Episode 3 Peace of Mind

One in four of us will face a mental health illness

at some point in our lives.

We may know the statistic,

but what do we really know about those who live with challenging conditions?

And the working lives of those involved in their care?

This series will bring them together,

to tell their stories.

Whitchurch Psychiatric Hospital has been treating the mentally ill

in Cardiff and beyond, for over 100 years.

The original building was a product of its time.

And while much has changed in modern psychiatry,

the stigma attached to housing the mentally ill in an asylum has remained.

It's now facing its final days,

before it closes its doors for good, in 2015.

Staff and patients are due to be transferred to purpose-built,

modern accommodation in a different part of the city.

But at the very heart of this Edwardian building is the pharmacy,

and dispensing medication from the patients on its nine wards

falls to the 15 staff who work here.

As long as you get it, I'm happy.

As a specialist mental health pharmacist,

my job involves being based here at the hospital,

and looking after two wards I have here.

I look after one of the adult acute mental health wards,

and I also am the named pharmacist for the intensive care ward.

The interaction you get with the patients is very, very close,

and involved, and you know,

you really feel like you've got a really important role

as a mental health pharmacist,

because you're involved in the choice of people's medications with them,

and I just took to it straight away.

One of those in Gwawr's care is 36-year-old Lucy Phelps.

She's been receiving regular reviews in medication for bipolar disorder.

I was first diagnosed when I was 20,

when I had an acute manic episode

and I was sectioned in this hospital.

I was in my first year at university.

I hadn't slept much at all.

I would maybe sleep for an hour in the afternoon,

between five and six, and at night I couldn't sleep at all.

It was just after I'd come home for the Easter holidays,

and I started to sort of have very strange ideas and beliefs.

In the end, I started to believe that the whole world was going backwards.

And that led to me going out in the night,

because I thought that was daytime.

And I got picked up by the police... early in the morning.

And that was a few hours before I ended up here.

I thought I was somewhere where people were going to do

experiments on me.

I kept trying to get out, because I hated it so much.

The ward was locked and I was followed everywhere,

because I kept trying to get out, because it was so horrible.

The psychiatrist would always ask, "Do you think you're ill,

"do you think you're ill?", and I'd say no,

and eventually I said yes,

and that seemed to be the key to getting out.

And that was the beginning of a long struggle with depression,

and rapid cycling,

so for years I would either be depressed or manic,

but nothing in between, really.

Mania is characterised by feelings of euphoria and self-importance,

that can also lead to risky behaviour without inhibition.

The depression which can follow is in sharp contrast to this.

Lucy isn't currently working,

but finds pleasure in her craft hobbies, at her parents' home in Penarth.

When I'm manic it can vary.

It can be a very exciting experience,

everything going very fast, feeling very confident,

needing very little sleep,

and you can have very grandiose ideas

and think that you're someone very special,

and that you have special powers and things,

but that doesn't happen to me so much,

because I manage it before it gets to that stage.

I experience colour in a very intense way.

It's not so much that colours seem brighter,

but I experience them really intensely,

and I get lots of pleasure out of putting different colours together.

I think that's where my interest in art and craft has stemmed from.

It's affected my life a lot, because my moods can change very suddenly,

so it's been very difficult for me to hold down a job.

I've had a paid job for six months,

and then got ill, and been off sick for six months, and then resigned.

I've done voluntary jobs and not being able to kept them

because I've been ill,

even though I was only working a few hours a week.

In the early years of my illness, I worked harder,

working on my early warning signs,

identified things like not sleeping, pacing up and down,

and then, if I had early warning signs,

I knew that I would have to take action.

As the years have gone on,

and as I've shown I can be trusted with medication,

then I've had medication which I can take myself,

and then tell a health professional that I've taken it.

Because I've become unwell so quickly,

I don't always have time to go to someone and get a prescription.

Lucy's control over her treatment

means she can aim to avoid readmission to hospital.

But deciding to take medicine for the long-term is a big decision.

Tim Verdon is 50.

He was born in the south of England, and worked as a farm hand

and book binder before moving to Cardiff.

Tim was given a diagnosis of schizophrenia,

a feature of which is hearing voices, 12 years ago.

I first heard voices when I was a really young child.

