I’ve only ever written fragments about what happened in the mental health hospitals and eating disorder units I was detained in as a child in the 1990s. I always felt I needed to protect people. This week someone asked me if I had and I’ve been thinking since about why I should.

Writing something more complete has always worried me, partly because when you’ve lived the sorts of things that happened in those places, it never leaves you. All of the rest of life is living despite it. Yet as a survivor, when someone else speaks I feel I have to bear witness.

So for other survivors out there, you aren’t the ones who need to read this. I don’t need you to bear witness today, but thank you for being there when I did. For now, look after yourselves in a way others didn’t do in those hospitals and units. Mute this thread if you need.

(This is something psychologists and others researching “trigger warnings” never seem to understand. The act of bearing witness as a fellow survivor is utterly different to reading a text you have not lived. Don’t tell people something is pointless when you don’t understand it.)

One of the hard things in coming to terms with what happened in the worst hospitals and units was many years on. Meeting now senior figures in mental health professions who casually say when they see the name of the units in my notes:

“oh we all thought that place was so weird”

“That was the place with [doctor who ran the unit] wasn’t it, they were notorious”

“We used to get patients coming back from there incredibly disturbed”

When I’ve asked them what they did about it, all I get is excuses.

“Oh we couldn’t we were just setting up our service here”

So this thread is to open a closed door. One of the closed doors that terrible things happen behind when well intentioned people in mental health know something is wrong but do not act, choose to turn away and focus on something “positive” instead of also addressing what is wrong

I’m not going to talk about everything. Although many years on I’ve found a small measure of peace there are some parts of what was done to me that are so difficult that I don’t think I’ll ever talk publicly. I’m also not going to talk about what was done to other individuals.

I will however talk about some of the things that happened to more than one person, and to us as a group. Regimes and collective punishments were a big part of how some of those units were run. But I won’t identify anyone else or go into detail about dates or locations.

When I’ve tried to talk about fragments of this before I’ve been inundated with messages telling me how irresponsible I am and that I’ll “put people off seeking help”. If you’re considering this, I’ll save you time. Don’t. It’s silencing and covering up abuse that’s irresponsible

This also isn’t “anti-psychiatry”. I’ve had good care at some points in my life. Good care is lifesaving. People who spend all their time absorbed in polarised debates and turf wars in psychiatry are just as irrelevant to me as a survivor as all the others who did nothing to help

Instead, it was my eating, and more specifically my weight, that people focussed on. I had a life threateningly low BMI on many occasions and serious physiological complications which on a number of occasions required intensive care unit admissions.

I spent around 4 years in total as an inpatient. My first admission to a mental health hospital was when I was ten. The four years as an inpatient spanned the next eight years, over multiple admissions. Most of these were “out of area” and more than 200 miles from my home.

Two of the hospitals in particular were abusive. One in what seems now like a misguided attempt at harsh therapy. The other with an undercurrent of cruelty. Both of these environments, allowed to continue unchecked, attracted predators who should never have been around children.

I’m not going to say more about that just now. But I will say that it happens. And when you choose to walk past knowing somewhere is “weird” or “harsh” or “disturbing” to focus only on “positives” in mental health, you’re not creating a utopia. You are failing to protect people.

This thread is going to get more difficult for survivors to read, so please consider whether you want to mute it, or mute/unfollow me. This is for the people who don’t know what was done. It isn’t for you to see again. I’d also not recommend it if you’re feeling at risk just now.

The first mental health ward I was admitted to was when I was ten. For a short time I was on an adult ward because the CAMHS unit didn’t have a bed. It was a mixed male and female ward. On the second day a man set himself on fire in front of me. The staff were in the office.

I became more unwell and was sent back to the children’s ward at the general hospital before eventually going to the CAMHS unit. The CAMHS unit was a long brick building hidden away at the side of a general hospital. It had a climbing frame inside a cage attached to one end.

I later found out that most of the other children and young people were there because they had been hurt. At one point four of the girls there in an 8 bed unit were admitted immediately after a sexual assault. But at first, and for a long time, I didn’t get to meet any of them.

It was a general CAMHS unit and the staff seemed excited to have an eating disorder patient whose BMI was so low. They were using a harsh approach which they called “behaviour modification” and seemed keen to show how it could work on someone who they saw as so extreme.

