‘The Locked Ward’ was the book I almost didn’t write. The suggestion was made to me by my agent, Stan. We were sitting at a table outside a pub in the Edinburgh afternoon sunshine in July 2010. After some talk about the direction of my fiction, and how I should have got the gig to write Susan Boyle’s biography (Subo and I both, at the time, lived in the ex-mining village of Blackburn, West Lothian), Stan said, “You should write something about that ward you worked in.”
 “The locked ward?” I said, slightly surprised.
 “Yep. And that’s your title, too.”

 At first, I thought he meant I should write a novel set in an intensive psychiatric ward. The thought had crossed my mind, from time to time. A love story. A heartening love story. With plenty of scope for comment on social issues. But no, Stan made it clear that he meant a memoir. I had shared one or two moments from my time on the ward with him previously, and he thought the raw material was there for a fascinating memoir.
 My initial reaction was an immediate ‘No.’ To me, there were far too many ethical considerations, not least patient confidentiality, to permit the writing of such a book. But Stan talked me round. There are shelves of memoir and anecdote written by medical people, he said.

 In fact, he was the agent for a few of them. There were ways to do these things.
 I said I might draft a 20 or 30 page proposal, incorporating one or two incidents and characters, and then we could see where that took us.
 I thought the notion over for a day or two. If I wrote this book, there would be plenty to interest a lay person: an abundance of incident; characters that were, as one reviewer has subsequently said, ‘Dickensian’ in their vividness; and an entire range of emotions. There were brilliantly funny moments (mainly stemming from my apprehension and insecurity) and profoundly sad ones too. I was sure I could interest people.
 But that was not enough on its own, in my mind, to justify the book. I wanted it to inform the man in the street too, to tell him something about the nature of severe psychiatric illness and how it is treated. But not as a psychiatric textbook; simply as the observations of an involved and interested party. Once I had decided that, it was comparatively simple to set down the proposal Stan and I had discussed. Thankfully, Dan Franklin liked the idea, and the project got under way.
 The greatest difficulty in writing it was deciding what material to leave out. There was, indeed, a wealth of character and incident to consider – and a millennium’s worth of attitudes to, and treatment of, mental illness. My primary consideration was to protect the people I’d helped to nurse over the years. Like I say in the book, I’d worked hard - we all had – to help them rebuild identities that had often been shattered by events. I could not have betrayed them now. Many incidents that could have illustrated a point or revealed an attitude, had to be omitted because the person involved was too easily identifiable.
 I wanted my tone to be as light as possible, so long as it was appropriate to the subject matter. And I think I’ve managed to keep the tone right, if not always a hundred percent light. As part of the process, however, I did have to cut one anecdote from the opening chapter, where I talk about my youthful attitudes to mental illness. This treated of a middle aged woman in my home town who had an ‘inappropriate’ relationship with the family dog. Through my teenage eyes, the story was bizarrely fascinating, and the way I was told about it was, I have to say, very funny.
 But, on re-reading the first draft, I felt that this anecdote, so near the beginning, struck the wrong tone, one that might have skewed the reader’s perception of the book entirely in a direction I did not want. So it had to go. Other incidents, from my time on the ward, for one reason or another, also landed on the cutting-room floor.
 But what remains is characteristic of my time on the Locked Ward, of the people I met, and of the things we did. And I hope it not only entertains readers but also interests them, informs them, and hopefully gives them pause for thought.

by Dennis O'Donnell author of 'The Locked Ward'