Illustration: Rosie Carmichael
“Mum, I need to talk to you.”
Safia*, now 21, is a young mother-to-be from Redfield who recently came out of a mental health hospital after she had her first psychotic episode in February. This meant being in hospital for 46 days.
Safia was suffering from depression months before her episode. She saw her GP once, but she was getting more and more unwell. In the early hours of one morning, Safia came into her mum’s room unannounced. “I just started talking to her about what I’ve seen and who I saw and what was going on,” she says.
Soon after, Safia was detained under the Mental Health Act (MHA) for the first time. Six weeks pregnant at the time, she was put on an out-of-area placement miles away from home.
An out-of-area placement is when a patient is sent to a bed outside of their local mental health trust – in Bristol it’s Avon and Wiltshire Mental Health Partnership (AWP). Often they happen when the patient’s needs cannot be met locally, or when there aren’t any beds available, but AWP have set the target of reducing them to zero by March 2021.
Patients are often sent to hospitals run by private healthcare companies – mainly by Cygnet Health Care and The Priory Group. Safia was sent 100 miles to Priory Hospital Woking in Surrey, at first, and then even further to Cygnet Hospital Beckton in East London.
From lack of privacy to poor communication, Safia and her mum speak of the challenges they faced navigating a complex mental health system, and the feeling of being constantly shoved from pillar to post.
Waiting for hours and hours
In early February, Safia began taking medication prescribed from the local Crisis Team. But it had no effect and Safia suffered multiple episodes, her mum says. Safia began to destroy things in the house, and nearly drowned herself in the bathtub, unaware of what she was doing.
“It wasn’t safe for her to be at home as she could harm herself and others,” her mum says.
On a cold February afternoon, Safia was taken to A&E at the Bristol Royal Infirmary (BRI). She and her mum patiently waited in a small unit for an assessment. But as hours went by, Safia was not coping well with the constrained space and people around because of her psychosis.
“They’re not used to dealing with mental health,” says her mum. “It was really bad. They were basically trying to say they we’re going to call security because she was walking up and down A&E, where they had equipment [and] she was pulling it.”
To the staff, she was being mischievous and disruptive. But Safia was distressed by how she was treated during the wait for assessment. “I heard some of the staff in the A&E unit sniggering, like laughing sort of,” she says. “It made me feel angry, so I started to react and I was going to start smashing up the place.”
Her mum noticed one of the staff members laughing at the way Safia was acting and she challenged them. “I was going to complain but I haven’t done that yet because there’s too much stress,” she says.
After the assessment, the mental health team said Safia had to be admitted to hospital. But with no beds available in Bristol, which is a problem up and down the country, it was uncertain where Safia would go.
Until staff found an available bed, Safia had to stay in the A&E waiting area overnight, which her mum refused. After finding her a small room, staff promised they would call mum when Safia was ready to be moved; mum left.
With no call back from BRI the next morning, Safia’s mum called the hospital only to be told by staff that she was about to be taken to Woking and they could not wait for her.
Upset, frightened and frustrated, she had to make her own way there.
Waking up in Woking, feeling scared at night
Safia woke up at a Priory Hospital Woking, where she would stay for a week. “I don’t remember them taking me from BRI to Woking,” she says.
She was in an open, low-security unit at the hospital where she could freely move around and mix with other patients. But Safia was feeling more unwell. And soon after being admitted she became violent and on day five of her stay destroyed the doors of a wardrobe in her room.
When her mum visited Safia after the incident, she found her room in a mess. She describes seeing the wardrobe’s shavings and sharp chippings from the incident still on the floor.
“No one picked up her wet towels, no one emptied her bins,” her mum adds. And it wasn’t the first time she had found the room in a mess. Disgusted at the state of the room, she asked for a vacuum and cleaned up herself.
After the incident with the wardrobe, Safia had to be moved to a more secure hospital due to safety concerns toward others.
Initially suggesting a hospital in Durham, her mum and the social worker pleaded with staff to find a hospital as close to Bristol as possible. The only option: Cygnet Hospital Beckton in East London, where Safia stayed for three weeks.