When the taxi from the other hospital arrived at the unit a nurse ran outside and shouted “No, get down” as I got out. Confused I froze. Then “Get the wheelchair”. The wheelchair was part of the regime. Getting into that taxi was the last time I was allowed to walk for 9 months.

I was wheeled inside, and into a clinic room, they made me take off all of my clothes and weighed me and took photographs. They were excited by how low my weight was and called other staff in to look at me. They made comments about parts of my body and touched me like a specimen.

I was cold, always cold in those days of illness and emaciation, and asked for my clothes back. They laughed at me. Then said:

“That’s not how it is here, you have to earn them”.

I was given a gown and was wheeled to a dark, empty room, curtains closed, a mattress on the floor.

[I will continue later]

I was in this CAMHS ward twice, for a year when I was ten and again a few years later. Both times it was the same. Empty room, mattress on floor, curtains closed. Every single aspect of life: being allowed to stand, walk, talk, lighting, a blanket, a pillow was now a “privilege”.

Privileges had to be “earned” by compliance with the regime. Specifically for me by gaining weight. Anything seen as non compliance meant that privileges were lost. Privileges could only be reset twice a week after being weighed. I spent three days in almost complete darkness.

This was what they called “behavioural modification”. The most basic aspects of life were restricted and taken away, and had to be “earned” back. They could be lost again at any time. It took me nine months to earn the privilege to walk. The harms from this were significant.

Being allowed to wash, brush my hair, use a toilet, were privileges too. The staff believed that “all anorexics lie” (this was common across units). They wanted to monitor fluid balance, but it was a poorly equipped unit. I was made to do this by having to urinate into a jug.

I then had to measure this and wait with my hands held open in front of me until someone told me I could move. If I didn’t do this I was accused of “tampering” with measurements and would lose privileges. There was no aspect of life that wasn’t used for degredation and coercion.

I was terrified of contamination in food and despite the confinement and punishment through loss of privileges I couldn’t make myself eat. As a result I was restrained several times a day and forcibly tube fed through a naso gastric tube into my stomach. It felt like torture.

They were not skilled in inserting the tube and would hold me down when they were placing it. There would often be blood. I sometimes wondered if I would die. Once inserted they would strap/tape it in and knot my hair around it to make it harder to remove. They found this funny.

Using my own hair as a form of mechanical restraint objectified me even further. Using my own body as part of what was being done to me. It still upsets me now when I see and hear clinicians tip each other to use hair to secure NG tubes in force feeding. Stop it.

For months I wasn’t allowed to speak to staff other than to answer questions. “Talk time” (in five or fifteen minute blocks) had to be “earned”. This intensity of sensory and social deprivation along with extreme deprivation of liberty and rights didn’t help my mental health.

As the behavioural modification made my mental health worse, and the incredibly restrictive regime led to physical problems (pressure sores, oesophageal perforation, and more) I started to ricochet between there and the children’s ward. People saw what was being done to me.

My deteriorating mental and physical health because of the regime and what was being done to me was seen as almost inevitable. The anorexic who was inevitably “complex” and “resistant” and needed more punishment and discipline. They’d been “too soft”.

As my physical health deteriorated on the second admission there the CAMHS unit decided to monitor my blood pressure. But then they decided to use this as a metric for restriction of privileges too. I could earn privileges or lose them by my blood pressure being acceptable or not

As I gradually gained weight and was allowed into different rooms in the unit I got to know some of the other patients. They were being treated badly too. It was a bizarre place. One of the nurses there used to take some of the patients home at weekends by “fostering” them.

This was not the only children’s mental health ward I was in where patients sometimes went home with staff at weekends or when the unit closed at Christmas. It happened to me at another unit. No one tried to stop this or asked us what was being done to us, or whether we were ok.

This is within living memory. Patients using services now who were in some of these units experienced this yet psychiatry, mental health nursing, psychology, social work are almost completely silent on this. Survivors are still treated badly. Made to carry the professions’ shame.

