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We Need to Talk About the Gaps in Psychiatric Hospital Care

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Disclaimer: This article isn’t meant to deter those who are struggling from reaching out and receiving the care they need but is a call to action for mental health professionals. Psychiatric hospitals are helpful in many ways and not all hospitals or facilities are the same. If you or someone you know is in a psychiatric crisis, please do not hesitate to reach out for help. 

When one thinks of psych wards in America, they often picture the horror stories shown in movies and television. They think of scary, violent, out-of-their-mind people being bound up, locked up, and forcibly medicated against their will. That’s the picture I had in mind throughout my life, even after graduating college with a degree in counseling. Even though those were the images in my head, I thought for sure those stereotypes couldn’t be accurate in this day and age.

While the stereotypes portrayed in the movies aren’t completely true, upon my first admission to a psych hospital, I found out they actually weren’t too far off from what I had envisioned. In my experience, it’s not a homey, inviting, warm welcome, but a sterile, scary, and overwhelming one. Patients are taken down corridors past multiple sets of locking doors and strip-searched upon admission. They are bombarded with nurses, mental health technicians, therapists, and doctors asking them the same questions over and over again forcing them to be vulnerable. They are told what medications will help them get back to “normal” and are medicated sometimes whether they want to be or not. Patients are then required to attend group therapies where they have to repeatedly be vulnerable in front of the ever-evolving group of patients. In my experience, the rest of the time spent is often spent watching TV in the common room.

Patients in a lot of psych hospitals are treated like criminals or children. Many people are even brought to psychiatric facilities via the police. They are locked up where they can only go outside when a staff member takes them out. They are put on halls and in rooms where furniture is bolted and caulked to the floors and walls and there are cameras everywhere. They are given little to no privacy. They are watched constantly like a child in daycare.

During my second stay in a psych hospital, I realized how many gaps there are in the treatment of patients. I had little to no access to therapists while in the hospital I was at. I had group therapy twice a day in which I got only a few minutes to speak to the therapist about my struggles. It took four days of requesting to speak one on one to a therapist or social worker before one finally met with me. Even then, the social worker didn’t offer any empathy or help. I lost all hope the facility and treatment team could make any difference. So, that brings up the question: What are the gaps of care in these facilities and how do we solve them?

One major gap that is showing up across many healthcare facilities in the country is a shortage of nurses, technicians, and staff. It was evident to me as a patient, the staff working with me were burned out, overworked, and overwhelmed. Patients need to be treated by medical professionals who are alert, energized, and ready to work with them. In a psych hospital, this is especially true as many patients test the medical staff’s patience by being antsy, angsty, anxious, and angry. Staff hired in a psychiatric facility should possess empathy and understanding for the struggles their patients face. Both the medical staff and their patients deserve better care.

Another gap I experienced firsthand was a lack of activities. Psych patients are coming to the hospital for safety concerns and severe mental illness, having patients sit around most of the day watching TV is typically not helpful. Patients need more than two group therapy sessions a day, they need the option for individual therapy, exercise activities, art therapy, music therapy, or even books to read during downtime. Having patients sitting around with their thoughts is not healing. I believe they should be given a structured schedule with the option to participate, as patients often need the option to rest due to medicine changes or their condition. When I brought up this gap in care to the staff, I was told these options weren’t available due to the lack of staff. Whether this is true or not, patients deserve better.

As someone who has been seeing a therapist and doctor regularly for many years, I found it distressing to have very little contact with them while being in the hospital for an extended period of time. My therapist tried to contact me, but had a very hard time jumping through hoops. I believe if a patient has a treatment team outside of the hospital, it would be very beneficial to have their treatment team work alongside the hospital team for treatment of the psychiatric crisis. The patient’s treatment team knows them, their history, their behaviors, and their coping skills which would be invaluable to those treating the patient in the hospital. Therapists should have the option to visit or do virtual sessions with their clients who are admitted so as to continue working through the issues that may be contributing to their crisis, especially if there is a shortage of therapists who are able to meet with patients when needed. Many mental health medications take multiple weeks to begin taking effect where therapy can begin working right away. Patients deserve more access to therapists.

There is also a gap in care when it comes to treatments that can be performed inside the hospitals. I was forced to wait until being discharged from the hospital to receive a lifesaving treatment targeted for treatment-resistant depression. Had I been able to receive this treatment while being hospitalized, my stay would have been far more beneficial. I learned later on that the clinic in which I received said treatments has been trying earnestly to get the hospital on board with administering this lifesaving treatment to patients, but the hospital has yet to do so. Hospitals need to work alongside providers in the community to provide the best options for those in crisis; otherwise, patients like myself might continue to leave their care in worse shape than when first admitted.

The last gap I noticed was the aftercare. Because I already had a doctor and therapist, the options for help upon discharge were minimal. I saw so many people given the option to leave and go to facilities in the area, whether that be homeless shelters, halfway houses, or even state hospitals; however, there were no options for those who struggle with depression, anxiety, or post-traumatic stress disorder (PTSD). At the time, I felt like I needed a long-term care facility, maybe a 30-day stay somewhere, but I was told there were no options for such things unless I struggled with addiction. We need more options for those like me struggling with mental health issues that are not addiction-related. We need more options for step-down treatments and facilities from the hospital level of care.

All that to say, I know psychiatric hospitals have a purpose. They provide a safe environment where patients are watched to ensure they do not harm themselves or others. It gives them a secure place away from the outside world to not have to worry about everyday things, but focus on getting better. However, to say the type of care being offered in these facilities is ideal is far from accurate. It’s 2022, we deserve humane, healing environments for those struggling with psychiatric crises.

You can follow my journey on Sarah’s Rambles

Unsplash image by ti nguyen

Originally published: January 28, 2022
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