Somehow, everyone knows what mental hospitals look like. Inside a large brick building, long empty corridors with locked doors on either side stretch to a point in the distance, and the only sounds are the ominous pacing of a sadistic nurse, and the wails of someone coming out of a shock-induced coma. The doors have tiny square windows of reinforced glass in them - not for the patients to see out, but the nurses to see in. And unlike prisons, there is no Hospital Reform Trust to suggest that the sunless shuffle from cell, sorry bedroom, to the communal smoke-filled lounge with a TV shackled to the ceiling may not be enough to keep a human being going, let alone to help them recover.
Of course, in reality mental health services in this country are not quite as grim as One Flew over the Cuckoo's Nest might lead you to expect. But when it comes to looking after the physical health needs of the patients there is room for improvement. Research by the Disability Rights Commission last November shows that people with severe mental illness have much higher rates of heart disease and diabetes than the mentally healthy. And they die an average of 15 years early.
One of the most obvious areas for improvement is physical exercise. The Prison Reform Trust recommends a minimum of an hour a day to maintain the physical health of inmates, but most inpatients, who have done nothing wrong, are lucky to get that in a week.
Common sense, experience, and systematic clinical research tell us that physical exercise doesn't only improve our physical health. Exercise is necessary for our mental well-being too, just as it is for any other animal. It gives us confidence in our bodies and our selves - just the things that disappear at the first sign of prolonged stress. And by doing so, exercise allows us to hope that our mental stability can be under our own natural control so we will not have to rely on drugs, prescribed or otherwise. So confining a highly distressed person to a ward for weeks on end, without encouraging them to exercise, is counterproductive at the very least.
And conversely, the evidence is that regular exercise can cure, or at least accelerate recovery from depressive illness. And depression is a problem for nearly every person who is ill enough to need inpatient treatment. The National Institute of Clinical Excellence has issued guidelines on the treatment of mild and moderate depression on the basis of that evidence, recommending that a programme of exercise be used as first-line treatment. When the illness is very severe, then the person may well have difficulty getting out of bed at all, but as things stand at the moment, being in hospital can be the main thing preventing them from starting to take gentle exercise as soon as they are able.
People who are physically fit are more able to cope with the usual stresses of life. And they are more likely to take care over what they eat, and to give up smoking - all things devoutly to be wished for psychiatric patients.
So why can't they take exercise in hospital? It is not always due to lack of facilities. Most psychiatric wards have access to gardens or gym facilities and exercise classes through their occupational therapy departments. But exercise is not routinely prescribed, or even seen as a priority. Locked doors confine people, even when they are legally not prevented from leaving the ward, by making it necessary to make a special plea to the nurse in charge of the ward, who though unlikely to be a Nurse Ratchet, may well be busy with what he or she sees as their main professional role - the administration of medication.
People who are detained under the Mental Health Act aren't in any better position. They have to have special permission from their consultant psychiatrist to leave the ward, even for such a health-promoting activity, and may have to be accompanied to the gym by staff who feel their time would be more productively spent on the ward.
The solution, of course, is in the hands of the doctors. We justify our lack of will by blaming the lack of money, the severity of the illness, the high turnover of patients, the lack of time to address anything but acute needs, the lack of staff, anything but ourselves. But the truth is we could prescribe a daily constitutional for all our patients if we wanted to. It simply isn't done.
So my dream is that one day every mental health unit in the country will be recognizable not by the silence of its corridors, but by the mass of chatting patients, and dare I say it, staff, jogging up and down them.
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Thanks for sharing this post. This is a very helpful and informative material.Patients in a small private mental hospital behave crazily much more often on weekdays .... Walks along corridors or into living room dressed like a hookah bar
Posted by Diane Jones on 17th Apr 2010
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