destigmatizing inpatient care/ what a psychiatric unit is really like

Hi everyone,

So in honor of mental health awareness month as promised I’ve done a few posts on different subjects. Like why therapy costs so much.

Today I’d like to explore something that there is a lot of stigma about from the general public and even those of us with mental illness. That is: what is it like being in a psychiatric hospital?

When people, including myself, think about a psych unit we think about it being a place of total chaos. Violent patients and staff with huge abusive complexes (think nurse Ratchit) People constantly being mechanically restrained, (tied down), constant physical aggression, people totally out of it from injections of drugs ETC ETC. Books and movies like The Bell jar, One flew over the Koko’s nest, I never promised you a rose garden ETC don’t help much in this regard.

One must consider the time period in which this media was published. In those times sadly the portrayals and practices at these hospitals were accurate. I wish there were more up to date accounts in books or movies. There are actually some in YA fiction, (Paperweight, more than you can chew, counting backwards ) many books I’ve reviewed or will review. In fact some of my favorite MH themed YA fiction are things that are set in psych treatment facilities, or therapy to compare the portrayals with reality.

So to speak from my own experience, I truly believed that these places were like the worst thing that cold happen to you hospital wise. I know that’s pretty dramatic. One of my outpatient caseworkers back when I was at FP and getting community mental healthcare worked as a psych tech. Every so often especially when she’d mentioned other clients being hospitalized I’d be like did anyone get attacked? Will they be ok, have they been bullied? Were you abused as a staff? And all sorts of things.

In my e-mail group blind mental health the topic came up of what it’s like being in a psych hospital as a blind person. I had never been in one neither had some of the other members. Though of course some had. So we ended up having a really productive conversation.

They described the routine of groups, meals, free time.What nurses and tech are like, from really good, to well less good, but by and large nothing abusive. It is a hospital after all like any caregiving organization. Anyone who did anything unprofessional would get kicked out pretty quickly. Anyway they talked about the other patients, some who were actually able to connect with them and maintain some contact after they were discharged.

We then also went into accomidations around what you could bring in as assistive devices as a blind person. Some talked about being able to have their braillenote takers, or phones (to use for writing purposes only) or laptops with them. Some were allowed their canes but most not. One person talked about their struggle around having their guide dog be allowed on the unit and mixed results on different units. I hadn’t even been thinking about accomidations when I pictured a psych unit. I was too busy thinking about the dramatic craziness I guess.

I was glad to get some education but really thought nothing of it personally. Until November 11 2013 when I almost attempted suicide and was hospitalized. I was very anxious about it but also more so completely crushed at having been found out before I could go through with anything. It’s like knowing that I was going to be made to be alive took all the fight out of me around going or not going. I didn’t care about the world anyway.

I was very fortunate. My first ever hospitalization was a really good one. The unit’s psychiatrist had worked at Friedman place for a long time and so they’d had a lot of experience working with the blind. I got to have more assistive devices there than any other unit. I got my braillenote for reading books and writing in groups/ journaling. I had my laptop which I ended up going online for. The staff was so impressed that I was using a computer as a blind person, LOL, that I guess they suspended their rule around not using it for internet. This became important as towards the end of my stay I was advocating for myself to get into facilities plus keeping friends updated.

I was even allowed my little pink nano ipod to listen to music, which one of the techs commented to another was about as soothing to me as a the meds in a shot, , though of course I got both. I was allowed to keep a stuffed animal and soft blanket a visitor gave me.

The techs and nurses were all extremely nice. They really made a point to connect with each patient ongoing throughout the day. This was challenging for them with me because I was so depressed and angry about being alive. But looking back I appreciate the effort.

They didn’t understand self-harm at all. They used the standard protocols to deal with it. Soon after getting there I was put on CVO constant visual observation. Meaning though I had all my stuff with me I had to sit in a reclining chair in the hallway the whole time, and sleep in the hallway. Constantly being around people particularly when things were noisy on the unit was extremely hard. And I had several incidents of being quite agitated and increased self-harm due to feeling trapped and there being no way for me to be alone. That being said they didn’t pester me about it or say weird things like was I hearing voices. They didn’t respect it as a coping mechanism in its own right like Jonathan does, but they didn’t flip out either. And they listened when I got really angry about everything.

There was a really good schedule of groups. They had two licensed therapists there. One was a certified rec therapist, which was really cool. Her name was Lanett. She was older like someone’s gramma. She ran half the groups and another therapist Jeff ran the other half. Speaking of half the unit was split in half. One side was for the more volatile patients and the other side was for the more calmer ones. Which cut back on issues. Though while on CVO I did witness for the first time someone being restrained which was not fun for everyone.