I see those professionals who are silent on this history. I see them excluding those who this was done to. I see them looking for “another side”, even blaming patients who suffered so much harm, saying how “difficult” and “complex” anorexia is. There is shame here. It is not mine

There was kindness in this unit. The ward cleaner and two of the night nurses would try to help when they could. The night nurses used to clean my pressure sores, let me sit up, and give me contraband pillows to go under my legs. The cleaner once smuggled me in a guinea pig.

Even as I gained more privileges it was still a bizarre place. I was allowed a day release to attend school but was told I had to go in the wheelchair. It was a hospital chair not self-propel. They left me in it at the end of the long school driveway, alone, not allowed to stand.

They also used a lot of medication, experimental combinations of many things. None of the doses seemingly adjusted for my body weight. Looking back and with the pharmacology knowledge I have now, I’m surprised I survived it.

There was other stuff there too, more than I can type now, but eventually I was discharged, more unwell than when I was admitted. I was relieved, but don’t know that within months I was heading for somewhere far worse.

(Within a few years of me leaving, this CAMHS ward was closed. It was left derelict, and for many years local kids used to break in and look for ghosts.)

[I will talk about the next unit later]

My admission to the next unit happened on a day I thought I was going to school. I was wearing my school uniform and went to the front door but found it blocked, I tried to get to the back but as I made it outside I was grabbed, restrained, and forced into the back of a car.

They drove 200 miles. I heard them talking about the name of the place I was going. Even as a child living hundreds of miles away I had heard of this place. It had a notoriety among staff at the previous mental health ward. For a while they had used it as a threat to coerce me.

We arrived at the hospital unit, I taken inside and the door was locked. Immediately I could hear a child crying, and an adult shouting. I was taken up to the weighing room and made to undress. My body had scars and they made me bend down, turn around, and lift up my arms.

Then the threats started. I was told that I wasn’t like the other children there. That they were “good girls” and were not like me. They said I was “lucky” to be there and it was my “very last chance”. That the next step was one they could enact at any time. The next step was:

“I will send you to a psychiatric hospital and they will throw away the key”. They said my scars were disgusting and that none of the other children must see them. They told me that my prescribed medicines were “poison” and that they would make all my teeth go yellow and fall out

They said they had told my parents that all anorexics are liars and that girls like me make up stories about this place, so they had been warned not to believe anything I said. I was told any attempted communication out would be monitored. They told me I didn’t deserve their help

I tried to put my school uniform back on. It was the only clothing I had those first few days. There were much worse things that happened in that first week that I’m not going to speak about. But am I going to talk about some of the things that I witnessed happening to others too

One of the features of that place was the use of collective punishment. And the way some children were favoured and treated very differently to others. Those two things were absolutely fundamental to maintaining the abuses of power that happened there.

[I will return to this another time]

Thinking back now to the collective punishment and the vastly different treatment some patients received. There is something important for people listening to patient accounts now, and in understanding dysfunctional or abusive systems. It’s important for patient safety.

One of the ways treating some patients so differently there acted to maintain the abuse was because there were always a few patients prepared to say that their treatment had been ok. To give a positive account. And that is what bystanders in mental health services prefer to hear.

This preference for positive accounts is endemic in mental health services. Patients are even schooled that to be involved in telling their story they should give positive elements to it. Positive accounts are highly favoured. They are valid. But more than one thing can be true.

It is very dangerous when positive patient accounts are used in such a way as to invalidate or cancel out “negative” ones. It’s dangerous when accounts of mental health care are seen in a binary positive or negative way, and “negative” discounted in favour of “what’s going well”.

For years I thought I couldn’t speak. I knew there would some people who had been there who had a very different experience to me. I knew due to the collective punishments patients who hadn’t been treated well were so frightened of hurting others it was hard to act collectively.

I also didn’t know who had survived. I stayed in touch with a few people but several died. The others never spoke about the unit. We stayed in touch but never talked about it. 25years later I asked one if she wanted to. She said no, that she does all she can not to think about it

If there are accounts of the same unit that are “inconsistent” mental health services tend to disregard the one describing harm. The “positive” account even leveraged against the person harmed. The abuse continues. The presence of positive accounts does not mean a unit is safe.

If a hospital’s response to people speaking about abuse or harm is to wave around “positive” patient accounts, trying to use them to cancel out “negative” ones, be alarmed. Be alarmed too at people who try to label some patient accounts as less valid because they are “negative”.

