On my first consultant ward round in Antrim, Northern Ireland acute psychiatric ward there was commotion outside the office where I was conducting the meeting with staff looking after patients. Unexpectedly, Medical Director entered the office and told me: "I have just prescribed sedation for one of your patients" and gave me the chart to see it. Oh, dear my patient was not under control. I thanked him as professional politness would demand. Immediately I knew there is no way that patient would be capable of seeing me that day judging by the medication he was prescribed. He would be asleep for a long time, indeed. I wondered if this patient was trying to make sure he is not fit to see me. I have never seen him before, but he could have seen many psychiatrists before me. Therefore, there had to be an explanation for what happened.
I asked the staff present at the ward round what was the diagnosis in this patient's case and I was told he had schizophrenia, alcohol abuse and was mentally retarded. I asked for how long he had been in the hospital and I was told: two years. This is a rather long inpatient stay for an acute psychiatric ward these days, I thought. I asked how he spent his time in the hospital. The reply was: he makes puzzles for MENSA and they publish it. MENSA is orgaanisation for people whose intelligence is in the top 2%. An example of one of their puzzles is above. See if you can solve it.
When I heard how see spends his time, I realized that at least one diagnosis was terribly wrong and told so the staff.
I went to see this patient the next day on my own and told him I thought that he did not want to see me and I wondered why should such an intelligent man stay in hospital for such a long time. He told me he was lonely outside hospital, was rejected by his family and if he went for rehabilitation treatment option social workers would put him in some Christian hostel and he would find it unbearable. There was nothing else available for him as an atheist.
Unfortunately, so much money has been given to religious bodies by government that patients like him suffer for many years just to avoid worse stress of so called "home" recommended for rehabilitation. I asked to see his puzzles and these were really good.
On return to England I met patients complaining that they wanted to attend non-religious day centres out of area where they live, and were fed up with religion pushed on them by medical staff. However, NHS psychiatric units operate on catchment only based system and patients suffer. I dare not think what would happen to these patients if they openly protested. More sedation, perhaps.