Hospitalization in a psychiatric facility

brainstorm77

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I would like to know first hand how you felt as a patient. Were you treated well? Did you get the help you were seeking? In your opinion was it a safe place to be. How did you find the nursing and medical staff?

PM me if interested in offering some insight. Confidentiality promised.
 

Xelebes

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Do you mean an in-patient psych ward/psychiatric emergency ward or a psychiatric hospital? Or both?
 

brainstorm77

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Do you mean an in-patient psych ward/psychiatric emergency ward or a psychiatric hospital? Or both?

Whatever applies to the individual situation.
 

Xelebes

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Well, there is a difference. One is for crisis management (from days to weeks) and the other is for long-term care (for years), usually for the criminally insane and for people with long-term violent behaviour. (In Alberta specifically.)

I have only been in the emergency psych-ward for catatonia and have only stayed for three or four hours until my catatonic episode was resolved and somebody came to pick me up. I didn't really get to experience the whole deal with the overnight stay and everything but the docs and nurses treated me nicely and the room, although spartan and full of fluorescent lights, was pleasant.
 

shadowwalker

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Well, there is a difference. One is for crisis management (from days to weeks) and the other is for long-term care (for years), usually for the criminally insane and for people with long-term violent behaviour. (In Alberta specifically.)

Just a quick note - down here (Minnesota anyway), crisis management is only for a few days; hospitalization can last from a couple weeks to several months to years.

Also, "criminally insane" is an archaic term and really meaningless. As a person with an MI and from others who have voiced the same strong dislike for the term, I find it a bit insulting for the connotations it places on everyone with an MI.
 

Rufus Coppertop

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Also, "criminally insane" is an archaic term and really meaningless.

How about "forensic clients?"

Speaking of archaic terms, I once worked at a community residential unit for three elderly women who had spent their entire lives on the back wards of Gladesville hospital in Sydney. This was in 1993.

They were "de-institutionalized" from a dreadful place with old sandstone buildings and hideously rambling instutionally green gardens filled with disgustingly institutional oak trees and flower beds and an absolutely miserable view of Sydney harbour.

They were dispatched off to a nice, uninstitutional, freshly painted and carpeted, fibro cement dogbox in a nice, uninstitutional suburb called Mascot right under a totally uninstitutional flight path of one of the airport runways and the place was set up with nice, uninstitutional Ikea furniture. And there was a nice, uninstitutional concrete garden out the back.

Strangely enough, they didn't get into the swing of things and embrace their new found freedom. Maybe it was something to do with the fact that they'd been in Gladeville since the thirties and forties.

Now to the archaic term.

One of them, let's call her Winnie, had been institutionalized since 1936. I found a document at the very back of one of the many volumes of her file. The document was from The Lunacy Court and she had been found guilty of lunacy by reason of irresponsible hallucinations and masturbation with phantasie.

One night I was cooking their dinner. She was sitting at the kitchen table and suddenly asked, who won the war? She was referring to World War II.

There's probably a story here somewhere. I won't be the one to write it though. I like happy endings too much.
 
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shadowwalker

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How about "forensic clients?"

Or just clients. Forensic again intimates that the mentally ill are inherently dangerous or criminal, when in fact they are more often the victims of crime. The only reason there are so many MI in jail/prison is because the mental health system has let them down and the legal system is still in the dark ages. The prison system is actually the largest mental health hospital in the world.
 

shadowwalker

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My ex is a nurse who works in mental health and addictions. Not a single person visiting any of the facilities he's worked in was there "seeking" anything. They'd been ordered there.

That could be - there are some "secure" facilities run via the penal system that are only for those committed through the criminal court system. Other (most) hospitals have both those committed through the civil court system and voluntary commitments.
 

Ken

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... no direct experience myself, as yet ;-)
If you'd like some fictional accounts I recommend two classic short stories:

Ward Six, by Chekov
and Red Flower, by Garshin.
The later is online. Just google "garshin red flower." (Google Books.)
 

jennontheisland

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That could be - there are some "secure" facilities run via the penal system that are only for those committed through the criminal court system. Other (most) hospitals have both those committed through the civil court system and voluntary commitments.
I'm not talking about committed. I'm talking about "you want your kids back from social services, you go to this facility for two weeks". Nothing legal keeping her there at all. She could leave at any time, but she sure as hell is not interested in addressing her bipolar issues and her heroine addiction. But she stays so she can get the social services credits back.

Or the75 year old schizophrenic crack head who ends up in the ER after taking a baseball bat to his hallucinations and holy crap the ER nurses don't want him, but look! he's got a mental health diagnosis so we can send him to that facility. So he goes because he knows the system and he'll have three hots and a cot for the next two weeks. And do his best to not take his meds for the duration of his stay.