Anyway back to groups. We had community meeting which usually envolved going over the daily schedule and some kind of movement/ relaxation exercise. Then was coping skills group taught by Jeff. Jeff was ok. He had kind of an annoying voice and just yeah. I liked Lanett a lot better. We had art group. I made a bracelet with beads and string that I’ll always keep. They also had medication group, groups on depression, self-destructive behavior (they tried to really get me to talk in that one no luck!). In the afternoon after lunch was always problem solving group taught by Lanett. This was really general group therapy and my absolute favorite group. It was a place to talk about what brought you to the hospital and how you were working on stuff and what you were gonna do when you got out. It was where we could really open up, cry, be angry, and get support from her and the others. The patients for most of my stay there were young adults and I’ll clearly remember some of their stories. Mostly because I wrote in my journal about it all but yeah. It was such a good group. Of course it was the most challenging for me because Lannet would not give up on getting me to talk. We did form a connection and she was a very wise and perceptive therapist.

In the evening people just hung out. I think there was a computer that they’d let you on to do e-mail. I know they had a “comfort room” on the wild half of the unit, not my half, but that anyone could go to. I guess it had a nice painting and a rocking chair. Not a sensory room but not a quiet room. They were moving a step in the right direction.

My stay was almost three weeks. Here in IL the minimum is five days. I know other states it can only be 72 hours. To me that’s not nearly enough time. I find the hospital helpful for adjusting meds which I would not want to deal with on my own, even here at Albany. They just don’t have the same level of constant supervision and peace of mind of knowing doctors are right there just in case. Also being there gives you time to just settle down, reflect on what’s going on get a different perspective and do things like these groups that if run right do really help. I was so lucky that I saw the hospital as a welcoming safe place my first visit.

Every unit is different. Sadly when I got here I couldn’t work with that same psychiatrist. I was assigned a psychiatrist who was really good at working with psychosis and that type of meds, but not so much everything else. And he hospitalizes at the drop of a hat. You tell him someone had a little tantrum and he’d sendthem to the hospital. So I was hospitalized at that unit twice. Once was new years where like I said in another post I’m lucky I lasted here that long. That said it didn’t really help me. He stopped one of my meds without tapering. Put me on something else that I had to ask the nurse what this new pill was. I saw the social worker a couple times. She seemed really nice for one meeting and then didn’t want anything to do with me. I couldn’t even find out when I’d be discharged until like a couple hours before. On top of that there were like no groups. You basically lay around all day in your room or dayroom. I was on one to one where they took away literally everything, I’m lucky I had a pillow. I could not have anything to do I always had to keep my hands visible, (not one under the pillow like how I sleep) And yeah. And had to wear disgusting hospital underwear and not my own clothes which I would have been allowed. CNAS often from other floors had to sit with me 24/7. The head of nursing was not happy about this because it meant extra people had to come in. So she badgered me into signing the stupid safety contract which I felt like throwing in her face. Basically nothing got accomplished.

The next time I went there was in March. I had actually again almost attempted suicide by trying to smash a roommates glass nail polish bottle. Well I never even was asked about this incident. Basically I was on one to one for a couple days. The rest of the time I was completely left alone. Literally no one met with me. It was the most stupid experience of my life.

So after which I switched psychiatrists. The next guy had an awesome psych nurse. She was great. If she had been hospitalizing at a different unit it would have been awesome. But no. You only see the actual psychiatrist in the actual hospital. And he too is quick to hospitalize though not as obsessed as the other guy. My two hospitalizations in 2014 were back to back. Making the whole month of june one long hospital stay. Again I was on one to one. But these people were in no rush. So I just sat there with a staff right there. Some were really good and talkative. I liked a coupleof the techs who happened to be male who had worked in girls treatment centers and actually got cutting a little. Some of them didn’t speak English well so that was hard. I was actually in a room for some of the time with a resident from here so that was kinda annoying. Some staff just sat and texted listened to music on their phone or studied for school. One guy was so immature he made bathroom jokes and was totally just weird. I slept a lot of the time. I was allowed my braillenote. But all other stuff was locked up. They have a no personal possessions rule. So my poor stufties were not even allowed.

There was a horrible week in there where my braillenote charger was switched with some guy’s assistive speaking device charger. It took a couple days to figure it out. And though common sense would say to call the patient’s family and tell them of the switch they said they couldn’t do that. So I had to sit a week with literally nothing to do with my hands. Which for a blind person needing tactile stimulation was completely terrible. I had more incidents of aggressive self-harm physical aggression to staff ETC then ever due to the lack of stimulation. Visited the quiet room a few times. A cold bare empty room which was not in the least helpful. Basically they put you there til you calm down from the shot. So finally the guy’s sister noticed something was wrong and the last few days I got my braillenote back. Everyone reported how I was suddenly doing so much better! Duh I had stimulation again funny how that calms your brain down.

