‘I had to be sectioned’: the nurse who became the patient

Rachel Davis’s experience as a former patient in an inpatient setting is informing her role as a trust’s peer support lead for other healthcare professionals

• The writer’s experience of being sectioned under the Mental Health Act (1983) is now informing her role as peer support

• Vicarious trauma is described as a process of change resulting from empathetic engagement with trauma survivors when caring for them

• Symptoms of vicarious trauma include stress, burnout and invasive thoughts about patients’ situations outside of work

A mental health career felt like the obvious choice when I was deciding on which branch of nursing to pursue.

Growing up I had witnessed the effect of mental illness on my family, and experienced anxiety and depression from my teenage years. This shaped my vocation in life and I spent more than a decade as a registered mental health nurse.

But two years ago, I had a particularly challenging day at work. I was on edge, scared and felt that something awful was going to happen. I couldn’t shake the feeling and knew that I needed to take some time off to recharge.

Following this, I spent two months trying to recover from what healthcare professionals assumed to be burnout, but which turned out to be severe depression. Then, in January last year, something inside me broke.

Loss of identity as a mental health nurse during psychosis

The sensation was like letting go of a helium balloon – I felt a disconnection from my surroundings and myself. It was truly terrifying. Over the next four days I entered a state of not sleeping, not resting, emotional lability, and had increasingly paranoid thoughts.

Ideas began in my head which later formed the centre of my ensuing psychosis. After failing to calculate a drug dosage I was planning to use to end my life, I believed I wasn’t a real nurse. I thought I’d killed a nurse and stolen her identity.

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My poor husband didn’t know what to believe. At one point he even questioned whether there was any truth in what I was saying as I was so convinced and convincing. Finally, after a weekend of emergency department visits, I was sectioned under the Mental Health Act (1983).

‘Being a mental health nurse on a mental health ward gave me an invaluable insight into how it feels to be a patient – and it felt awful. I was humbled and shocked in equal measure by the way I was treated’

I was certain that I was not unwell but evil and that, on release from hospital, I would have to kill myself. Slipping in and out of reality, I was utterly confused. I developed dissociative amnesia: I couldn’t remember anything clinical, wash my hands in the correct sequence, recall medication names or sign my own name. I spent three weeks in one of our trust’s acute inpatient units during which time I developed psychosis and experienced hallucinations and delusions.

These delusions led me to believe that I was in an experiment, that the ward was full of actors and that I had a rare illness. I believed I had to solve a series of clues to get myself out of the unit.

The memory that sticks most in my mind is of me walking around the courtyard wearing a cape fashioned out of my blanket with my hair in a back-combed messy bun, mud smudged on my face as war paint, and an uprooted lavender bush under my arm as I thought the ward needed flowers. This symbolises the whole experience for me – here I was, an intelligent, sensible, respectable professional who had finally buckled under pressure resulting in me donning my superhero cape.

Experiencing the symptoms of vicarious trauma

Now when people ask me if I am well, I’ll always say: ‘Am I wearing my cape? No? Then things are okay.’ Once my brain ‘broke’, it was like an instant download – a reconnection between the present and the past. I remembered things I was unaware of knowing: I could name songs, artists and album covers from bands in the 1990s.

I experienced what I can now identify as vicarious trauma, which is described as a process of change resulting from empathetic engagement with trauma survivors when caring for them. The symptoms included: taking on too much responsibility; difficulty leaving work at the end of the day; invasive thoughts about patients’ situations; becoming overly emotionally involved in situations; loss of connection with one’s self and others; and loss of a sense of one’s own identity.

What is vicarious trauma and how does it affect mental well-being?

Nurses who work with survivors of traumatic incidents or torture survivors, should be aware of vicarious trauma, which can occur from empathetic engagement with trauma survivors when caring for them, and can so often affect healthcare professionals’ mental well-being.

