A Real Look at Psychiatric Hospitalization
By Melissa K. Vassar-Belloso
I think that most people can come to an agreement that hospitals are not fun places to be. No person wants to be in a hospital regardless of the reason and as places they have a sort of common trait of being sterile and sort of unnerving. Now I’ve been open in past blogs about being a somewhat sickly person so I definitely see my share of medical facilities and obviously hospitals in the past but today I’m going to give you a real glimpse of what it’s like to be in a psychiatric hospital.
I want to put forth a small disclaimer before I delve into the article though. For privacy reasons I will not be disclosing the name of the hospitals or any names of people I’ve met in those hospitals. Because of the nature of why people are in them and just for the sake of respectful confidentiality this will be the case. Second, please understand that I am one person and not an across the board view of these services. The extent of these services and the legal circumstances around them will vary person to person and state to state so I can only attest to my personal experiences and not act as a universal instance of how psychiatric hospitalization functions. Third is of course that this is going to be a blog about being in a psychiatric ward so some content may be “triggering” as the kids say these days. Please read at your own discretion. If you think it’s a bit too heavy of a topic join me in a few blogs when I talk about fidget spinners but don’t force yourself to read something that might be uncomfortable.
Some Basics about Psychiatric Hospitalization
So for starters we’ll take a sort of brief look at the process and system of these institutions. Psychiatric hospitals have been around for quite some time but have evolved from a neglectful and overcrowded facility where people often left mentally ill loved ones to waste away to much more regulated systems that are sometimes housed alongside outpatient facilities. Depending on your resources and what’s available in your area there may even be some that are closer to a fancy rehab center. But let’s make a distinction here. While there are still larger facilities that would be crudely fitting into a model closer to an older mental facility model these are not the hospitals I’m speaking of today. Those larger facilities are more in place for people who are much more severely ill,not able to live independently on a long-term basis, or a consistent danger to themselves or others. The facilities I’m speaking of are a model on a smaller scale that are typically attached to a typical hospital and accessible to your common working stiff having usually an immediate and life-threatening bout of mental illness that needs short-term observation and slightly more intensive care than what outpatient mental health services can offer, but not the fully institutionalized experience.
This level of psychiatric hospitalization can apply to perhaps a person having a nervous breakdown or a person having an unusual spike in normally manageable mental health symptoms. The key criteria that is required for this type of care is typically the presence of homicidal or suicidal intentions, but depending on the laws where you are, suicidal ideation is also valid criteria and exception can be made based on the facility and regulating laws that apply. Suicidal ideation is by loose definition thinking heavily about death or taking your life but with relatively low risk of acting on it. In this case the person is being taken in so they can be safe and observed until that sensation passes. Ideation is typically not considered as heavily as an active attempt. I can attest to that personally. But it should be noted that ideation is as dangerous as taking a knife to yourself or popping too many pills. It’s the mental equivalent to standing on a cliff edge and is still a key component to having suicidal tendencies. It’s also in general and as many doctors have relayed to me, not a healthy trait.
The first stop when a person seeks inpatient care at a facility like this is the emergency room. You typically see a regular physician first so they can rule out any other causes to your current state beyond a psychiatric issue. They also take blood and urine samples. As a pee shy person who’s afraid of needles this is actually the worst part for me. I can deal with a rock hard and cheap mattress or not having my phone but needles and peeing in a cup crosses the line somehow. Now a lot of your comfort level at that point will depend on how much you dislike hospitals. I don’t think anyone likes them but I think everyone has a varying tolerance for them. This is also the point in the process where the road splits for people.
Some people are actually okay just making the step to air out their concerns so after speaking with someone about your issues you may be fine to be discharged home as long as you aren’t a danger to yourself. If you get deemed as being at risk and meet the criteria you may be walked through the process of voluntarily signing yourself in for a minimum of usually 72 hours. But there is also another alternative as you may have guessed so from here we’re going to walk down both paths. I need to disclose before doing that however, that I can only first hand talk about voluntary as I’ve never been in a psychiatric hospital involuntarily in the three times I’ve been there. I will do my best, as I have spoken to other patients who were there involuntarily, to at least give a loose idea of that experience.
The Voluntary Journey
Voluntary intake is typically a minimum stay of 72 hours or three days. The general experience of one of these facilities is mostly the same whether you are there voluntarily or otherwise though. While in these facilities every patient there will share the experiences of taking medications if necessary,attending group therapy sessions,and attending one-on-one sessions with a staff doctor. Now you may have seen some movie versions of these hospitals that dramatize the day-to-day activities drastically so let’s crush a few myths while we’re here.
- You can wear regular clothes. Aside from some stipulations like removing strings from shoes or not being able to wear anything with metal on it you can wear your own clothes and a comfy pair of socks or house shoes. You aren’t forced to live in a hospital robe or denied access to your own wardrobe while there. You also aren’t typically placed in a straight jacket in these types of facilities. They might even give you some free pairs of those cool hospital socks with the rubber grips on the bottom. I personally love slipper socks so don’t judge me for considering that a perk.
