Patients or Prisoners?: Inside the United States’ Mental Healthcare System
I was 19 years old and less than a month postpartum when I was admitted to psych for the first time. After months of withstanding verbal and emotional abuse from my mother, combined with the hormones raging throughout my body, I had a mental breakdown. I won’t go into too much detail about this, as it causes me a lot of distress and may be disturbing to some readers.
Regardless of why, that same night I found myself at the hospital, voluntarily admitting myself into inpatient psych. I’m not sure what I was expecting them to do for me — I didn’t really understand how inpatient treatment worked — but it was the only option I knew, and the only way for me to get a reprieve from my mother’s cruelty. So, I went. And this was a decision I would come to regret shortly.
The majority of the first night was just waiting. I waited in a cubicle in the emergency room for about an hour and a half before a nurse came to speak to me, after which I was transported to the basement, where all psych patients were kept before being transported to the behavioral hospital. None of this was explained to me at the time, either. I’m just going based off of what I know now, 3 years later.
I was led into a wide hallway, with rooms on either side completely exposed by large windows. My room was large and white, with only a single bed in the middle and a TV hanging in the corner. The TV was set to ESPN, which was absolutely torturous for me.
In this room, my vitals were taken once, and I was handed a hospital gown to change into. I figured they would take me to a bathroom to get changed, but after giving me the gown, the nurse left the room and locked the door behind him. I was left with no choice but to change right there in the room, hoping no one walked past and saw me through the window.
In the following hours, I entertained myself by playing with the sticky film on the back of my EKG stickers, avoiding the ESPN commentary in the upper corner of the room, and manually milking myself. It’s pretty gross, I know, but I had no other way of doing it and I didn’t want my milk supply to suffer while I was in the hospital.
After hours of waiting and waiting and waiting, I realized nobody was going to be coming back. I had no concept of time, but knew it must have been incredibly late at that point. Even though the room was blindingly bright, I was covered in milk, and the TV was blaring, I pulled my gown over my head and tried my best to sleep. It was difficult, as I’m autistic and have severe sensory issues, but I managed to get a few hours. I was woken in the morning and tied to a stretcher, unable to move my arms or legs, and transported via ambulance to the behavioral health hospital.
Thank god, I thought, as soon as we got there. I’m finally going to be able to shower and get some real sleep in a room.
Yeah, fat chance.
I signed myself into the facility, was asked a few COVID-19 screening questions, and was sent to wait in another waiting room. I was one of only 5 or 6 patients there, so I figured it wouldn’t be too long of a wait to get processed.
I was in that waiting room until well into the afternoon. During that time, I was taken to the back to be evaluated, where they took my shoes and the drawstrings of my shorts, and forced me to strip naked in front of a male nurse to do a “squat-and-cough.” I was given the famous infamous psych ward grippy socks and sent back out to wait. (I think it’s important to mention that I had to wear these socks into the communal bathroom, which was soaked in piss.)
By the time I was finally taken into the ward, where they would decide which unit I would be staying in, I was freezing, starving, sleep-deprived, filthy, and still extremely hormonal. I was desperate to speak to someone who would understand what I was going through and empathize with me; offer me some sort of comfort.
The woman who was taking down my information looked at me with disdain, like she was looking at an utter lunatic. I was stumbling over my words, shaking, trying desperately to explain what a horrible experience I’d just had and how I needed help, but with every plea she would just feign some sort of empty acknowledgement and continue down the list of questions. I realized, then, how crazy I must have looked. I was just like any other person she’d ever seen in this job, and she didn’t understand what had made me that way. She just thought that was who I was.
Thankfully, this intake had been the last step to getting me into a room, and I was finally able to get some sleep. I was, thankfully, sharing a room with another trans person around my age. We were in a general unisex ward, which meant that people of all types were in there with us, for all different reasons. About half of them were grown men detoxing from hard drugs, with the other half being young females suffering from mania, depression, or both. This, in itself, seemed like a totally flawed way to group people together, but that’s just how it was.