People like this are free to leave at any time.
 

shadowwalker

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Well, this illustrates one of the biggest problems the mentally ill face - we're a "problem". We don't cooperate, we don't "behave", and we irritate. If we do the same things "sane" people do, we're using our illness as an excuse for it. We also get called nutcases, crazy, lazy, get told we don't have to act the way we do. If people knew the hell we go through when the illness acts up - but that's exactly when we cause the most problems.

Nobody asks to be mentally ill. Nobody can prevent it. Some can be treated, some can't. Of those who can, the degree of success varies. But it's never cured. There's always a chance it will flare up again. And the social, family, and work costs to those who are ill is unimaginable.

And we're probably the only people in the world that get blamed for being ill.
 

brainstorm77

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My MC however did admit herself to a facility under the advice of her doctor following a complete breakdown.
Again, I'm looking for personal experiences. My only experience is from the outside looking in.
Shadowwalker, I agree.
 
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Vanatru

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Well...from the inside looking out. It's no fun. Your in a secure area with nut jobs of all types; though, none of them realize their nut jobs...of course, neither do you. Locally, you can be Baker acted if someone has concern that you'll harm yourself. A family member or local law enforcement can do that. At that point you get transported off to the local nuthouse, which is actually a local hospital. You'll remain there for at least three days and during that time your treatment will vary on what reason you were brought there for...keeping in mind that as a citizen you can check yourself if your feeling "odd" and then check yourself out later once you feel better.

However; if the po-po bring you in on a Baker act, your F'd. You'll be there until you've seen three shrinks...and if once, serparetly, think your ok, you'll be let out. Otherwise, your in for the duration.

It's....most fustrating to be there. You a prisoner....but in hindsight, if your there, it's because your an f'ing nutjob.

Stand by, I gotta run. If you need more, just let me know. I'm out in the real world and it's very nice. :)
 

Rufus Coppertop

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Or just clients. Forensic again intimates that the mentally ill are inherently dangerous or criminal,

It merely distinguishes between the mentally ill who are inherently dangerous and criminal and those who are not.

Some people with mental illness are inherently dangerous and criminal. Most are not.

Some people without mental illness are inherently dangerous and criminal. Most are not.

when in fact they are more often the victims of crime.

Like people without mental illness, sometimes some of them are victims and sometimes some of them are perpetrators.

The only reason there are so many MI in jail/prison is because the mental health system has let them down

Or because they committed crimes and got caught?

and the legal system is still in the dark ages.

I have an image of people being tied up and thrown into the local mill pond. If they sink they're innocent, if they float, they're guilty.

Some people say that psychiatry is in the dark ages. Fortunately, we don't use the mill pond as a diagnostic tool, not in Australia at least.

The prison system is actually the largest mental health hospital in the world.

What does this actually mean?

Is your prison system full of people with mental illness who committed crimes and got caught? Is it used to house people with mental illness who have not committed any crimes? Are there people who committed crimes because they were arseholes but who just happen to have schizophrenia and are now requesting a transfer to a forensic psych' unit because they think it'll be a softer option? Other options? All of the above?

Are there relatively harmless crimes, where a flaring up of psychotic illness actually can excuse it, where there was no violence committed and where the court system couldn't be bothered because it's all a bit difficult so let's just throw them into prison instead of a psych unit where they should be at this time?
 
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Rufus Coppertop

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Well, this illustrates one of the biggest problems the mentally ill face - we're a "problem".

Human beings with a problem that affects their behaviour are a problem when the problem affects their behaviour.

We don't cooperate, we don't "behave", and we irritate.

And some of you have the absolute sheer gall, to knock on the nurses' office window at three in the morning, from the high dependency section of the ward and ask for a cup of tea and a few biscuits. The nerve! The absolute nerve!

Seriously though, some people with mental illness who are lovely when they're well, are not just uncooperative and irritating.

Some are downright bloody well dangerous and need to be secluded and forcibly medicated and when we go in with a doctor to do a mandatory TPR BP thing, we need to plan it and decide who holds which arm, who holds which leg etc.

It needs to be taken seriously.

And we're probably the only people in the world that get blamed for being ill.

Not by most psychiatric nurses, but by a large segment of the population no doubt.
 
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shadowwalker

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It merely distinguishes between the mentally ill who are inherently dangerous and criminal and those who are not.

Some people with mental illness are inherently dangerous and criminal. Most are not.

Some people without mental illness are inherently dangerous and criminal. Most are not.

The point is that putting such terms with mental illness only continues the stigma that "crazy people are dangerous".

Like people without mental illness, sometimes some of them are victims and sometimes some of them are perpetrators.

