Editor’s note: the author of this article wished to use a pseudonym and not submit a headshot for privacy reasons.
It is strange how some months remain etched on one’s mind whilst other months are scarcely remembered at all. How some years haunt you with a constant reminder of something, while others pass by with an air of insignificance. This is my story of one such month that then became an array of three years ticking by relentlessly.
It was March 2017, March being one of my most favourite months generally, but not in 2017, oh no, this March was to be one I will not forget for the rest of my entire life. In March 2016, I was working as a counsellor and living in my flat in Wales. The rest of my working day would incorporate studying and reading work-related subjects — psychotherapy was a fascinating subject, and I wanted to find different methods to help my clients and improve my knowledge. I had completed an eight-week mindfulness course and use to meditate each morning. To ensure I had a life-work balance, I engaged in an array of different hobbies such as walking in the local woods, painting, writing stories and poetry and singing whilst playing the guitar. It was a perfect picture of the life I had worked hard to achieve; it was my perfect existence.
It was Easter 2016 and I had just been on a retreat in the Gower; it was a wonderful experience with an amazing couple who ran the retreat. I was full of the joys of spring and then in a health store in Cardiff, I met a man. He was charming and before long, we started a relationship. I did not realise at the time I was dealing with a violent, narcissistic man. I found this out in the August of 2016 when he first hit me. I went on to experience the worst violence I could ever imagine; this is hard to talk about but it is relevant as it was the cause of my breakdown, which presented as Post-traumatic Stress Disorder (PTSD). Anyone who understands the complexity of abusive relationships and the entrapment that one finds oneself in will understand that I could not ‘just kick him out’. There would be threats to ruin my life and destroy me if I did kick him out; I was caught up in the cycle of abuse, in which there would be violence followed by promises and good behaviour until the next violent outburst. Living in a constant state of hypervigilance and with the sympathetic nervous system (SNS) in fight/flight/freeze mode, I was on survival mode and trying to get through each day just walking on eggs shells. Trying to pacify and be obedient were the only tools I had to cope with these horrific months. I would wake early and think of ways to get out of my situation and meditate to try to calm myself.
Then one day in February 2017, I had had enough and I told him to leave as I had a sense that he was having an affair and I knew he would go if he was seeing someone else. At this stage, I was not sleeping enough and not eating sufficiently; I was working less as I had decided not to take on any more clients. After I kicked my partner out, he would not leave me alone and would stand outside my window calling me. I would reluctantly let him in if only to stop the neighbours from complaining about the noise. He would sit in the window seat of the pub across the way and watch my window. By now you are probably wondering, “Why did I not just call the police?” — FEAR! I was too scared and I did not know what the consequences would be if I did contact the police.
In March 2017 I was having to move out and this was the final straw. I had been in a heightened state for so long that I felt unable to cope. A few nights later, I broke down and had some experiences that could be called psychosis; I started to struggle to make sense of what was happening around me, and I could not understand what was real and what was my imagination. I was so scared. I was paranoid. Now jobless and homeless, I went to see my old supervisor and told her I was scared and did not know where to go for help. She let me stay with her and her family while we tried to figure out if I was ready to return to any form of work. My supervisor lived outside the town centre and I was fine staying at her home but each time I came into town, I would split and become reactivated and delusional; it was as if being around town would set me off (a trigger) and I needed to return to her home to feel safe (a safe base). I am eternally grateful to her and her family, as it was a challenging time for them as it was for me. I was not sleeping and in a constant state of hyperarousal. My supervisor had taken me to see the community mental health team (CMHT) but I did not want to be assessed, as I feared I would be sectioned under the Mental Health Act.
