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What It Is Like to Be in a Psychiatric Ward

Lori Colbo's personal experiences, research, and writing on mental illness have given hope and understanding to those affected by it.

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Entering a hospital for psychiatric treatment can be a very scary prospect. First of all, there is the stigma. 'What will others think if they find out?'

Secondly, our minds immediately go to Hollywood's depictions of such places which are rarely even close to accurate.

Fear of the unknown is what keeps people away sometimes.

In this article, I will share the admission process, procedures, and how things are generally run in psych wards or psych hospitals. Some is based on personal experience.

Not every hospital is the same and protocols may differ in each state or county but this is a general explanation of the procedures.

Mental Health Crises That Might Lead to Inpatient Treatment

This is about voluntary admission only. Here are some criteria for being admitted to a psychiatric hospital or unit.

  • The person has to have symptoms that impair their ability to function in daily activities, to care for oneself, and/or to keep themselves or others safe. These would be situations in which outpatient treatment was not intensive enough to protect the person's safety.
  • Acute severe depression
  • Acute severe psychosis manifesting in hallucinations (auditory, visual, sensory), delusions, and paranoia
  • Suicidal ideation

In 2009, a for-profit company took over the mental health system here in several counties in my state and they shut down all but one hospital unit. The only people they took were people who were a danger to themselves or others. They are now out of our county, and they have set up a new system.

Process of Being Voluntarily Admitted

It is standard protocol in most communities around the nation to go through the emergency room of a standard hospital when the crisis hits (some people of means go to a private facility and check themselves in or by recommendation of a doctor). Family members or friends, the police, or a therapist may take or send you there. Some people go alone to seek help.

You can expect several hours of waiting just for someone to see you if you go to a regular hospital. Sometimes it's much quicker. It depends on the number of people in the ER. Private psychiatric hospitals offer a much quicker process. Then there is the waiting for the admission process. Sometimes there is a wait for a bed. Some hospitals have special rooms or sections of the ER for psych patients and have mental health professionals there, or on-call, to come and assess. It does not speed things up much.

Most often a general doctor will see you first. Sometimes it's a mental health social worker or DMHP (designated mental health professional) who has specific training. Hopefully, the staff is compassionate.

Every hospital has its own rules, and there are state and federal laws and guidelines on the types of searches they do. A security officer will scan you with a wand, empty pockets, purses, wallets, backpacks, etc. There are strict laws about strip searches and are not allowed except under strict, specific situations for which there is an assessment process to it. It is usually conducted only when there is warranted suspicion or risk of drugs or weapons. There are state and federal laws to protect the privacy and dignity of vulnerable patients (See the Mental Health Declaration of Human Rights later on in this article).

After the intake and security check, you will be taken to the unit and a more extensive assessment is done. Your treatment and how the things are done are explained to you. You will be taken to your room and given a tour of the unit to know where things are and told the rules and information on how the program is run. The staff might also go through your belongings and take away things that might be used to harm yourself or others (universal standard protocol for all psych units). If and when you have a bag full of clothes and toiletries etc. brought in from home, they will go through that as well. Shoelaces, razors - electric and straight - scissors, nail clippers, and anything with a cord are taken and put away and can be used under supervision. Cell phones are also put away. Some units will allow brief use with permission and supervision, others not. This is disappointing for the patient, but it's a good rule. People are preoccupied with their phones, texting, calling, and internet activity. It's too much temptation for patients to spend all their time on their phones, even during sessions and groups.

Read More From Patientslounge

You will be given the option of whether you want people to know you are there in case they call to inquire or show up. That is a legal right. If you want your privacy

Seeing a Doctor and Having One-on-One Time With a Staff Member

It is customary and mandatory to see a psychiatrist at least every couple of days. They will assess your progress and medication needs. Some hospitals only have one or two doctors on staff, others have several that rotate.

When seeing the doctor for the first time he or she will ask lots of questions about your psychiatric history, your present issues that brought you in, then go over medications. Often times doctors throw a lot of new medications or higher doses of what you are already on. Benzodiazepine medications are used often upon admission, at least (Xanax, Ativan, Klonipin), because patients are often stressed and agitated.

You have a right to request another doctor if you are not satisfied with the one you have if another one is available.

It is usually a goal for patients to have one on one time with a therapist, nurse, or social worker at least once or twice a day to touch base, or to deal with something the patient is going through. The practicality of that depends on the patient population, urgent matters with another patient, or some other difficulty or challenge. But those one-on-ones are very important and helpful because the patient has the undivided attention of a caring staff person. It helps them know they are not alone and forgotten. It's an opportunity to express your anxieties, questions, and feelings. The staff person can give you advice and counsel.

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Accommodations

Decor varies of course. Units in regular hospitals tend to be more pleasant. Although most of the furnishings are non-descript, they are modern, much like you see in doctors' office waiting rooms. They have nice art on the walls here and there. And almost every psychiatric unit or hospital has patient artwork or poems pinned on the walls somewhere. It's fascinating and impressive to see how much a person can express how they're feeling or see life in a piece of artwork to poetry.