- You aren’t forced to take unneeded medication. Only those who have a life sustaining or previously prescribed prescription they have to have access to while in the hospital have medications. They will not give you a medication you haven’t been prescribed. You are also told exactly what you’re taking every single time you take it so sorry movies….there are no mystery pills and no sinister forced medication routines just for the sake of you being in a hospital. You can get general OTC stuff as well so if you need cold medicine or headache medicine they’ve got you covered and won’t judge you or make you suffer without.
- The food isn’t bad at most of them. It’s basically cafeteria food and you get very reasonable portions. The one hospital I used even had some pretty well balanced and nice planned menus so I was eating three full meals a day and they were pretty darn good. I would say they were definitely better then some cafeteria food I’ve experienced. They even made room for special diets if people were vegan,diabetic,or had food allergies. Additionally, it was a normal looking dining and recreation room and not something out of a prison.
So now that that’s out of the way, let’s take a breath and appreciate that most of the psychiatric hospitals you’ve seen in movies are in fact dramatized. They make psychiatric hospitals look a lot scarier then they actually are. It’s a lot more mundane than what the media makes it out to be really. While I can’t attest to a larger more secured facility the psychiatric ward of your local hospital is not likely to be a real life Kubrick experience or Unsane.
But there are some things you’ll be restricted from while there that at the most will maybe bum you out or make you a little bored. The main restrictions are for safety reasons and to prevent anyone having the tools for self-harm. Now if you are unfamiliar with self-mutilation or or suicide the items you can’t have will surprise you. The list is pretty large but here are the big ones you’d notice and maybe lift an eyebrow at.
- Pencils with erasers
- Metal parts on clothing (so say goodbye to your blue jeans for 72 hours and call someone to bring you sweats)
- Spiral notebooks
- Shoelaces in your tennis shoes
- Underwire bras (so you’ll have to let them fly free or have someone bring you a sports bra)
- Pretty much anything with metal or plastic parts
- Hair ties with metal on them (so you’ll need to slum it with ouchless ones for a few days or just rock that fro)
- Pretty much any shoe that isn’t a house shoe or slipper
- Cigarettes and/or lighters
- Travel Mugs
- Stuff with strings (and yes they will remove strings from hoodies if you want to keep them out)
- Mouthwash with alcohol and actually any toiletry with alcohol
In addition your toiletries and any outside snacks brought in for you are locked so you do have to ask for access to them. But the good news is you do get snacks. You can also have visitors and it’s not like a prison visitation room. Most of these places have a recreation room/cafeteria area which is where visitation is. You do have the restriction that you can’t touch or hug while there but other than that you can talk about whatever for 30-60 minutes or even a few hours depending on the day and the facility. You can also be like my husband and jokingly slide a candy bar across the table before the visit starts like it’s illegal contraband. Some facilities even have smoke breaks if you are inclined to that poison.
But they’ve taken all your stuff, so what can you actually do in your free time?
Here’s a list of stuff you can do:
- Art and creative activities
- Puzzle books
- Jigsaw puzzles
- Watching TV
- Reading a book
- Talking to other patients
- Playing select board games
- Taking a nap
- Staring at a wall
- Walking up and down the hall and burning some calories
- Go to the bathroom as much or as little as you want (because some of us have public bathroom phobias)
Some of those are me messing with you but you get the idea and I won’t judge you if you like staring at walls. If you do have a bathroom phobia and you’re polite enough you can try wheedling your way into the staff restroom or just use the toilet first thing in the morning after it’s been cleaned. Consider that a pro tip I guess.
Basically there are things to do, so when you aren’t with group therapy or a doctor you can mindlessly watch TV or try some more mindful activities when you realize the cable is garbage in a hospital. Sometimes too frequent naps are frowned upon but I kind of had a free pass with my fibro and anemia and never got questioned, so that’s something for you to try out for yourself.
But let’s move on to the facility itself. What are the people like and what’s the therapy like? Well the facility I went to was actually pretty great staff wise. They typically have nurses on staff in shifts all day and the doctor will be there during the day. The nurse were always really great to me and responsive so in my personal experience it was a really positive and comforting atmosphere. Now it should be noted that I’m a very quiet and polite person around health professionals so whether they were nice because I was a nice patient is up to you to decide. But there were some nights where I was not easy to deal with because I needed a snack to boost my sugar at 2:00 A.M. or I was just freaking wide awake and in the hall at 4:00 A.M. because my body clock is just that way. They were still really nice to me and helpful in those situations and even listened to me talk a little before I wandered back to my room so kudos to you nurses going that extra mile. It does matter.
I was less impressed with my doctor because as one would expect, a person whose entire schedule is a revolving door of patients one after another can’t really get to know you and can’t spend too too long focusing on delving deep into your issues. If you have to go to one of these facilities just keep on the doctor because they can be a little more easily distracted and indifferent in those places. I would also keep my standards low and save your big breakthroughs for your regular therapist if you have one.