I felt so helpless and lonely. I thought I missed him — I could not understand why I would miss my abuser but I imagine it was a case similar to that of Stockholm syndrome, alongside the fact that I was still grieving the loss of the relationship. So, I called him and went to stay with him. This was a huge mistake but I was so vulnerable and did not know what to do. The violence began instantly and I went to see the doctor asking for help and she took me to meet the CMHT and to meet a psychiatrist I will name Dr T. Dr T did not even give me eye contact as she asked an array of questions. She did not ask what I had just experienced but was only interested in my mental health and if I was at risk to myself and others. I was taken directly to Hospital A. I had never been to a psychiatric hospital before so I did not know what to expect and it was more frightening than I could ever imagine. Patients with an array of different diagnoses on different medications sharing wards can be frightening if you have never seen this group dynamic before and you are struggling with the reactions associated with a diagnosis of Post-traumatic Stress Disorder (PTSD). While there is controversy about describing these reactions as part of a ‘disorder’, the description of the experiences associated with this label fits with what I was going through:
Research studies have indicated that between half to 98% of people with experience of ‘psychosis’ have had at least one traumatic event in their life. This includes emotional, physical and sexual abuse. People who have experienced ‘psychoses’ are much more likely, therefore, to fit the criteria for ‘PTSD’ than those who have never experienced it. The paranoia that comes with ‘psychosis’ often mirrors the experience of hyper-vigilance of those diagnosed with ‘PTSD’. http://www.mentalhealthcare.org.uk/mental-health-diagnoses/post-traumatic-stress-disorder-ptsd-and-psychosis/
The experiences diagnosed as ‘Post-traumatic stress disorder’ have been shown to occur as a result of domestic abuse. Even when the victim escapes their abusive partner, it can take time to adjust to a safe environment. When trauma is not processed properly, it can linger in the subconscious and cause severe psychological problems that inhibit a person’s day-to-day life. https://www.ptsduk.org/what-is-ptsd/causes-of-ptsd/ptsd-from-domestic-abuse/
As my story unfolds, you will see the correlation between my behaviour whilst in hospital and the known consequences of being a victim of a trauma such as domestic violence. On my first admission into hospital A, I had one bag of clothing, one set of clothes and no money. It was soul destroying and shameful to be in such a position. Suddenly, I was on a ward with other patients trying to make sense of what had happened to me. I was prescribed medication which made me feel and sound drunk and I was confused by this new routine. It was the most confusing time in my life and I found the other patients very challenging and would have angry arguments with some of them. I was still hypervigilant and the term ‘rabbit in the headlights’ never rang truer. The hardest part was watching other patients ‘drugged out’ and unable to function other than sleep most of the day, eat and watch television. I was unable to sit still and would pace the hospital corridors and hospital grounds from morning to night. I would overhear the other patients talking about mental health, medication and being sectioned. I thought: this is not going to be my existence. I will not let this be my life story — I have fought too hard to get to where I was in my life.
I was still in contact with my ex-partner and when I called him, he would call and ask me if I would be drunk, as I sounded so drugged. He became my ‘lifeline’ to getting out of this hell, as I did not have a phone and he was my only contact with the outside world. He came to see me one day and said that he was going to help me get out of the hospital. That day I inquired about my section and was told that I was not under section but I was in hospital voluntarily and could leave. I demanded to be released the very next day and I packed my bag and waited for Dr T to prescribe me my medication so I could leave. My intention was to go back to where I used to live and go to the homeless shelter and find accommodation. I waited all day until around 3pm for Dr T to write my prescription and I was in a good mood, singing and laughing to be free. I went outside into the garden and there was a woman lying on a bench. As I walked past her, she told me to shut up, I ignored her and she then unbeknown to me, followed me to the other side of the garden. I went over to say goodbye to a woman who had been on my ward and we had been friendly to each other. Suddenly, I turned around and the woman who had followed me pushed me off the platform I was standing on and I landed against the fence with such force that I broke my collar bone. I went into shock and got up and started to run into the hospital, and the woman chased me and slapped me on the face. I managed to get inside and call for help from a staff member who came to my rescue.
I was examined by a doctor on the ward and taken to Hospital B A&E to have my shoulder examined before been taken to Hospital C for an overnight stay before going back to Hospital A to be discharged back into the community under the care of the Community Mental Health Team (CMHT). The housing officer working on my case alongside my Community Psychiatric Nurse (CPN) had arranged for me to be housed in a supported housing room in my old town. I arrived and there was no bedding, so I had to go to my ex-partner’s flat to sleep. He was hellbent on vengeance for me kicking him out and the violence and abuse started again. At this stage, the attack at the hospital had made me more frightened and hypervigilant and I was having ‘psychotic-type’ experiences again. Luckily for me, my CPN was an amazing, empathic nurse and she saw past my mental health problems and saw me as human.
Unfortunately, I was still very distressed and after a few months, an incident happened and I was taken back to Dr T who felt I was at risk to myself, so I was then sectioned under the Mental Health Act and taken back to Hospital A. The second experience was as frightening as the first but now I was on Codeine for my broken shoulder and Diazepam for my anxiety which I had been on since my release. On my second admission, Dr T started me on Lithium, Quetiapine and Olanzpine. I found the Quetiapine was the worst medication of the cocktail of drugs they had me on and so I found a way to distract the nurse each evening and pocket the Quetiapine but I would take the other medications. Before I was caught hiding my medication (which I managed to do for an entire week), I was allowed into town each day and would escape the hospital and walk around town all day. I was still delusional at times and my imagination was overactive and I sometimes believed things that were not true, but when challenged, I was able to make sense of my reality.