Obviously. Again, I'm trying to point out the crappy image the mentally ill are saddled with simply because they have an illness.

Or because they committed crimes and got caught?

Many, many, many mentally ill commit crimes not because they are greedy or selfish but because they are self-medicating with drugs or alcohol, or because their illness makes them do things that are in some way criminal. The system lets them down because there aren't enough affordable clinics or medications or follow-up. Health insurance companies (which only in the last few years had to even cover mental illnesses) can put ridiculously low caps on coverage.

Is your prison system full of people with mental illness who committed crimes and got caught?

Or is it used to house people with mental illness who have not committed any crimes?

It is filled with people who are mentally ill and who, if they had the help they needed, would not have gotten caught up in the criminal justice system.

I know a lot of people would love to throw MI in jail and be done with them. I know that many people say being MI is just an excuse. It's like I said earlier - MI are the only people who get blamed for being sick. People's attitudes about mental illness are still gathered round the mill pond.
 

Rufus Coppertop

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The point is that putting such terms with mental illness only continues the stigma that "crazy people are dangerous".

From a nurses point of view, sometimes it's necessary in a professional context to make the distinction and use the term "forensic client" or state that "client so and so needs to be in the forensic system".

I do see what you mean about the stigma though.

Many, many, many mentally ill commit crimes not because they are greedy or selfish but because they are self-medicating with drugs or alcohol, or because their illness makes them do things that are in some way criminal. The system lets them down because there aren't enough affordable clinics or medications or follow-up. Health insurance companies (which only in the last few years had to even cover mental illnesses) can put ridiculously low caps on coverage.

What you're saying here is perfectly true and I know it applies here in Australia also.

It's a very multifacted thing. On the one hand, yes there needs to be more follow up and many "outpatients" are self medicating with illicit substances and caught up in this hideous subculture of drugs, they're stuck in boarding houses with other people using and dealing drugs and it's like - "oh fuck! There but for the grace of the gods go I!"

Sometimes though, it's a case of, "Oh you bloody idiot! How many times do you have to be dragged in here by the cops, in the back of a divi wagon because you stopped taking your medication and smoked crack or took ice or whatever, before you learn? And now we have to seclude you and inject you and you've spat on my shirt and you've punched Mary in the face who's just trying to help you and which part of we are not your enemies, don't you fucking well understand?"

Whilst the vast majority of us realize that we're seeing clients at their very worst, and that we're there for the benefit of the clients and we knew what we were getting into when we chose psychiatric nursing, it can be an extremely frustrating profession and it seems to be getting worse with more and more paperwork inflicted on us which means less opportunity to just hang out with the clientele, talk, pop out for a ciggy with them, play pool, watch telly, listen to them and talk to them and just generally be there with them and be there for them.

:rant: I hate the unnecessary paperwork! I so *&*ing well hate it! :rant:

We seem to spend so much time trapped in the bloody office or running about with a clipboard these days. It seems as if the very part of psychiatric nursing that is meaningful is being slowly strangled by bureaucrats and a managerial culture that actually thinks it can abolish every aspect of risk and turn psychiatric units into production lines of statistics pleasing to the Minister for Health.

It is filled with people who are mentally ill and who, if they had the help they needed, would not have gotten caught up in the criminal justice system.

Very true. Sometimes, they need to help themselves a bit. Sometimes they need a bit more help to help themselves and they just aren't getting it.

I know a lot of people would love to throw MI in jail and be done with them. I know that many people say being MI is just an excuse. It's like I said earlier - MI are the only people who get blamed for being sick. People's attitudes about mental illness are still gathered round the mill pond.

In spite of the fact that I've come across some absolute bastards who really are just using MI as an excuse for bad behaviour, at a general level, I think you're right.
 
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veinglory

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There are plenty of facilities that take "walk ins" who are seeking help, and get plenty of them. Generally you go into such a place having acute problems such that you probably aren't having a good time. But fellow patients are sometimes a great source of support and sympathy. You should have a case worker keeping track of you and a psychiatrist tracking your progress as well as various people coming in to provide counselling, health care etc. When it works well it is functional and as pleasant as dealing with an acute psychiatric problem can be.
 

Xelebes

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There are plenty of facilities that take "walk ins" who are seeking help, and get plenty of them. Generally you go into such a place having acute problems such that you probably aren't having a good time. But fellow patients are sometimes a great source of support and sympathy. You should have a case worker keeping track of you and a psychiatrist tracking your progress as well as various people coming in to provide counselling, health care etc. When it works well it is functional and as pleasant as dealing with an acute psychiatric problem can be.