Signs that indicate you are experiencing vicarious trauma

• Lingering feelings of anger, rage and sadness about a patient’s victimisation

• Becoming overly involved emotionally or over-identification with the patient, for example, envisaging horror and rescue fantasies

• Experiencing bystander guilt, shame, feelings of self-doubt, loss of hope, pessimism and cynicism

• Being preoccupied with thoughts of your patients outside of the work situation

• Experiencing difficulty in maintaining professional boundaries, such as trying to do more than is in the role to help your patient

Coping strategies to help reduce the risks of trauma

Increase your self-observation – recognise and chart your signs of stress, vicarious trauma and burnout.
Take care of yourself emotionally – engage in relaxing and self-soothing activities and nurture self-care

Maintain a healthy work/life balance – having outside interests is hugely beneficial
Look after your physical and mental well-being
Be realistic about what you can accomplish, and avoid wishful thinking

Take regular breaks and take time off when you need to
Don't take on responsibility for your patients' well-being, but supply them with tools to look after themselves

Take up training opportunities that are offered
Seek social support from colleagues, family members, and use peer support and opportunities to debrief
If needed, take up time-limited group or individual therapy

(Adapted from British Medical Association)

Invaluable insight as an inpatient in acute mental health setting

At one stage while an inpatient, some of my fellow patients represented someone I had cared for in the past who had a traumatic story attached. My brain would make a connection between the patient on the ward and the person from my history – such as their name, something they were wearing or a song they had sung.

Being a mental health nurse on a mental health ward definitely had its challenges: it gave me an invaluable insight into how it feels to be a patient and it felt awful. I was humbled and shocked in equal measure by the way I was treated. There were staff who made me feel safe and warm just by the way they looked at me. And there were staff who made me feel utterly worthless by being dismissive, hard, uncaring and not hiding their frustration when I was unwell. That crushed me.

‘The trauma I experienced left me feeling as though I was recovering from a brain injury – my thinking was muddled, I was constantly exhausted, and I found sequencing tasks was a challenge’

My fellow patients were wonderful. They pulled me through some dark days and showed so much respect and humility, I will be forever grateful to them for that. My official diagnosis is complex post-traumatic stress disorder (C-PTSD) – a psychological disorder resulting from prolonged, repeated experience of interpersonal trauma. A number of my experiences, such as depression, anxiety, emotional dysregulation and dissociation can all be symptoms of C-PTSD. That makes sense now.

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I never thought I had experienced trauma, and certainly not compared to the women I had nursed, but I now see that I have compartmentalised some painful feelings and memories and intellectualised my experiences.

My recovery is still ongoing. Unfortunately, within a week of getting my liberty back, the country was forced into a national lockdown due to COVID-19. I had planned to be engaged with my recovery, taking part in recovery workshops and classes and putting my energy into moving forward.

However, everything was paused and the only thing I could do was walk, breathe, notice the small things and spend time with my family, which was just what I needed in the early days.

Fundraising efforts to inform and educate nurse colleagues

The trauma I experienced left me feeling as though I was recovering from a brain injury – my thinking was muddled, I was constantly exhausted, and I found sequencing tasks was a challenge.

In time, I plan to write a fuller account of my experiences to help educate healthcare professionals about the way we care for people and to remind people that what happened to me could happen to anyone. I’ve been fundraising to help write my story with the support of a ghostwriter and editor. I’d also like to talk to healthcare professionals about my experience in the hope that we can change some of the culture around inpatient care.

I returned to work in June 2020 and, due to my experience, I approached our trust’s chief executive and director of nursing to share my thoughts with them. As a result, they offered me a secondment into the peer support team – a group of individuals employed by the trust with the focus of using their own lived experience to develop meaningful, reciprocal relationships with service users who access our services, and supporting their recovery through inspiring hope and leading by example.

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I am now in the team permanently as a peer support lead and love the role as I am able to draw on my personal and professional experience to help move the service forward.

There is no greater privilege than caring for someone in their loneliest, darkest moments and offering compassion, comfort and hope. But for now, I have a different job to do. I intend to use all my knowledge – personal and professional – to be the voice of lived experience in an arena where this is not given as much recognition as it deserves.

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Find out more

• British Medical Association – Vicarious Trauma: Signs and Strategies for Coping
• Intensive Care Society – Wellbeing Hub
• Mental Health Foundation – How to Look After Your Mental Health During the Coronavirus Outbreak
• Mind – Complex Post-Traumatic Stress Disorder (C-PTSD)
• NHS Employers – Free Wellbeing App for NHS Staff
• NHS Every Mind Matters – Get Your Mind Plan
• RCN – Counselling Service
• Where’s My Cape? Rachel Davis’s fundraising page
• World Health Organization – Mental Health and Psychosocial Considerations During the COVID-19 Outbreak

Rachel Davis is peer support lead at Devon Partnership NHS Trust