So to sum up this very long post experiences at psych units vary widely. I’d love to get lots of comments to show this and hear about others experiences. It all depends on the rules/ structure/ environment of the unit, the staff there, and other patients. A unit could be great but if you’re with a bunch of agitated patients it’s less good. You could be in a good unit but what does it do if you’re only there three days? I think that if a unit does have a nurturing compassionate environment, where staff truly want to listen to patients and work with them then it’s helpful. I still maintain for myself that I will go inpatient without hesitation if I feel I need it. Again for med adjustments or if I’m simply so overwhelmed I can’t function day to day and know I need the recharge. And the good news is that with the new good psychiatrist I have she does work at an excellent unit. She also is very wise about hospitalizing only if absolutely needed. And she works with the caseworkers here, and I’m sure patients on the outside to determine this as it should be. For all the ups and downs I promise that the negatives never lived up to my dramatic horror stories. Nor have any of my friends. I think inpatient is one of those things that’s such an individual choice. It can be good or bad or completely out of the question depending on a person’s individual reasons. I feel that ideally patients should feel able to explore this with doctors and others like their therapist and that the best possible inpatient environment should be available to everyone if needed.

So now that I’ve talked your ear off from an hour would love to hear from you. What’s your experience been like inpatient? If you haven’t gone what are your thoughts on why or questions if you plan to go? I would be happy to answer anything that could help a new person feel a bit more not alone or talk to someone once they get home to process. Also interested in experiences of those with MH/ other disabilities and how those were accomidated or not. Look forward to hearing from people!

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5 thoughts on “destigmatizing inpatient care/ what a psychiatric unit is really like

  1. Hey Sammy-Girl.

    Psych Units at hospitals can vary, as you so well pointed out. I have been to two different psych units, and both are fairly good. The one psych unit that I do go to now… (which is one of the two that I’ve gone to) I still consider a very good psych unit. However, like most psych units, you still have issues on the unit.

    I think, Sammy, that I’ve told you about my last stay there. Two patients were constantly having altercations with each other – which were mostly initiated by one of the two guys. I was only in the unit for five days, and you know what? I was actually grateful to be able to come home at that point instead of the usual one to two weeks that I normally stay in the unit.

    And you know how this place irritates me to know end. Overall I like the staff at the unit, but there is one or two that I don’t care for all that much -one of which is a nurse. He works the evening shift… has a very monotone/evenkill voice that just rubs me the wrong way. And every time he talks to me, I feel like he’s talking down to me / treating me like a child, etc whenever he is my nurse.

    Most of the others are pretty good. I don’t have too much contact with the overnight staff, as I’m usually knocked out by ‘lights out’. For the most part, I have had good roommates, and even had the chance to have a private room for a few days during one of my stints in the unit. I doubt that that will ever happen again.

    They have some decent groups, but it does get repetitive if you’ve been in the unit multiple times. I actually find that soothing in a sense – I pretty much know what to expect and all that.

    The unit has seen me quite a few times, and when I go, I am usually a direct admit. That basically just means that I go directly to the unit instead of going through the ER/Crisis Unit. I actually prefer the direct admit thing than going through the crisis unit, but that’s just me.

    There have been a few times when I’ve gotten to the unit pretty dang late in the evening. There has even been a time or two when I’ve gotten there past the change of shift (11 pm). How I managed to stay up that long with my meds in me, I have no idea. But I did. I think that was one of the few times that the staff was actually seriously concerned about me and wanted to put me directly into the observation room for the night.

    I’m not entirely sure how I managed to avoid that, but I did.

    In both units, I was able to get my medications relatively on time (which for me, is a good thing)… had decent meals… and the like. At the one psych unit that I go to, when they say 9 am meds, they usually do pass the meds out around 9 am. Same thing with the 5 pm and 9 pm meds. 6 am is usually between 6 and 7 am.

    Both units that I’ve had been on had pretty sucky showers in the rooms, but had good public showers.

    Most days, the psych dr was on the unit. There has been only one time where the psych dr. was in on the weekend (as in she had a coverage person), which was unusual. But it did work out… so no biggy.

    Not sure what else to say at this point; if I think of anything, I’ll let ya know.

    • Hey. Thanks for the comment! Yeah I’m really glad that overall you’ve had good experiences. It means for you the hospital is a safe place to recharge and get things adjusted and be in a different routine for awhile. Fighting can be hard. At thorack there were a lot of agitated people and you could hear them banging on the safety glass and yelling in the quiet room which was hard. Hated that room. I’m glad you have the soothing room there.

  2. I’ve had mostly good experiences in psych units. there have been a few incidents, but nothing really dramatic. i have seen people restrained, given shots, etc. it wasnt pleasant. but overall the hospital has been ok for me. i always go to the same unit. there isnt much choice here you have to go where your psych doc works from. xxx

    • It’s so different seeing how different countries do things. Like here in the US there are very few cases of people being in the hospital for months and months. In Ireland the netherlands UK ETC it seems if the powers that be decide you could be in the hospital for like a year or something! These section level things just sound nasty. I was surprised you were able to do things like go out on passes. This used to happen in hospitals here but now with insurance no way. What I find discouraging is hospitals where you can only stay a few days. You can’t even see if a med is working in just a few days.

      • Yeah we get to go out after a while of being in there. It’s good. It helps get things back to normal. Sometimes if people have been in hospital for a long time they get to go out overnight before being discharged, like they will go over night for a couple of times before their discharge

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