Our rooms were about 60 degrees, and we were only provided with thin, scratchy blankets to cover ourselves. As well, throughout the night, patients would be screaming and moaning, the noises echoing down the whole ward and making it impossible to sleep. The showers were tiny and triangular, with the showerhead pointing directly at the bathroom floor, leaving a flood behind every time it was used. During mealtimes, we were ushered through the halls in a straight line, and if you did not join the line in time, you were left behind and would not receive a proper meal.
The first few days I was there, I was constantly begging the nurses to let me speak with my doctor so I could explain to her that I needed to leave. The environment was dirty, the patients aggressive, the nurses apathetic, and I felt significantly worse than I had when I first admitted myself. I was told that if I had done so voluntarily, I would be able to leave at any time. It wasn’t until the third or fourth day that I finally met my doctor for the first time. At that point, I was hysterical and pleaded with her to let me go, but with one glance at me, she refused. What I said didn’t matter, but my demeanor spoke volumes.
What she did allow, however, was for me to be moved to an all-female ward that same day, for which I was grateful. She also placed a phone call to my mom requesting her to bring my breast pump, so I could stop milking myself and making a mess, and my baby would have access to real breast milk despite my not being at home with her.
The rest of the week went by much more calmly at that point, as no women were allowed on the ward that would pose a threat to any other women. The staff were rather rude to me for needing to use my breast pump every 2–3 hours, and they were much stricter about sleeping during the day, but overall it was a lot easier to get through the remaining days.
Re-entering the real world after a week of seclusion in a sterile environment is incredibly trippy. Your surroundings appear in much more vivid color, the radio is deafening, and you realize just how bright and addictive your phone can be. Every space feels cluttered and claustrophobic, and the demands of the outside world feel so much more pressing.
But, leaving psych for the first time is not the end of this story.
About 6 months later, I was still living with my abusive mother, who called the police on me one day for snapping and attacking her with a broom. Not the classiest look, I know — but after so much mental torment, it’s not unheard of to turn it back onto the other person and completely lose control of yourself.
This time, I knew what to expect when going into psych, so I was able to mentally prepare myself for the great deal of waiting I was going to face. During that time, I was lectured by several nurses over why it’s wrong to hit your mother with a broom. It was clear they empathized with me, but couldn’t understand why I didn’t just choose to be the bigger person. At that point in my life, I was starting to recognize how twisted this situation was, and I didn’t feel nearly as guilty for what I did as these nurses wanted me to be. I still stand by it all this time later. There’s only so much you can torment a person before they are going to retaliate.
Anyway, that’s neither here nor there. I was now in a much better mental state, as I no longer had those postpartum hormones ravaging my body and brain, so the experience of being in psych was much more bearable. I was preparing myself to deal with horrible patients, detached staff, and nightmarish living conditions. And the funny thing is that I did have to deal with all of these things, but the week I spent there this time around is actually one I look on fondly.
I was in the same unisex ward I’d been in the first time, but this time I was granted my own single-bed room due to my trans status, which was really nice. I did request to move to the female ward, but changed my mind upon meeting a few friends in the unisex ward.
I first met Jess, who had been arrested for a similar reason as me — her husband had been threatening to take her kids away from her, and she retaliated with physical violence. She was a very meek person, constantly crying, and I could tell she felt very defeated in her life circumstances. During the week, her father called her to tell her how disappointed he was in her, and how he’d reported her to CPS. She locked herself in her room after this and didn’t come out for the rest of the day, but we could hear her sobbing behind the door.
Another woman I met was Rachel. She had lupus, and was constantly shaking, and despite the bags under her eyes and her exhausted demeanor, she carried this air of glamour and poise that really drew me to her. She used to own her own business and was passionate about freelancing, helping marginalized people, and cooking Japanese food. She was an incredibly intelligent, fascinating, and multi-faceted person, but the staff at the hospital just boiled her down to “hysterical woman” because she loudly called out one of the orderlies for staring at her and Jess in the shower. Rachel is someone I will never forget.
