I've seen a few questions lately about psychiatric facilities and figured I'd just write my own Take about my experiences in one. I worked in a locked-door psychiatric facility for a year before I moved across the country and I figured that there were some things I should point out that seems to be frequently asked about them.
Holding People Against Their Will
There's typically some conspiratorial type thinking that comes along when people start talking about psychiatric facility. Lay people seem to think that psychiatric facilities are going out of their way to lock up people against their will for some nefarious reasons. I think this is quite silly. Many facilities will have policies about holding people against their wills only in the case of a patient being a danger to themselves or others. For example my hospital mandated a 24 hour hold for persons who had survived a suicide attempt for monitoring and counseling. This was to ensure that the person wouldn't just leave the hospital and walk into the road and kill themselves. This is largely a protective move by the hospital to prevent the family of the person from suing. We additionally would frequently get patients from the police who had harmed themselves or others and needed some psychiatric evaluations or medication in an attempt to prevent this behavior from continuing. These people who are held against their will are done so for good reasons in my experience.
To demonstrate this point I'll give two examples.
-I had one patient who had postpartum psychosis and had attempted to kill herself and her child in response to severe command auditory hallucinations. She wanted to be released, but the hospital was concerned that she would get out and attempt to kill herself and child again and as such mandated that she be held against her will for a 24 hour evaluation. During that hold it was determined that she was a threat and her family asked that she be held for treatment. After a few weeks with counseling and medication she seemed to have gotten far better and last I heard she had gone home and was doing quite well.
- Another patient was suffering from drug-induced psychosis and these delusions were causing him to lash out at both family and others in the general populace. He was arrested and sent to us against his will for the safety of other people around him. While with us he attacked multiple staff members and had he not been with us he likely could have killed them.
Abuse By Staff
People frequently point out instances in which staff members abuse patients and say generalize this to all facilities. This simply seems to be a false generalization to me. It is important to remember that hospital staff are people too. Just like we can have bad police officers, bad nurses, bad teachers etc who abuse those in their care you can have some bad people working in psychiatric facilities too. I personally never saw this happen in my facility, but we had many safeguards to ensure that this wouldn't happen and if it did then the patient was protected. We had several cameras throughout the facility and if anyone was injured we'd go over the film to assess what happened. We additionally had a policy of no staff being alone with a patient, if a patient had to be stripped or confronted we had to always have at least two staff members present to ensure that there was no abuse. The only case I could think to bring up here was one instance in which I think the policy went too far.
- We had one patient who was a young child who suffered from extreme autism and was prone to hurt himself and engage in other aberrant behaviors that required he be always within arms distance from a staff member. He would frequently pace about within any region he could and as such at night we would sit in a chair by the door to his room to effectively block it off as a possible route for him to walk in. This would just leave him to pace within his own room but not go outside at night as he would wake up other patients (and we'd have to force him to wear clothes which was very difficult because he didn't like them). One doctor walked in and saw this and despite no abuse occurring the doctor had the staff member fired because... well just because.
Injuries In The Facility
This partially goes along with the previous section, but I think it's important to separate these two on the basis of intention. During my year we had several patients be injured and although most of them were self-inflicted a few of them came about during conflict with staff members. These are far more rare than self-inflicted injuries, but even then in my experience were explicable. We also had to undergo training for how to take a violent patient down safely, but two injuries stick out from my memory.
- One woman was attacking staff members and was chasing after a security guard. He put his arms up in defense of his face and she ran into his elbow crushing her orbital socket. This was her fault and when I took her to the hospital for surgery she apologized for her behavior, but still the hospital paid for her surgery.
- The other injury was an older man who woke up and thought we were his sons and raping him. He started punching us and screaming. When going to hold him down and give him medication to calm him his arm was fractured. This was likely due to his age and not abuse or excessive force on the part of the staff members.
History
This is one that I don't disagree with. Psychiatric facilities and the field as a whole have come a long way. I don't think this is relevant to facilities today, but it is a blight on their history. Thankfully as the facilities and the science as a whole have progressed these problems have fallen by the wayside, but it's important to remember how recent this was a problem.
- I had one patient who had been in and out of facilities for decades and he was telling me about how it was when he first started with the ice-baths and electro-shock without muscle relaxers.
Conclusion
I'm not sure how well this went and my thoughts were kind of all over the place. My general point is that in my experience psychiatric facilities are far more helpful than they are detrimental, and the problems pointed out by others who think they're bad are all explicable.
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