One of the most troubled, abusive, neglectful teams I ever came across as an adult does this. They have favourite patients. They even had some interviewed by a broadcaster then nominated their own team for an award. Then used it as evidence of how good they were, silencing abuse.

The collective punishment at the second hospital I’ve been describing was frequent. It was often around food or weight. This was a ward for children with eating disorders and it weaponised food and weight in ways that are hard to imagine unless you were there. They used fear.

[I will continue tomorrow]

One of the most common collective punishments there, often daily, was making other patients wait at the table until the last person had eaten all they were being made to eat. This wasn’t all patients, there were two eating areas, but all of those who were made to eat in that area

You might be thinking that doesn’t sound too bad, but have you ever waited for someone who is utterly terrified of food and on “doubles” (up to 4500 calories a day) to finish eating something that is making them reflexly vomit on the table? And no one being allowed to clean up?

Waiting at the table while another child finished (in a unit that could have around 30 patients) could mean waiting there all day. It also meant children missing weekly 10 minute contact with parents on the phone and more. Unwell children encouraged to coerce another child to eat

The doctor at this hospital “didn’t believe in refeeding syndrome”. They said it was “invented by the anorexics”. Refeeding syndrome can kill. The nutrition there with a focus only on high caloric intake was dangerous. There was no routine medical monitoring other than weight.

The unit had been set up to make money, and the owners were open about this. They’d sometimes tell you how much they were making from your admission. The doctor there claimed to be a specialist but had never qualified beyond junior doctor level. Staffing ratios were very low.

The hospital ran on a regime of people being too frightened to disobey. Contact with the outside was very limited for patients who were not favoured. Some allowed parents phoning for ten minutes, visiting at the weekend, allowed out with them or weekend leave, others not.

Visits and leave and any parental contact was as well as dependent on favour, dependent on weight. Weight was the metric the regime used to measure success. No psychological measures were used. We were weighed twice a week, unfavoured patient made to be naked, others wore pyjamas

“Spot checks” were a thing. These were implemented because some patients were so terrified of the consequences of not gaining the required amount of weight every week, and having more time added to their sentence, that they would do almost anything to keep “on their graph”.

This was mostly drinking large (dangerous) volumes of water before being weighed. A group of us who had fallen behind on our graphs after food poisoning used to gather in a bathroom at 4am on weigh morning and take turns using an empty shampoo bottle to drink out of the sink tap.

We had our rooms checked for drinking glasses or bottles so we used a shampoo bottle. There were no staff upstairs at night. At bedtime patients would be locked upstairs and staff would sleep in the TV lounge downstairs, so we had time. Then they started taking the taps off.

But we were desperate. Really frightened. The fear still catches and takes my breath away. So for a while we used the toilet cistern. I had contamination OCD, but was more able to drink dangerous amounts of water from a toilet cistern than face what would have happened otherwise.

Sometimes people were too physically unwell or too frightened to eat. That was never an option. Forcefeeding happened only in one of the eating areas. Favoured patients didn’t have to witness it. The first technique was to restrain the child on a chair and tightly hold their nose

Eventually, to breathe you would have to open your mouth, at which point they would try to force in the food you were most frightened of. By this point the feeding had often escalated away from the meal the child had started with to double cream, butter, peanut butter.

Trying to breathe and having good forced in my mouth at the same time left me feeling I was choking. Sometimes I was. No one helped me. My friends were too frightened too and the staff would just force more food in. They were treated badly too and didn’t have time for this.

When that wasn’t working the child would be restrained and NG tube fed. They didn’t often leave tubes in there. There would only be two staff on duty and no one to supervise so it would often be reinserted every time. They made it as aversive as possible as a warning to others.

The children in that eating area would be made to watch as they mixed up double cream, chocolate, butter, anything the child was scared of but utterly unsuitable as a liquid diet and then force it down the NG tube. At one point I had nothing else nutritionally for over a week.

Strip searches were also a thing, again only for unfavoured patients. I once had 3 strip searches in a single day. I had been allowed out to a shop but had returned five minutes late because it was a week before Christmas and there had been a queue. I was punished for a week.