Another person, whom I met towards the middle of the week, was a trans man named Danny. He was very outspoken about his radically liberal views (which was pretty fun to listen to, I must admit) and told us he had Dissociative Identity Disorder. I saw him switch a few times, and I am unsure whether this was genuine DID because of some of his other behaviors, but I am not in the business of questioning someone else’s experience, so I went with it. Danny was a chain-smoker who constantly complained to the staff about not being allowed to smoke, despite being 19 years old. In the end, he got the cigarettes, so I guess the method wasn’t too flawed. He struggled with meth addiction and relationship troubles, as well. The entire time we were in the hospital together, he was talking constantly about his fiance, only to then tell me they’d only known each other for a week. A day after I got out, I learned that they’d broken up.
This time around, the staff and the adult male patients were much worse, behavior-wise. There was one deaf man who would run towards the younger women in the ward — myself included — and cough on us (this was before the COVID vaccine, too), or raise his fist and pretend to hit us. When we complained, the orderly on duty told us he couldn’t do anything because the man was deaf, and threatened to lock us in our rooms if we didn’t, and I QUOTE, “shut up.”
I didn’t meet my doctor a single time, but was medicated with a strong dose of benzodiazepines, despite having a history of benzo overdose. Still, the overall experience was much better, and it was actually nice to get a break from my mother. The inpatient world felt more real to me than living in an abusive household, in the middle of nowhere. I got to know myself when I was alone, and not on constant guard. I got to know who I was when I was with people who liked and accepted me. Over the course of the week, I learned that I wasn’t the monster my mother had made me out to be, and this made it all the more difficult for me to go home.
I was the last of my little friend group to get picked up, so I knew that staying longer was not a choice. There was nothing really keeping me there. But still, I was terrified of what I would face when I got home, and was inconsolable in the hours before my mother came to pick me up.
In spite of the good memories I made during this second stay, now that I am living on my own and in a much better mental state, I can confidently say I am never going back into that inpatient program. There were a slew of other horrific experiences I and others endured there, but not enough time to detail them all.
Our every move was accounted for, we got very little privacy, and very little protection from the staff. Any show of emotion from the patients was met with disgust, vitriol, or a straight lack of empathy. In psych, all you are to them is another crazy, regardless of why or how you ended up there to begin with.
I know not all inpatient programs are like this, but I think the difference here is the lack of money and healthcare that most Americans have. If you have a lot of money or excellent insurance, then you will have access to higher quality care. If you’re poor, and especially if you are a minority, you are left with little options. I certainly didn’t think free mental healthcare would be great, but whatever I was expecting, it was a far cry from what I got. I hope that through this post, I can spread some knowledge on the true state of mental healthcare in this country, and the ways in which it can leave people in worse condition than they came in with.
I left my first week in psych with incredible trauma, and was thrust back into an abusive environment having to deal with that trauma. I know the same was true for Jess, as well (though I’m happy to say she has since left her abusive husband). I can easily foresee a situation in which someone left the hospital, only to spiral even further into addiction, mania, or depression. To know that this has happened to so many people disgusts me.
If you have made it this far, I would also like to call out this institution by name. The hospital I had these experiences in is called San Antonio Behavioral Healthcare Hospital, and if you check its Google reviews, you will see where hundreds of other people have shared their similarly traumatizing experiences there. Many of the reviews are met with rude, invalidating responses from the hospital, as well. But I hope that in sharing my story, you all will believe that these things absolutely DO happen — every single day — in mental health facilities across the country. The entire healthcare system in this country is infected with ableism, classism, and victim-blaming, and is just one of the many wounds in our society that needs to be healed.
If ever you find yourself or a loved one considering going into psych, please be sure to do thorough research on the facilities in your area before doing so. These places are not designed to help people, but to keep them in a box so that they cannot harm themselves or others, and keep all of their actions and behaviors on-record. It is possible that if you are admitted into inpatient psych, you may leave in significantly worse condition than how you entered.
Stay safe, everyone.