Here, that's called an Outpatient Psychiatry Ward which is what I went to for most of my treatment. Suffice to say, there is a remarkable difference in atmosphere and conditions treated with Outpatient and Inpatient.
 

veinglory

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I was discribing a facility I know where there is both out patient and inpatient. The difference is where you sleep at night. They also have locked wards and open wards.
 

Wiskel

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As a psychiatrist, I was planning on staying out of this thread as the OP asked for experiences of people who'd had hospital stays so my professional experience can't help her.

On my first day as a junior psychiatrist in an inpatient unit many years ago. the first person with mental illness that I met was the consultant I was to work for, who had bipolar illness. That taught me something important about people with mental illness.

Anyone can have it. Life is harder in so many ways if you do.
Perpetuating negative sterotypes doesn't help.
Society taking the view that bad behaviour is a mental illness doesn't help.

I truely believe that in a couple of generations time, the way we manage and treat people with mental illness, the way we stigmatise it, the under-resourced wards and hospitals, the two year wait for counselling and the lack of money available to services in general will be one of the things that history will judge us very harshly on.

Craig
 

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I've been on both sides of the proverbial desk. My mom was in the outpatient mental health field and in the liberal early '80s, I was a small child who thought it great fun to hang out and go on field trips and play games with her clients. I ended up getting my BA in psychology and have worked at inpatient facilities from transitional housing units to full lockdown hospitals.

When I was 18, I went through a series of major life events and ended up in a serious depression. I wrote a suicide note and my parents caught me right before I started on the bottle of pills. They called the cops, who told me I could go voluntarily and check myself in, or I could be Baker Acted (involuntarily committed). I knew the system well enough to know that a) voluntary was a much better option and b) I really did need help.

I was in a small private psychiatric hospital in a medium-sized city. Since I already knew the system so well, there was none of the fear or apprehension I would imagine most people go through. I had the routine initial intake (search the suitcase for contraband, take away the belt and shoelaces and other possible "weapons"). I got a list of the rules, a sandwich since it was after dinner and I hadn't eaten, a few minutes to see my room/meet my spaced-out roommate (she was detoxing), then off to evening group.

The next day I started the regular program, except for being pulled out for around half an hour for a quick physical and meeting with the nutritionist (I'm really skinny, always have been, so she reviewed my diet to make sure I wasn't refusing to eat or anything).

It was pretty much the same routine there that it has been everywhere I've worked: set time to get up, hygiene/room cleaning time, morning group, lunch, afternoon group, "house meeting" (time to air grievances/work out differences in living arrangements), dinner, evening group, lights out. At some point during the day you see the psychiatrist and/or therapist. Most of your time is spent with the hands-on staff (mental health techs, sometimes psychiatric nurses). Depending on the type and facility and your personal level of recovery, there may be field trips and you may be granted a pass to go home for a period of time.

Meds may be administered by nurses or techs, depending on local laws and facility procedures. If it's a lockdown unit, you're generally handed whatever you take, while being verbally told what it is. In transitional facilities, the idea is that you're learning to live on your own. So you're expected to know what you take when, approach the med cart and ask for it. If you don't, someone will track you down and give it to you, and it'll be noted in your chart.

I was going through some trouble with my family and trying to make several decisions about my life, so the psychiatrist recommended I stay for a week and take time to think things through. I was diagnosed with situational depression (brought on by specific events) and offered meds if I wanted them, but the psychiatrist said that in his opinion, I didn't need them. I opted out, because I didn't want to feel like I was using a crutch.

I do feel like I got the help I needed. I was fortunate that my depression was situationally induced. The hospital gave me a safe space to step out of my life and analyze it from a new perspective. I spent a lot of time talking to staff and other patients, and things in my life improved dramatically when I got out. I am actually thankful for having had that experience, as I feel that it really helped me relate to my later clients. Interestingly, around 35% of patients at the time I was there were in the mental health field themselves--psychiatrists, therapists, special education teachers, psychiatric nurses. I was told that the field is extremely burnout-inducing.

If your character just wants to go through the motions and get out, one of the biggest keys is conformity. It's really sad to say, but everything you do (or don't do) is noted in your chart and used in making decisions on when you are ready for release. Eat whatever's being served whether you like it or not. Go to every group and fully participate. Come up with a reasonable suggestion for improving residential life and present it coherently at your house meeting. Set goals with your therapist and work to achieve them. All of these actions show personal responsibility and the ability to successfully live within the community.

I don't know how common this reaction is, but I was surprised to find that I was a bit nervous about getting out. Even though I was only in for a week, it was kind of a safe and easy place to be. I had my doubts about whether I was really ready for "the real world," and I ended up spending another week at my parents' house, transitioning slowly back into real life.
 
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brainstorm77

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Thanks everyone for the replies both here and in PM. I appreciate it.