Furniture is typically worn, which is understandable with so many people using it every day.

Unfortunately, there are the occasional old and tired environments. It makes the new patient more apprehensive when they first arrive. But usually, the staff come through to make your experience more pleasant and helpful.

"Hospital beds are comfortable," said no one ever, and the beds on psych wards are no exceptions. The beds are not standard beds you find in regular hospital rooms. They are single beds with no mechanical apparatus. Some look like your bed at home but with a thinner mattress and flatter pillows. Each hospital is different, but most offer double or triple occupancy. A single room is not the norm. They usually will have some sort of painting on the wall. Something to make it a little homier.

The dining areas are the same - a little fridge and cupboards with snacks and drinks, a coffee maker of some sort, napkins, plastic or paper cups, and plastic spoons and condiment packets. The refrigerator and cupboards are kept well stocked with snacks and drinks. Commonly the fridge holds puddings, jellos, yogurts, sandwiches, cream cheese, bagels, and juices, and milk. Coffee and tea are always there with cream and sugar, and graham and saltine crackers in abundance. As to menus and cooking of meals, it varies from place to place.

There is always a rec room or lounge where books, magazines, puzzles, games, art supplies, and a television are available. Television is always scheduled and supervised. There is often patient artwork on the walls.

Hospital bathrooms are the same wherever you go. Smaller, white, sandpaper bath towels like you find in Motel 6. If you don't have your own toiletries from home, you're provided hospital issue ones. You are usually allowed to have someone bring you towels, toiletries, and blankets from home.

There is usually a whiteboard in the lounge or dining area with the schedule or other necessary information.

Some wards have two or more rooms for classes and groups.

Activities and Schedules

Psych unit life is highly structured. Some places let patients rest in their rooms the first day. Others not. Classes, groups, meals, leisure, visiting hours, and bedtime are all scheduled. Some are more rigid than others about letting patients bow out of groups and classes.

Days are filled with educational classes and therapy groups. Educational classes ran the gamut from learning about mental disorders to medication information to strategies for symptom management. There are yoga, relaxation, and exercise classes, and always recreation therapy consisting of art projects and therapy games.

Therapy groups vary from hospital to hospital. There is almost always a touch base group where patients check in with each other in the morning and in the evening. Sometimes it is goal setting for the day. On day one, brushing your teeth may be the only thing you can do. As the days grow, so will your goals.

Processing groups, grief and loss, and other thematic therapy are also on the schedule.

How effective classes and therapy groups depend on a variety of factors: The condition of the patient, the willingness of the patient, the skill and personality of the therapist, the curriculum, design, or the subject matter. You will find good and bad no matter where you go.

Leisure is necessary. There is a lot of napping on breaks. Some people like to sit in the lounge or dining room alone or with one or two others to chat or do something in the rec room alone or in a group. Television may be allowed on breaks. These are times when patients begin forming relationships. It's wonderful to identify with other in your common struggles and lighthearted conversation and laughter are a blessing beyond measure.

Most psych wards have movie nights with popcorn. The movies are carefully chosen. Anything with violence, explicit sexuality, paranormal, psychological thrillers, etc. is not in the DVD library. These may trigger some people so the programming is usually light and upbeat.

Visiting hours can be wonderful, lonely, or stressful. No visitors can be hard and if there are toxic family dynamics it can be very stressful. But usually, it is a great blessing to know you are not forgotten and to have that connection with family and friends.

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Difficult Staff Members and Doctors

Most staff members are caring and work there because they care. But it doesn't matter where you go for professional medical care or why, you are always going to run into difficult medical personnel or even the person running the front desk. There may be the occasional bristly one; some are overworked and exhausted; some are inept or rude, or they have no bedside manner. In a psych ward, it's even more important to have someone who is connected, kind, and present. and most are. On the other hand, working with psychiatric patients who are in crisis daily can be taxing on a professional. Sometimes, a nice one will have a bad day, as we all do. I think the worst kind is the one who is indifferent and disconnected.

The Citizens Commission on Human Rights has created the Mental Health Declaration of Human Rights (PDF). It is for every person receiving mental health treatment, inpatient or out. This should be displayed somewhere on a psych unit and outpatient clinic and made available at any time. It will be shown to you upon entering treatment hopefully. If you experience a violation of any of these rights you must report it so it won't happen again. It can be hard if you are still suffering from mental health symptoms. If that's the case, employ the help of a loved one, friend, outside doctor, or a mental health ombudsman.

Sometimes, it's simply a matter of telling the staff person in a respectful way how they are making you feel or affecting you. Here are some examples:

  • I feel like you're rushing through our time together.
  • I feel like you're not listening or understanding me.
  • Your tone of voice sounds impatient. Can you tell me why?
  • That was rude or snarky.
  • I'd rather talk to someone else right now because I feel like _________ (fill in the blank).

Keeping your cool is not always easy but as in all things in life, how you approach or respond to someone can make things worse. But there is no excuse for not treating patients with respect. You can always ask for another staff member. If you feel someone is consistently rude or otherwise mistreating you it's important to report it. Find out from another staff member to make a complaint.

