Lori Colbo's personal experiences, research, and writing on mental illness have given hope and understanding to those affected by it.
In this article, I will share more of the formal things, like the admission process, procedures, and how things are generally run in psych wards or psych hospitals.
I would very much like to hear your experiences in the comments. It may be different than mine, but I think sharing our experiences can perhaps help us to get involved in advocating for better policies, rules, and laws for better treatment.
Mental Health Crises That Might Lead to Inpatient Treatment
This is about voluntary admission only. Between 1999 and 2008, the criteria for voluntary admission into a psych ward was much broader in my county than it is today.
- The person had to have symptoms that impaired one's 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 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
I have never been involuntarily committed to a psychiatric unit or hospital so I don't know the details about that type of experience. This is about voluntary admission. 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.
Always expect several hours of waiting just for someone to see you. Then waiting for the admission process. Sometimes waiting 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. These encounters are not very compassionate. Some not at all. I went to one hospital ER that had the "special room" for ER psych assessment. It was old and beat up - scuffed institutional colored walls, an exam table like apparatus that looked like it came out of storage and that was it.
The man who assessed me was cold, impersonal, and had no business being in his line of work. It's not what he said and asked, it was his tone that left me feeling like I was scraped off a dung heap and dragged in. It was evident he'd rather be treating feral cats than a psych patient. Fortunately, this was not my typical experience. Most of my stays were with two specific hospitals, and I was usually treated compassionately or at least cordially.
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 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).
Having the security experience was humiliating to me my first time even though they were kind and professional. They found a big long nail in my purse that my little boy had put in there. I forget why but it brought a moment of levity for me, my friends, and the security guy.
After the intake and security check, I was always taken to the ward and a more extensive assessment was done. My treatment and how the things are done were explained to me. I was shown to my 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 also went through my belongings and took away things that might be used to harm myself 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.
I was always given the option to be to keep my presence there confidential or not. If someone calls asking questions and you don't want them to know you're there the staff will not tell them. That is a legal right.
Seeing a Doctor and Having One-on-Ones With a Staff Member
It is usually customary to see a doctor at least every couple of days in the hospitals I've been to. One made it mandatory daily. I'm sure these policies vary. Some hospitals only have one or two doctors on staff, others have several that rotate. When it came to doctors, I preferred the hospitals with only one or two because they tended to be better qualified and professional, and they were more invested in the patients. The only negative part of my experiences was that they had a rotation of several doctors and they were all pretty lame. There was a large turnover. First of all, most of them had private practices so they'd come in early in the morning and only stay until ten or eleven or so. There were two or three doctors there that couldn't hold down a job in private or group practice.
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. It has been my experience that most psych ward 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 were always helpful and meaningful to me, with an occasional exception.
In my opinion, there is never an excuse for having a dreary environment in a psych ward, but it is often true. Some units I was on were old and worn with little cheer. In need of fresh paint, and a pop of color would be nice. If there was anything on the wall in the old places, it was old and ugly, or nondescript.
Furniture is typically well worn, which is understandable with so many people using it every day, but some places had furniture that looked like they found it in a yard sale from the 70s.
The hospital I went to most often was modern. A little worn here and there, but pleasant from the front desk lobby area to the bedrooms. They had artwork on walls here and there and that was pleasant.
"Hospital beds are comfortable," said no one ever, and the beds on psych wards are more substandard than those on the standard medical units. The dining areas are the same - a little fridge and cupboards with snacks and drinks, coffee maker of some sort, napkins, plastic or paper cups, and plastic spoons and condiment packets.
There is always a rec room or lounge where books, outdated magazines, puzzles, games, art supplies, and a television are available. Television is always scheduled and supervised.
Hospital bathrooms are the same wherever you go. White, tiny little sandpaper bath towels that couldn't wrap around a baby. If you don't have your own toiletries from home, you're stuck using the little hospital issue ones.
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 ward 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 medications, grief and loss, to symptom management. There are yoga, relaxation, and exercise classes, and always recreation therapy consisting of art projects with a therapeutic purpose or lame 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. 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.
Most psych wards have movie nights with popcorn. The movies are carefully chosen. Anything with violence, explicit sexuality, paranormal, psychological thrillers, etc. are not in the DVD library.
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. Most places give the option to not allow staff to tell callers that the patient is there.
Difficult Staff Members and Doctors
It doesn't matter where you go for professional medical care or why you are always going to run into difficult medical personnel. Some are bristly, some are overworked and exhausted, some or 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. 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. It makes me feel as if I'm free-falling or abandoned. Fortunately, in a hospital setting, I haven't experienced it often.
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.
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.
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.
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 places that keep more severe cases; people who stay there for weeks, months, or even years.
I visited a state mental hospital once. A group of comics and I performed for the staff and patients. It was a sad state. The patients were so drugged they didn't laugh. Only the staff laughed. How some places get away with being unsafe is beyond me, but I recommend to be a squeaky wheel. All people deserve respectful humane treatment.
Please leave questions and comments below. I would love to hear from you.
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
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 Pacific Northwest 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 Pacific Northwest 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 Pacific Northwest 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.