The Life and Times of Inpatient Mental Health Care: What Needs to Get Better

L. B.
L. B.
Aug 28, 2017 · 6 min read

There’s a problem with the psychiatric units in general hospitals in America. I know, because I’ve been to them more than I care to tell.

I still remember my last visit in March, laying on a paper-coated bed in the back of the ER, in a cold and flimsy dressing gown that didn’t tie up right in the back. I was there for cuts on my arms done with a fine needle. If anyone asked if I was a danger to myself or others, the answer would have been a firm no, but I was weak and scared at the time and my mental state had certainly deteriorated, so I volunteered to be admitted and have an extended stay.

The unfortunate thing about these units in a general hospital is that they are where each and every person suffering from an episode goes, and not all episodes are equal. The only designated quarters for these people in the hospital are equal and share patients. This means that for an autistic patient, such as myself, the only room I get to stay in during what is supposed to be my stabilization and treatment is the one shared by patients who are very ill — who scream and break things and can’t handle the sole radio in the room being at a different station or a lower volume. The nurses are similarly equipped to deal with patients in an equal way — Everyone is out of their rooms at 8, quiet time only happens from 2 to 4 pm, bedtime is at nine. The rest of your time is spent in the communal room, where people of all disorders bide their time by trying to keep their cool to get out sooner or joining in chaos.

I can’t count how many times a nurse was rude to me for asking simple questions about why my pills, which helped with my insomnia, were changed without my being informed. How tired en masse they were of dealing with everyone, from the worst cases to the most simple. I verged on somewhat annoying to them, because sensory overload was getting to me and because I could take no objects in with me that could comfort me or calm me down, even as simple as a blanket that smelled like home. I could feel myself worsening under their care instead of getting better, but lord, did I fake being better the best I possibly could. That’s what everyone in the ward was concerned about, and would warn me if I got upset with our mutual treatment — keep your head down, take your pills, get out. Not ‘get better’, get out.

I took my pills. I pushed down every bit of meltdown and overload to put on a smile and a recovering face. I sat down next to the people who were coloring pages and colored a few myself. I attended lectures I couldn’t stand, almost none of which focused on a topic relevant to our very individual problems for being there. It was mental health filler. One of our speakers hadn’t been a very good one — he wouldn’t dim the lights for people who were reacting badly to bright lights due to medication, and he used us as a soundboard for his own history with mental illness rather than using that knowledge to relate to us.

The same man trapped me in the rec room (a broken exercise bicycle, a few chairs, a table, and a flatscreen TV) to talk about how good he was at dealing with mentally ill patients, that he feels like he really reaches out and grabs at them and how it fulfills him when everyone who left the room after his sessions thought he was a self-centered crock who was more inspired by his own recovery to understand the differences between himself and those that hadn’t recovered yet. I’d felt so distinctly uncomfortable that I had written about the scenario on my review for my stay.

The phone (the singular phone we were allowed to use, anchored to the wall) was my lifeline out of that place. Talking to my friends for the ten or so minutes I was allowed gave me the power to keep going, to talk to them again in an hour or so. One of them sent me a package in the mail, something the nurse remarked with rude curiosity that it “simply never happened,” with the kind of suspicious implication that my breakdown was premeditated, and not “my friend cared enough to send me mail”. My visits with my family were only occasional, and one night a friend visited and I simply cried against her — not because of the distress that had put me in the hospital, but because the hospital itself had become the distress.

There needs to be individual accommodations for individual patient problems. The cover-all therapy was almost useless to everyone there, with people only half-filling out their sheets and working on their own projects and crafts instead. If one person had several 5–10 minute sessions individually than a few hours with the entire group, I have no doubt it would have made more of a difference. We had that with our doctors, but for no longer than three minutes and sometimes, we had to wait for them until 10 PM.

There should be no reason to group mutually distressing patients together. People with autism, anxiety, and being prone to overload should have the option of leaving a room that is unbearable for them and returning to their own instead of being offered “the isolation chamber” and its constant radiator hum and searing white lights. People who need their medication adjusted in order to feel stable and otherwise don’t pose a threat to themselves or others should be able to have access to a normal hospital room, and the amenities allowed to a normal patient. For some, like me, the internet is not a source of stress — it is my support group, who are willing to help me through hard times and cheer me up, and something I’d absolutely need in a time where things were stressful enough to be hospitalized. Noise cancelling headphones should be an available option for anyone who needs them and has them to use.

When you put people with anxiety, ADHD, depression, autism, bipolar, OCD, dementia, schizophrenia, and other illnesses in the same room, there is only so much you can do before overlap between them becomes antagonism. To stress: I don’t mean these people can’t get along in real life as completely ordinary people. I mean in the context of things going so poorly for them that they have been hospitalized meant tensions were high and the worst parts of the illnesses we shared were out. This is what happened to me time and time again. At times, I was at my worst. People who I considered friends would suddenly come out at their worst. People who had spent the entire stay in total agony would relentlessly and helplessly act out while nurses only had enough patience to make sure they ate their food and took their pills, at which point their job was done.

I understand it must be the hardest job in the world, and your empathy for the mentally ill must run out faster than a high school teacher’s believability for a reason to go to the bathroom. I understand there are probably nurses who work very hard and take passion in their job. There was one or two who had gone out of their way to be kind and talk to me individually — others were the same kind of late twenties-early thirties out of nursing school and already deeply tired and exasperated with their job.

Even understanding how hard their job is, it’s just not enough.

People in post-surgery don’t have a communal room where they’re forced to 20 year old VHSes about the positives of coming out of hip replacement, regardless of how many people in the room actually had hip replacement. That’s because their treatment is private, well-monitored, and most of all — prioritized as comfortable. They are evaluated on a case by case basis instead of insisting on being thrown in with the rest of the ‘mentally ill’ and forced to adhere to a schedule that helps some and worsens others.

There’s no reason mental heath hospitalization can’t be healthy, considerate to all different cases, treated on a scale of severity, and planned beyond “adjusting medication rapidly until you’re used to it.” When we consider hospitalization, we acknowledge that we need help. As someone who has very recently considered hospitalization, I decided against it, because even in the state I’ve been in the past few weeks, nothing would worsen it more than what I experienced in March.

I’d rather take instructions over the phone from my psychiatrist’s nurse than risk my wellbeing at the behavioral ward unless I am ever truly in the kind of danger that merits intervention — whether the visit helps make me better or not.

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