Dr T did not believe I was a counsellor and so asked if she could contact my supervisor. Once the other members of staff heard I was a counsellor and that most of what I said was the truth, their attitude towards me changed. I found most of the staff very reasonable and I had good conversations with them; they made a few allowances for me such as letting me go for a walk in the evening if I was very stressed. Once they found out that I was not taking the Quetiapine, they stopped my freedom of going out of the hospital until I had seen Dr T. I informed her I would take the Lithium and Olanzpine but not the Quetiapine, she reluctantly agreed as long as I did not stop the Lithium and Olanzpine. What choice did I have at the time? I had to arrange for a solicitor to have the section 3 lifted and eventually, after around three months, I was allowed to be discharged back into community care under the care of the Community Mental Health Team (CMHT). I was rehoused in a supported house in Wales.
In September 2017, I made contact with my mental health advocate (MHA) and asked him if he would help me contact the Aneurin Bevan University Health Board to make an official complaint about my mistreatment at hospital A and their lack of duty of care towards me. I had been violently attacked in a place that was meant to be taking care of not only my mental but also physical wellbeing. My main objective was for changes to be made at hospital A, so that no-one ever needs to experience what I had been through.
On the 7th December 2017, I received a letter from Aneurin Bevan University Health Board confirming that following an investigation and according to available records, the attack could not have been foreseen nor prevented. In their opinion, the correct level of observation was applied and they thought that no breach in their care towards me was evident. The Health Board added that this incident was very frightening and left me emotionally and physically distressed. They had no idea the extent of my distress having been the victim of a domestic abusive relationship and suffering from undetected PTSD. They added that they were sorry I had had to endure this experience whilst a patient at the hospital and wished me all the best for the future. What future I did wonder? They wanted to reassure me that “lessons will be learnt from my experiences” and finally, they suggested that I contact the Public Services Ombudsman for Wales (PSOW) if I wanted to take the matter further.
I asked my mental health advocate (MHA) to kindly help me construct a letter to the ombudsman. The Public Service Ombudsman for Wales (PSOW) carried out an investigation and published a report. Among other conclusions, it stated that the staff on the ward should have taken into account my aggressive (PTSD) behaviour towards the other patients which would have increased my risk of harm from other patients. They did not recognise that as I had just been in a violently abusive relationship, I was likely to react strongly to others I perceived as a threat.
The PSOW added due to the lack of prompt risk assessment, formulation and risk management plan, and the lack of reviewing my case and increasing my observations back to Level 1 due to my vulnerability to harm other patients was poor practice. That stated that in their view, my safeguarding and well-being were not sufficiently protected whilst I was under the care of the Health Board. The PSOW stated that they felt there was a lack of awareness by the staff on the Ward that the risk to patients is not just based of the risk of that a patient may present to themselves and others, but also the risk of the dynamic environment where groups of patients will association and the group dynamic of the patients on the Ward at any given time. In regard to Patient A, the PSOW also found inadequacies in the care plan and general management. Finally, they stated that my complaint that the risk from Patient A was not well managed by the Health Board and that my complaint that the assault could have been prevented if sufficient observation were carried out, that they upheld both my complaints.
In November 2018, I made contact with Express Solicitors and ask them to represent my case. I explained what had happened and how I had received a letter from Aneurin Bevan University Health Board stating that they felt there was no lack of duty of care. Express Solicitors were happy to take my case on, and we started a long and drawn-out process. I had to send them the letters I had received from Aneurin Bevan University Health Board and the documents that I had received from the ombudsman. Furthermore, I had to attend two appointments with a specialist to inspect my broken shoulder and I needed to have both an X-ray and MRI scan done. I had to request permission from my GP, the Community Mental Health Team (CMHT), MIND, Hospital A and Hospital B all to send any information or records to Express Solicitors to build my case.
The case went to Court for a procedural hearing in July 2020, and I was contacted by Express Solicitors to inform me that the Defendant had stated that since I had contacted the Public Services Ombudsman for Wales (PSOW), I did not have a case for compensation. This is where I am grateful that I had chosen Express Solicitors, as the lead solicitor noted that if the Defendant won this case, then ‘no-one’ would be able to use the ombudsman again in the future if they then wanted to take their case to a solicitor. He has a sense of humanity and decided to contact the PSOW in relation to my case rather than just walk away from the case. The Public Services Ombudsman for Wales (PSOW) is a free service that people can access to have injustice put right and to investigate, in my case, a lack of duty of care to a vulnerable person. However, the Defendant was adamant that I did not have a case. The PSOW wrote to the Defendant and stated that it was their role to investigate any wrongdoings that happen to a person and that after an investigation is conducted, they would indicate what action needs to be taken by the opposing persons, in this case the Aneurin Bevan University Health Board. They added that the award (payment) made by the Financial Ombudsman Service was not binding and therefore, I would have the right to make a separate claim for compensation for my injuries from the Aneurin Bevan University Health Board. The Public Services Ombudsman for Wales (PSOW) wrote to the Defendant stating that if they continued to pursue the argument (that a PSOW decision meant the case had been judged), then the PSOW would go to court alongside me and the Defendant would be responsible for the court costs. The Defendant eventually backed down. Express Solicitors were able to resubmit my case to the courts.