I was told that

that was wrong, you know,

and I would have to ignore them,

which I did, and they stopped.

They started again about 12 years ago, very clearly.

Schizophrenia is commonly thought to mean a split personality, but it's

in fact a disorder which can cause a breakdown in thought processes.

It can lead to hallucinations,

such as hearing voices and seeing visions.

Tim experiences auditory hallucinations

in the form of voices.

His first experience of these voices,

it was almost as if he felt it was something supernatural,

something outside the body, something beyond his control.

And I guess that's a good way to describe psychosis.

'I'd been living with people who were drinking all of the time

'and who just wanted a fight, so I'd started drinking for some

'sort of Dutch courage to deal with the violence that was going on.

'When the voices came back,'

one of the girls that I hear was saying to me,

"Don't leave us now. Don't leave us."

'That was the only thing that really stopped me

'drinking at that time, was the voices.'

I can have a dialogue with these voices or these people.

They hear what I think and reply to it.

They realise that, you know, I'm in a difficult

position as far as culture and society's concerned, you know?

Would view us probably as dangerous

or weird or freaks or whatever.

I'm sure some people would like to burn us at the stake

if they could get away with it still, you know?

Tim would be vulnerable if he were to talk to people

he meets about his symptoms, or talk openly in the street to his voices.

It would be the fact that perhaps members of the public

wouldn't necessarily understand.

But, certainly one thing I've learnt is it's not anything to fear.

Tim's been offered medication to make the voices go away,

but he's chosen not to take it.

-TIM:

-'The voices have supported me quite a lot, some of them.

'So, you know, I would rather that I can hear voices.

'The idea of having a world that you can't see'

where the spirits of people of a previous generation are living in,

effectively, that is how I interpret the voices that I hear, because

of their individual characters,

their individual accents.

And it's people that I hear speaking to me.

So, I've had to look for a context to put that into.

-PHILLIP:

-Tim's got some books going back three, four centuries,

about people who hear voices,

and they were perhaps deemed to be the special ones, the chosen ones.

People who can see into the future, who can hear the dead,

people who can communicate with the spirit world.

Erm...

..I guess because I've got an open mind,

I judge every case individually.

I haven't got necessarily a firm view on it either way.

When this hospital was opened in 1908,

the choice of medication was very, very limited.

Certainly in the beginning, it was often sedative medications only,

because there weren't treatments as search, so they relied on

sedatives to help people with anxiety

and agitation and aggression.

Dr Goodall, who was the first medical superintendent here, actually had

his own mosquitoes that he infected with malaria

in order to treat general paralysis of the insane,

which is an end-stage feature of syphilis.

The idea behind using mosquitoes infected with malaria

was that the high temperatures caused by the malaria

would kill the syphilis bacteria.

And, of course, it did work,

but unfortunately the patient then was infected with malaria.

Obviously, our understanding of illnesses associated with

the brain are better now than they were,

certainly when this place opened, but still we've got an awful lot

to learn, because it's such a complex disease.

-LUCY:

-I have a real horror of coming back into hospital.

I would do anything to avoid coming back into hospital.

Anything, especially in the early years.

That was what motivated me to take control myself.

'But as things have gone on and turned out,

'if I hadn't learnt how to take control,

'my life would just be going in and out of hospital,'

and I have a much higher quality of life

by managing things in the way that I do.

'I have a lot more freedom.'

BUZZER

Hello.

Lucy's at Whitchurch Hospital for a routine monthly meeting

with Gwawr to discuss her treatment.

Lucy's tolerance to medication is very, very

what you'd describe as sensitive, I think,

and we have to be extremely careful with the doses that we use.

'Whenever we try something new, we exercise great care.'

OK?

-LUCY:

-'The help I get from Gwawr is vital,

'because if I can talk to somebody quickly,'

I can stay in control.

You're not feeling any different yet, I don't suppose?

I do feel less tired,

-but I'm still very tired.

-Mmm.

In that this week I had to get up quite a lot...

..and it's been really difficult.

I think the opinion of the person taking the medication

is extremely important.

'I mean, quite possibly, Lucy's an exception,

'because she does manage her illness so well, but certainly

'things are moving in the direction where patients themselves

'with the illness are having more of a say'

in their treatment.

