations liable
• Contact News and Media groups
• Contact Torture Advice groups and Specialist Solicitors
• Apply to the High Court for urgent judicial review yourself to prevent readmission cycles that prevent hearings (form N461, fee waiver via EX160 if eligible). Grounds: Illegality, Irrationality / Unreasonableness, and Procedural Unfairness (pick one).
• If appropriate, contact 999

If everyone ignores you…

• Contact Protect (whistleblowing charity), NHS Freedom to Speak Up Guardian, Speaking Up Support Scheme (NHS England), Public Law Project, Freedom from Torture, REDRESS, Liberty

• Try to refrain from going so mad you climb the walls (they will chase you and track you down, and sometimes publish about missing vulnerable people)
• Try talking to the radio

Typical staff you will meet on the ward…

• Paramedic Staff (you will usually be brought onto the ward by paramedics and they will sit with you while you are introduced the lead nurse at the time you arrive)
• Nurses (usually the first people from the ward who you will see, you can ask about the process, there is always a nurse on duty)
• Healthcare Assistants (HCAs) (They should quickly make sure you are not hungry, and assist with how things work generally, good conversations can be had with HCAs)
• Mental Health Doctors (there is usually one doctor per ward, in some wards they will enter the general space, they will eventually come to your room if you don’t speak to them)
• Medical Doctor(s) (who cover physical health and will usually also be in Ward Round meetings)
• Psychology Team (Psychology is distinct from psychiatry, and represents and different spectrum of disorders dealt with in psychiatric hospitals)
• Social Workers (there will be short visits from social workers to verify that detainment is legal and sign any Section or CTO paperwork)
• Ward Manager (they are sometimes the only consistent face on the ward most days during regular work hours and are quite busy)
• Hospital Manager (who oversees the entire mental health unit with multiple wards)
• Occupational Therapists (OTs) (who provide therapeutic activities)
• Careers Coach (who can assist with banking and benefits claims)
• Sports Coach (who can assist leave for physical activity, or attending the gym)
• Security Staff (often a shared role)
• Pharmacy Team (they will reach out to you to discuss medication side effects)
• Phlebotomy Team (there will be weekly visits from the bloods team to take blood samples if you want to give them)
• Student Nurses (from local universities currently studying or junior doctors in training, and will often tail doctors or nurses and ask questions)
• Chaplain (religious support, they can assist with the process of attending the hospital chapel, and probably give you some reading material if you need it)
• Cleaning and Catering Staff (great to be friendly with cleaning and catering staff, they will cook and dish up your food, clean your room pretty much daily, check your bin, and restock your bathroom)
• Therapy Dog Team (often a therapy animal will attend the ward every two weeks, often the dog is in high demand)
• Advocacy Staff (will be on the ward maybe once per week)
• Mental Health Solictors (they dont work for the mental health department, but there are a core staff that are in regular communication with them)
• Maintainance Team (there will be realtively frequent visits from maintainance technicians who will be wheeling trolleys in and out to check and fix things)
• There are some other staff who are there often (such as porters, general hospital security, post people, and ECT technicians)

You will also routinely see these people…

They might not work for the hospital or be involved in your care.

• New mental health patients
• General shop or canteen staff
• Other people’s family and friends
• Fast food and delivery people
• Taxi drivers
• Police
• Opticians or Hearing Specialists from private companies
• Other hospital staff from an attached main hospital
• The general public