On arrival at the secure unit, staff were friendly, Safia’s mum recalls. But a few days in, she realised she wasn’t allowed beyond the reception area and couldn’t visit her daughter’s room. “I didn’t realise [Safia] was going to a prison,” she says.
Transitioning from an open to a closed unit was difficult for Safia. At Woking, she could freely mix with other patients and her mum could visit her in her room, but neither was possible at Beckton. Safia described the place as “the scariest place she’s been to”.
Safia was on one-to-one observation, meaning that at least one member of staff stays with her at all times, including nights. She didn’t take issue with this, understanding it was for her own safety. But she felt uncomfortable with male staff doing one-to-one observation during nights in her room.
“In the night time you would have one-to-one watch (observation) the whole time, but you would have male staff coming in sitting by your door watching you sleep,” Safia says.
“I wasn’t comfortable with that and I told them I didn’t want a male looking at me when I’m sleeping…I thought it was wrong,” she adds. When a distressed Safia raised her concerns to staff, they explained that shifts are based on rotas, which change all the time.
Safia had to accept this uncomfortable reality, which left her feeling “really conscious” about men. “I had a little teddy with me which I always kept by my side because it was really scary in there,” she says.
Enough of being shoved from pillar to post
From the start, Safia’s mum has had difficulties with poor communication, particularly not being able to reach staff directly. She already had a mistrust of the mental health sector as her brother tragically passed away in a mental health hospital 15 years ago, which she says was “induced from medication” and due to neglect at the hospital.
Early on, this feeling of distrust was worsened by confusion around her daughter’s medication at Woking. When Safia’s mum asked the staff what medication Safia was on, they realised there had been a mix up. “If I hadn’t asked about it they may have given her the wrong medication,” her mum says. “That is very dangerous.”
It’s already challenging being a carer, Safia’s mum says, with little to no financial support and traveling long distances to the hospitals. So clear communication about her daughter’s welfare was immensely important in giving her confidence that things were going well.
But that wasn’t happening at Beckton. Mum would call the hospital on many occasions with a promise of a call-back, but wouldn’t hear back from staff for hours or not at all. She would also get conflicting information from different staff members, she explains.
“One person says she can have a phone without a camera and when I bought it, they took it from her,” she says.
Meanwhile Safia was getting anxious and feeling isolated with not being able to contact her mum, family and friends directly.
Two weeks into Safia’s stay, her mum became so frustrated with the situation that she filed a formal complaint about these issues, which has been seen by the Cable. “I had enough of being shoved from pillar to post.”
The hospital manager at Beckton immediately responded, apologised and Safia got her phone back soon after. In a statement, Cygnet Health Care said that as soon as the issues were raised, the mum was offered “immediate assistance to resolve the issues”, adding that if there are any further issues they welcome feedback from service users.
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While the response to her complaint was swift and a call from a doctor later in the evening followed, Safia’s mum explains she would always have to chase things up and keep pushing. “My mum had to fight for me to get the phone,” Safia adds.
The whole experience caused a lot of distress and frustration to Safia and her mum. “When you’re taken away from your family, taken to another city and you don’t even know where you are…it’s horrible for anyone to go through,” Safia says.”I wouldn’t want to see my worst enemy go through it.”
After three weeks at Beckton, Safia returned to Callington Road Hospital in Bristol as an informal patient for a further two weeks in March.
In the end, Safia was in hospital for 46 days. She continues to take medication, and is getting support from the local mental health community team and family. Looking to the future, both mum-to-be and mum “look forward to meeting the little one” in the autumn.
In a statement, the Priory Hospital Woking said that they take medicine management seriously, adding that they “work closely with our hospital pharmacist to ensure that all medication processes are robust and safe”. On cleanliness, they said there is a robust cleaning schedule and regular checks on the cleanliness of the hospital, with any issues being reported and resolved quickly.
A spokesperson for University Hospitals Bristol and Weston NHS Foundation Trust, which runs the BRI said they “take the concerns of patients and their families very seriously” and are “unable to comment on individual cases”, but encourage the family to raise any concerns to the hospital.
*Name changed to protect anonymity
If you’re in crisis and need immediate support, please call 111 or call the Samaritans for free on 116 123.