I think it's really hard for people who've never had

a long-term condition to understand the kind of relationship that

'you build up over many years.

'And I feel one of the battles you have as a psychiatric patient'

is to try and get people to not treat you as a psychiatric patient.

Because people can be very patronising

and you can be left in situations where you're completely powerless.

I'm just a bit concerned that you're sleeping as much as you are,

and if I can do something about it with the combination, then...

But, on the same side, if that's going to be stressful,

thinking about, "Is my sleep going to go off again?"

I think I'd like to leave things the same until I get back again.

'You know, it's often not very pleasant to have to take medication'

long term, so a lot of it's to do with education.

'We have a very good relationship, from the point of view that

'I never say what she should do with the medication.

'We have an equal discussion,

'I would say, and I'm very much guided'

by Lucy as to when we do dose changes,

because it's only when she's ready to do dose changes.

And any actual medication changes, again,

I'm very much guided by Lucy as to when she's ready.

-LUCY:

-'She treats me like an adult.

'She understands that drugs have side effects.

'It's not easy making the decision to take a drug and to stay on it.

'And one of the things Gwawr will always do,

'if we start something new,

'is to increase it very, very gradually to give me

'more chance of tolerating it.'

TIM: There are a group of people that I hear and that I plan things

and I talk with.

We like to get away from it all sometimes,

and this seems a suitable place to escape to, you know?

I'm sort of not here on my own, you know?

No-one can really imagine it, but I am here with a group of people.

There's four girls that I hear, women that I hear, and two blokes.

Generally, it's the women who are more intelligent, more friendly.

TIM: 'Just the freedom, the feeling of being with nature,

'I just really like it.

'I like that connection of being amongst that.'

I like looking at a robin and seeing the robin's looking back at me.

'It is what I prefer, you know? It's a lot more comfortable.'

'Nurses come, people come, doctors come and they go.

'And the people that I hear, I'm still talking with.

'They're still with me.

'My sort of loyalty is towards them, basically.'

If we'd met Tim

or if someone came to the service perhaps 20 or 30 years ago,

I think we would probably be more concerned about

trying to eradicate those symptoms

and trying to normalise the person, if that's the right word.

Tim sees aspects of his symptoms as being a kind of gift...

and...an insight, a special insight.

Almost a sixth sense.

So, it's something that I wouldn't want to take away.

I view them as real people, and nothing will change my mind

that they are actual real spirits

of people who've passed on.

I refuse the idea that I was told by psychiatrists that this is

a disease, that it will get worse and that's the end of it,

and I must treat it with pills while I can.

The Hamadryad Hospital in Cardiff Bay is home to

one of the seven Community Mental Health Teams

in Cardiff and the Vale.

Nurse Phil Ball is preparing to visit Tim to draw up a new

Care and Treatment Plan.

I certainly believe that medication can help.

We've seen people whose lives have been transformed through

medication, and they're able to lead the lives they were

leading before they experienced the psychotic episode and illness.

'By the same token, I liked Tim.

'I know people who've developed ways of coping with their experiences'

and can also lead fairly full lives.

TIM: 'I don't really like interacting

'with the Community Mental Health Team

'as a rule, but I know when the nurse would be coming, I'd get

'stressed out before they came, then they would depose their things on me'

as to what I should be doing and the medication

and what I'm supposed to think.

And then they would leave

and it would take me a few days to get over their visits.

But my nurse at the moment,

he seems reasonably tolerant, you know?

Hello, there! How are you?

Tim's had some poor experiences in the past where

he hasn't been listened to, or he's experienced, perhaps...

..maybe a purely medical approach to his illness.

Now, I haven't seen you for a couple of weeks, Tim.

How have things been in the last three or four weeks with you

and your voices, for example?

-I've been all right with the people, the voices.

-Mmm.

They've just been moaning about sort of modern society

and the Olympic Games

and having to see the Spice Girls put up as an icon of British culture.

The Care and Treatment Plan actually focuses in on the various

aspects of people's functioning.

'Their social life, their recreational life, their living needs.'

Something I want to go through with you today

is the Care and Treatment Plan.

And part of what we were saying last time about how you

manage your what we would call illness, OK?

I know, it's your experience. How you manage your experience.