Other times I couldn’t take any more of other things that happened there and I ran away. Children who ran away were kept in the eating area, and were restrained by being tied to a chair. I was tied using ankle straps to the wooden chair. I saw this happen to someone else too.

I was gaining weight but getting more and more unwell. When I was away from the other patients in the weighing room I would be threatened with being sent to a psychiatric hospital, locked up and them “throwing away the key”, I was threatened with ECT (was delivered as a threat).

[Taking a break. Unfortunately there is more]

There was a patient there who didn’t walk, talk, or eat. They did cry. But they couldn’t wipe their tears, and none of the staff helped. We weren’t allowed to. The tears dried on their face and clothes until they were washed away when they started crying again.

They should never have been there. None of us should have. But the things I saw happen to them were there when I closed my eyes for years. They weren’t continent so were left to sleep on bin liners. They were often left without trousers, incontinent and in their underwear.

They spent almost all their time in th eating area, all of the less favoured patients did as a group punishment while they were there as they were unable to feed them self. They were moved around the unit by staff by being dragged by their arms, with heels dragging on the floor.

At one point the owner of the hospital left them in the middle of the floor of the eating area, partially clothed, on a bin bag, and put a sign on them with an arrow. The owner was laughing, and made some of us gather to be told the sign showed which way to walk around them.

One day a medical photographer came. He wanted photos of two of the most emaciated children in underwear. I wasn’t allowed to consent. The owner consented to everything. Just like the many times the media were invited there. We were told if we were doing a story or not.

I still wonder if I’m going to come across photos which I didn’t consent to in medical textbooks. I don’t look. I have another picture of me in unit with someone who is now an anchor on the evening news. They were there as a young reporter doing a piece on the unit. I don’t watch

Even after discharge I wasn’t safe. The unit promised NHS areas paying for children to be there that the children would maintain weight after. You were weighed every week on a Thursday at home. If you had lost more than 1kg from “target” you were sent back after school on Friday.

Being sent back for the weekend you weren’t formally readmitted. You were made to sleep on the floor in the school room in the hospital. There was a cupboard in the school room that had mats like yoga mats for sleeping on. Several of the mats had blood on them.

This would go on every week until your 18th birthday. Some people’s parents realised something was very wrong and never did it. My parents respected authority and believed all they had been told by the hospital. It carried on for years.

I had double physics every Thursday morning at school during A levels. But I’d have been up since 4am drinking water - litres - or swallowing objects to try to gain weight to avoid being taken back. I left class each week vomiting and with muscle spasms. It was so dangerous.

I’m going to pause for a while now. But before I do I want to ask the professions of psychiatry, psychology, mental health nursing social work, why you haven’t done more about this? Look at the replies here - others remember this too. You can turn away but it will still be real.

It isn’t good enough to say we must focus on the future, on best practice, only celebrating “positives”, to simply ignore and pretend nothing else exists. That kind of attitude enabled and maintained the abuse that happened to me and so many others. It made space for it.

It isn’t good enough to say “oh we have had lots of inquiries, we know it all, we need to move on”. Did you really know all this? None of this surprised you? Where then is the truth and justice programme for those harmed? Why are people who lived this still let down and excluded?

How certain are you that none of this is happening now? How certain are you that all those harmed by the collective failure of professions and society to self regulate and protect children in these hospitals have seen justice or have had help to enable them to survive this?

There is a tendency in professions to not get involved in things like this, to focus on something that feels like a higher calling. But these problems were endemic. It wasn’t just one unit. Focussing away means benefitting from a structure that maintained and enabled suffering.

Professionals often don’t feel very powerful, but you are. If you don’t use your professional power in mental health to oppose and eliminate abuses like this, who do you think will?

This matters at the individual level too. All of those “very disturbed” 30-50 year old patients with long eating disorder or CAMHS histories so often neglected by services and seen as beyond help. Labelled as resistant or not engaging. Sometimes left to die. Ever wonder why?

Ever felt curious about why some mental health patients with CAMHS experience from this time look at you when you say that they need to be admitted to hospital: “to be kept safe” and cannot find any words at all to reply to you? Or manage only: “hospital isn’t safe”.

@threadreaderapp unroll please