Finally got more privileges. We have a pretty simple system of privileges here in the hsopital:
- Privilege 1: Stay on the ward.
- Privilege 2: Go Off the ward accompanied by someone (with 2A meaning you can go out with staff only and 2B meaning you can go out with any adult).
- Privilege 3: Go off the ward for up to fifteen minutes alone.
- Privilege 4: Go out alone for up to an hour.
- Privilege 5: Go out alone for up to four hours (and longer with a doctor’s permission).
I used to be on privilege 2B ever since I came here three months ago. A week after my admission, my doctor asked one of my primary nurses whether he thought I could handle privilege 3, and from then on, this has been a recurrent topic of discussion. For the first three or four weeks, the reason I wasn’t getting privilege 3 was that the staff were worried that I would get lost - even though I was pretty sure I knew the way to all places within a fifteen minutes’ walking distance: the therapy rooms upstairs and the nearby cafeteria.
Then, the issue became that staff were worried I’d run off and do something dangerous. I was still pretty suicidal at the time, and knew this risk to be greater than my risk of getting lost, although even at the time I was pretty sure that the risk was still fairly small - it would have to be that I was in an acute crisis when the staff let me out, because otherwise fifteen minutes isn’t enough time to do anything dangerous, I thought. But because the staff knew I was suicidal, they didn’t think it would be a good idea to give me more privileges.
In early January, I finally got privilege 3 after asking to get more privileges so I could get off the ward when things were unquiet on the ward. However, the day before my privileges were extended, I freaked out while being outside with a nurse and stood still in the middle of the road. I now know this to be a dangerous action one can take with privilege 3, because the road I stood on was within a fifteen minutes’ distance from the ward. The nurse forcefully guided me back to the ward and reported the incident to his colleagues. However, the psychiatrist had already written a note to extend my privileges, and my doctor took this at face value when she spoke to me the next day: in between lecturing me on the dangers of standing in the middle of a road, she told me and the nurse that I had been granted privilege 3.
As soon as the psychiatrist found out about the incident one day later, she withdrew my privileges and I was back on 2B. That was also the day the time-out policy was introduced. I was fine behaviorally apart from one incident where I poured boiling water over my hand, that I didn’t inform a nurse about till more than a week later, for the next three weeks. Within these three weeks, a nurse asked me several times whether I wanted more privileges, but I declined to have it requested to the doctor because I feared losing my privileges again. Then, last Thursday, I was pretty irritable because of still being on the closed ward with privilege 2 etc. The nurse I spoke with proposed to ask a doctor about extending my privileges, but I feared losing them once again and wasn’t sure. Besides, the last time I asked for more privileges, in early January, the fact that I was irritable at my beign here etc. was the first stage in things going downhill. She reported it anyway and I was granted privilege 3, but it was noted that we should stick to my crisis signalign plan. There is nothing in the plan about privileges - I should write something into it, so that I don’t have to explain what it should say to every nurse -, but what is meant is that nurses should watch for signs that I’m having a meltdown and not let me out when I am. Some nurses whom I’ve explained the policy to, say this is logical, but there are nurses who believe that, when you have privileges, you should be able to take full responsibility for using them correctly at all times. Of course, as one nurse with whom I spoke about privileges yesteday, said, no-one on this ward can guarantee that they can take full responsibility for their privileges at all times. Does this mean they cannot have privileges? In my opinion, not necessarily. Like, in my case, mostly I’m fine being outside, but there are times when I am absolutely not capable of being outside safely.