It's something that you do manage, seem to manage, very well.

Bottom line is, you tell me what you think you need,

I'll see if I can go away and help you with it.

-If I can't, I'll try and find someone who can.

-All right.

The main part of work is to reassure people.

It's to try and gently reinforce reality with people,

try and help people rationalise their thoughts.

'I think, in Tim's case, he's learned to live with the voices,

'so the role for myself and perhaps the team should be to maintain

'Tim's quality of life'

and help him continue to live with the voices.

It's not a given that we try to take people's voices away from them.

-So, you're prescribed this regularly.

-Yeah.

-But she don't take it?

-No.

-OK.

It's a reassurance if things go, you know, bottom-up, as it were.

But I've not been taking it, it's just there in case.

TIM: 'I don't view it as an illness.

'I view it as a natural part of my life, the way it should have been.'

To me, it seems as if that makes sense of who I am, really.

-OK, Tim. I shall see you in a few weeks, OK?

-Right.

-It's been nice talking today, as ever.

-All right.

All right, take care.

And don't forget, I'm there if you need me, all right?

-Seriously. All right.

-Thank you, pal.

'I think Tim's come out the other side, almost,

'and he's found some positives with regards to his experiences.'

And that's quite refreshing for me and it's a learning curve for me.

Allowing me to instil hope in others, as well,

where they feel their lives are unravelling.

Tim's perhaps an example of how you can turn it round a little bit.

TIM: 'The doctors, you know, say that I'm different,

'say that I've got this, that and the rest of it.

'I'm let them carry on with that and I think'

in a hundred years' or more's time,

scientists will have to come to the conclusion

that there is a bit more going on than a simple disease.

Hopefully, Tim's involvement in this programme will go some way

to reminding people that Tim's a normal guy.

He just sees the world a little differently.

Lucy's spending time on holiday with her family on the Isle of Wight,

and finding the opportunity to enjoy one of her greatest pleasures.

-LUCY:

-'If I can read, it generally means that I'm feeling OK.'

The idea that you can escape into a book

and into another world has always been how I've coped.

'One of the hardest things about my illness is having that taken away,

'so to be able to do it is just wonderful.

'And it's something you don't think about you have a mood disorder,

'but mood is fundamental to everything.'

So if you have a mood disorder,

you can't actually ever switch off from it.

So, you can't just switch off and escape into a book,

unless you feel well.

But although the holiday offers a welcome chance to relax,

Lucy can't take a break from the daily doses of medication.

This is quetiapine, which is the drug that I've been

building up gradually over a year,

which we're hoping will work as a mood stabiliser.

This is zopiclone, which is a sleeping tablet.

This is lorazepam, which would be very difficult to be prescribed with

someone who doesn't know me, because it's a benzodiazepine,

which is potentially addictive.

This is temazepam, which is another benzodiazepine...

..which I take to help me sleep, but I wouldn't take these two together,

cos that would be really bad.

On risperidone, which is this one,

which I still have to take, if you increase the dose

of that one you get terrible stiffness,

which is like a form of Parkinson's disease

and you need to take another anti-stiffness drug on top of that.

And it would make knitting, which I do for relaxation...

I couldn't knit, because my fingers would be too stiff.

It would be difficult for me to put my shoes on.

I had difficulty turning taps on and off.

Difficulty using mobile phones.

So when you most need to be in contact, you get quite cut-off.

Which is horrible.

I like to be my own psychiatrist,

my own pharmacist, my own everything.

And then I respond best

to professionals who understand that I'm very well informed.

But I will listen to them,

because I know they're more informed than me.

Yeah, I like to be an expert patient,

that's quite important to me.

'But I feel that I've been put in this position by the fact

'that I've had so many relapses.

'And one of the reasons I wanted to do this filming was because whenever

'I've heard somebody with bipolar being interviewed in the media,'

they always say, "Oh, I became ill, then I took this lithium,

"then I came off lithium, and I had a bad relapse.

"Then I did it again, and now I've learnt and I'm just going to

"stay on lithium and I'm fine,

"and I grow my own vegetables and everything's fine."

And I end up screaming at the radio,

because my experience of bipolar is not that I can just take

medication as prescribed and everything will be OK.

I've always done that and I've always had lots of relapses.

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