What psychiatric hospitalisation taught me?

One of the questions I have often been asked since my manic episode in 2023 is what psychiatric hospitalisation taught me.

The answer is complicated.

Prior to my admission, I had spent years working in the mental health sector. I had worked in peer roles, participated in advisory groups, advocated for people with lived experience, and witnessed the significant effort that consumers, carers, clinicians, and policymakers had invested in improving mental health services in New South Wales. I entered the hospital expecting that conditions would have improved significantly since my previous admission nearly twenty years earlier.

What I discovered was both surprising and disappointing.

My hospitalisation taught me that despite decades of advocacy and reform, many of the fundamental problems within the public mental health system remain unchanged.

One of the most striking observations was the lack of therapeutic intervention. During my admission to the public system, there was virtually no therapy available. There were no structured counselling sessions, no psychology groups, and very limited opportunities to explore what had led to my crisis. The primary intervention was medication, combined with time and rest.

This led me to an uncomfortable conclusion: the public mental health system appears to rely largely on medication, containment, and the passage of time as its primary recovery tools.

My admission also highlighted the persistence of an "us versus them" culture. While there were staff members who genuinely practised collaborative care and treated consumers with dignity and respect, they were often the exception rather than the rule. Many clinical decisions appeared to be made behind closed doors, with notes written about consumers rather than with them. The language of recovery and partnership was often present, but the practice did not always reflect it.

I also became aware of the gap between policy and reality. Throughout my career, I had learned about consumer rights, recovery-oriented practice, collaborative care, and shared decision-making. Yet during my admission, many of these principles seemed absent or inconsistently applied. Procedures were not always followed, rights were not always explained, and opportunities for meaningful participation in care were limited.

The physical environment itself also left much to be desired. Some facilities were not functioning properly, while others simply did not exist. There was little meaningful activity available throughout the day. Many consumers spent long periods with little to do other than wait. For people already struggling with distress, boredom and isolation often became additional challenges.

Perhaps the greatest lesson I learned was the enormous difference between the public and private mental health systems.

After transferring to a private hospital, I experienced a very different model of care. Therapy was available. Group programs were offered. Procedures were more consistently followed. Collaborative care was more visible. Most notably, access to psychiatrists was dramatically improved. While I had seen my psychiatrist only three times in three weeks in the public system, I saw them daily in the private system.

The contrast was difficult to ignore.

My experience taught me that while both systems rely on medication, the private system is often able to provide the therapeutic and relational supports that are essential for recovery. The public system, constrained by resources and demand, frequently struggles to provide much beyond crisis stabilisation.

Yet hospitalisation also taught me something positive.

It reminded me of the importance of lived experience advocacy.

The reforms that have occurred over the past twenty years did not happen by accident. They happened because consumers, carers, peer workers, and allies continued to speak up. While progress may be slower than many of us would like, the solution is not to abandon advocacy. If anything, my experience reinforced the need for it.

My hospitalisation showed me that there is still a significant gap between the mental health system we aspire to create and the one that currently exists. It highlighted the need for greater access to therapy, stronger implementation of collaborative care, meaningful consumer participation, improved facilities, and a continued commitment to human rights and recovery-oriented practice.

Most of all, it taught me that recovery requires more than medication and containment. People need connection, purpose, understanding, therapy, and hope. Until these elements become consistently available across the public system, the work of reform remains unfinished.