I had an outpatient therapist who was always glancing up at the clock. I felt like she was just bidding her time until she could have a break. I finally told her how I felt. She stopped and things continued well. I had another therapist at a clinic who rarely said anything except to ask an occasional question, or sometimes she would say, "Boy, you really are depressed." She had worked there for 20 years and was just there for the paycheck. I told her I was there for therapy which involves the participation of the therapist and I had plenty of friends who were good listeners. It surprised me that it seemed baffling to her. She tried to say more after that, but she was so inept at it. She quickly slipped into her old ways and I requested another therapist. They gave me another one who was nice enough and did all a therapist was supposed to do, but she seemed depressed herself and was distant She had trouble making eye contact. I figured she was going through something in her personal life (therapists are human) and rather than say something, just asked the front office for another therapist. I wasn't angry. Sometimes, a therapist and patient just aren't a good fit. That's life. You can always try another.


Safety Practices

Most psychiatric hospital units have a locked door (0pen doors are out there but not common). This is for safety, not punishment or demoralization. What are the safety issues? Consider these:

  • Some patients may be agitated, confused, aggressive, paranoid, suicidal, or experiencing symptoms of psychosis and could be a danger to themselves or others.
  • The possibility of someone attempting to bring illegal substances, alcohol, or weapons.
  • To prevent the coming and going of strangers with no purpose.
  • To protect the safety and privacy of patients who may have no desire to see anyone or certain people who might upset them.

There was a study done in Germany on locked wards versus open wards. The final result was that Locked wards saw no reduction in the rates of suicide, suicide attempts, or absconding.1

Personally, I would much rather have a locked unit. It's never comfortable realizing you are locked in, but I can remember an unwelcome visitor who was a threat to my emotional well being (there was no threat of physical harm) and part of the reason I was there in the first place. I had not put any restrictions on visitors but when this person showed up they asked if I wanted to see him. I said no and he was turned away.

Most units have a safe room or isolation room for patients who are a danger to themselves or others. They are now reevaluating this and may phase it out.

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Some Bad Facilities Still Exist

From my research and speaking with professionals and patients, there are some facilities out there that are dreadful scary places. These are usually state hospitals but sometimes private ones that keep more severe cases; people who stay there for weeks, months, or even years.

I visited a state mental hospital once. My comedy classmates and I performed for the staff and patients. The patients were so drugged very few laughed. Only the staff laughed. Afterward, I gave it some thought and decided at least they got a pleasant reprieve for both patients and staff. I was thankful that the hospital provided something like that for them.

Please leave questions and comments below. I would love to hear from you.

Sources

1Locked wards vs open wards: does control = safety? (2016, July 29). National Elf Service. https://www.nationalelfservice.net/mental-health/suicide/locked-wards-vs-open-wards-does-control-safety/

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2020 Lori Colbo

Comments

William Kovacic from Pleasant Gap, PA on April 25, 2020:

Thanks for sharing a lot of good information, Lori. Looking forward to Part 2.

Lori Colbo (author) from United States on April 19, 2020:

Thank you Dora.

Dora Weithers from The Caribbean on April 19, 2020:

Lori, thank you for sharing your insights and observations on this matter. I like that you mention both the lows and highs of the experience. This is an important, helpful education that you are offering.

Lori Colbo (author) from United States on April 16, 2020:

Ruby Jean, I so appreciate your sharing your experience from the other side of the bed so to speak. I wish more people understood that mental illness is like any other illness. I might email you sometime and ask you some questions. God bless and thanks again for sharing.

Ruby Jean Richert from Southern Illinois on April 16, 2020:

Your article was interesting and easy to understand. As a nurse, I've worked on a psyche ward. It seemed that everyone had a story to tell. It takes patience and a willingness to listen and learn. I had one close call with a young man in his 20's. I couldn't find him after searching extensively. I later found him at the back of the building with his head in a plastic bag. He had passed out from sniffing glue. I think the most important aspect about mental illness is for everyone to know that it is a disease like any other disease, it needs treatment.

Lori Colbo (author) from United States on April 16, 2020:

Bill, im in full agreement about government. Interestingly, the statistics show that during this pandemic crisis calls have gone up 800%.

Pamela Oglesby from Sunny Florida on April 16, 2020:

Lori, This is a wealth of information that is excellent. As an RN I never worked in a psychiatric wad but I have worked in the hospitals and I had training to work in a psychiatric ward. However,you are more knowledgable than I am.

I appreciate all of the personal information you shared. There are sure good and bad situations. You have spelled things out very clearly.

Stay safe and healthy, Lori.

Bill Holland from Olympia, WA on April 16, 2020:

Great information, Lori, and I love that you shared your own experience. Now if we could just convince the government to stop cutting funding for these services, and raise the funding tenfold.

Blessings to you always!

Eric Dierker from Spring Valley, CA. U.S.A. on April 15, 2020:

Wow, this is very interesting. We must follow the rights as laid out. People understand a flu or a broken leg, but these issues need more education of the general public. This is a good service Lori, thank you.

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