In the meantime, I was fortunate enough to be offered a flat in a different part of Wales, I was able to apply for a grant from the government to buy the basics and I was so grateful to the support workers who helped me apply for the grant. The medication seemed to stop my brain function and I was suffering from brain fog. I would sleep 12 hours a day and would feel so low and unable to concentrate or focus on anything for any period of time.
Once I had moved, I was put in contact with the local CMHT and allocated a CPN who would come and see me every week. I had signed up with the local GP and I had support workers from different charities ensuring I had all the essentials I needed. My life felt as if it was over, I was labelled and this was not going to be my ‘new’ life. It was hell; I was not depressed just could not see the wood for the trees, I had worked so hard to get to where I had been before my breakdown and now my life was living on state benefits and sitting around all day. I was emotionless and I think it was the Olanzpine that caused my disconnection from my feelings. I would pace the flat like a chained animal and I had so much anger inside me that I did not know how I was ever going to live again, I was the living-dead. Most of 2018 was a haze and I hated my life, he was still around but there was no violence, just emotional abuse most times I saw him. Then in 2019 the violence started again and then fate decided it was time to give me a break. May 2019, I told him I did not love him anymore and he left the country. That was when I decided I could either die in this ‘hell’ or I could stand up and start fighting. I decided to research bipolar, mental health, PTSD and trauma. I joined Woman’s Aid and attended both their courses on domestic violence and suddenly I was able to forgive myself and make sense of what I had been through. I contacted MIND and had 12 counselling CBT sessions. Then in the November on 2019, I started volunteering for a local charity as a counsellor. I received such good feedback from my first counselling case that I suddenly realised — I could get back to work as a counsellor. I had hope for the first time in three years — it was a battle but I was on the road to recovery.
Then it was 2020 and lockdown happened but I carried on with the volunteering counselling working on the telephone. I needed to remain focused and busy, so I attended over thirty online workshops related to counselling and I completed six online courses on health, diet, counselling and PTSD. All my research informed me that I did not fit the criteria for ‘Bipolar’ but ‘PTSD’, if not ‘Complex PTSD’ from my childhood abuse. I decided in January of 2020 to reduce and stop the Olanzapine, which was hard work; my brain had to readjust to not having this toxic medication, but there were no signs of ‘mania’ or ‘psychosis’. At the start of April 2020, I decided it was time to stop the Lithium, so I reduced it slowly and then stopped it too.
Then in August 2020 I had a call from my GP’s surgery and I was told that my last blood test came back showing that I had developed Graves Disease. I recall that one of the side-effects of Lithium was thyroid problems, alongside, liver, kidneys and bones, so I once again researched if one could indeed develop Graves Disease when coming off Lithium which was confirmed by a thyroid specialist in my local hospital. I went for a blood test a month later and it was normal. No more Graves Disease and my hormones levels were stable.
I found a private psychotherapist to work on my recent life events and to support me as I came off the medications. I have a great, empathic and understanding doctor and she asked me to inform the CMHT that I was no longer taking Lithium which I reluctantly did the next day. The psychiatrist’s first and only words to me were that I needed to start taking my medication as soon as possible. He did not listen to me as I explained that I had not been on Olanzapine for six months or Lithium for three months and that I had no signs of Bipolar. I had done my research and informed him that the CMHT could not enforce me to take medication unless I was psychotic or at harm to myself or others.
The main reason I am writing my story is because through working with a few clients who have been let down by the CMHTs and my own experience, I want others to see that there is another way. We do not have to end up on a cocktail of drugs to function if we have a mental breakdown, and with support from the professionals, we can reduce our medication or stop all medication and get our lives back. On the 31st March 2021, I received an email from Express Solicitors stating that the defendant had made an offer. It was never about the money for me so I accepted the offered as I just wanted the case to be closed and not to have to go to court.
In April 2020 I started working with my first private client and I retrained online to work as an online counsellor. As the year progressed, I started working more and in November 2020 I was able to come of state benefits and support myself completely. I now am still working as a counsellor in private practice and live in Wales.
As a mental health nurse on an acute inpatient ward, I recognise the apparent narrow thinking shown by the ‘professionals’ in Hospital A and the belief that medication will stabilise you; experience tells me that people respond better when they have a voice that is listened to, and has options that allow them to feel safe and valued, whilst exploring and possibly coming to terms with what is distressing them.
Sending people home because they are stabilised on medication is a very narrow view on wellness; continuing to spend money on this model is wasteful and worse than that, maintains and adds new trauma to the person in need of support.
I am sorry you have had to go through this, your story should be required reading for all decision makers, on what not to do and how services really should not be run.
I hope you are able to maintain your strength and recovery; I’m sorry you had to go through this but thank you so much for sharing your story.
Thank you for your comment, I hope one day we will see change.