The facility itself was clean and organized. It still had the sterility of a hospital and the safety plastic furniture,windows you can’t open, and rock hard small mattress will remind you it’s not a luxury hotel but to be fair you have a roof over your head,a bed to sleep in,and three meals a day with mental health care added in which is a lot more than a number of people have at that very moment so don’t be a snob and appreciate that. You are still in a hospital. You might end up with a roommate but that can really go either way and they typically try to make an effort to put people by themselves or make sure the roommate is a good match if room and circumstances allow for it. If you do get a shit roommate they will usually try their best to accommodate moving you.
Group therapy is surprisingly mundane. It’s not nearly as exciting and jaw-dropping as TV and movies make it. Sometimes it’s a talk on a mental health topic or even just some basic art therapy. The idea is to keep you active and encourage you to engage other people but it probably won’t be life changing. You won’t be forced into it or dragged in and thrown into a cold metal chair. You will be enticed to join other patients in the recreation room and if for some reason you feel sick or don’t want to, you probably will be left alone.
The last thing to sort of touch on is cost though. This type of hospital stay is pricey. When I went I had insurance and it was over $1000 but I think that the price that matters if you feel like you need help with a mental health emergency is the value of the care and your peace of mind. Don’t assume you can’t afford to take care of yourself. Most hospitals will listen and even work out payment plans with you if you don’t have insurance. Getting your life back shouldn’t have a price tag.
The Involuntary Journey
Now the day-to-day is about the same when you’re admitted involuntarily but getting there is not. Involuntary intake is usually a result of a domestic situation or the next step after a person fails a suicide attempt. There are a few key things to remember here though. The first is that these situations aren’t always involuntary. My first trip to one of these facilities was when I was still in high school and had done some cutting with a piece of glass on my left arm. I was able to sign in voluntarily. Most facilities do give you some options if the circumstances allow to still come in as voluntary. Additionally, if you show marked improvement and openness to treatment, you can have your stay switched over to being a voluntary one after a few days.
I actually recall having an argument with someone on Twitter when I started seeing trailers for the Unsane movie that you can’t be “tricked” as the movie implies into being admitted and this is a truth. There are a whole bunch of forms and clearances involved with being admitted and as long as you read before signing, you’re golden and doing what most adults with common sense do. You cannot be tricked into voluntary admission or involuntary admission because for legal reasons hospitals just don’t do that. There are a ton of papers and procedures that come before you even see the psychiatric ward. They also ask you after every single form if you have questions about it. No one is forcing you to sign or not allowing you to read the fine print so if you sign something without reading it is sort of on you at that point. Reading things before you sign them is another pro tip. I’m truly on fire today.
If you happen to be at this type of facility as an involuntary admission I would say to keep an open mind. Don’t assume it’s a bad situation. You may need the cooldown period because of a recent incident in your life or really find some benefit in a mental health vacation you didn’t realize you needed. If you are trying to get it switched to voluntary that will never happen if you aren’t receptive to treatment and discussing what landed you there in the first place. Mental health can be tricky and we sometimes jump unconsciously and don’t realize we’re in freefall until someone catches us and wakes us up.
The Discharge Process
So now we can talk about going home. The first steps here are that you need to in a voluntary status and cleared by the doctor. But there’s really very little difference from a typical hospital discharge. Sometimes the paperwork can take a few hours to get gathered up but after a staff member reviews the papers and you arrange a ride you just leave out of the normal hospital entrance and go home. You typically do a follow-up a few weeks later with an outpatient therapist and then you pay your bill. It’s really pretty straightforward and mundane. You get all your stuff back that you came in with that had to be locked up for safety procedure but trust me,everything will be there. They do an inventory of everything you came in with down to the color of the underwear you had on at the time of intake so all of your belongings will be accounted for and returned in pristine order. You half a tree to take home with you as a bonus that has discharge instructions and if you were prescribed anything those medications get sent out to your pharmacy before you even leave.
The Missed Value and Misconceptions of Psychiatric Hospitalization
One of my big goals with this blog was to open some eyes to the benefits and myths surrounding psychiatric hospitalization. Once you wrap your mind around the fact it’s not like it is in media, you can grasp that it can be a huge benefit if you feel like things are falling to the wayside and you need a brief vacation from your own life. I don’t want to lie and say there isn’t something scary about the process though. The scariest thing about this type of facility is the reality but one of the things that can save you when mental health is bringing you down is seeing that sometimes it can be worse.
I can still vividly picture a girl who was a patient on my first trip to the hospital in the same ward,covered head to toe in razor cuts. I never thought of cutting my arm again and wanted to work even harder toward getting better when I was released. I met children who were moving to their fourth or fifth foster home and didn’t know who their real parents were. I met what could have been my future if I gave up on myself. As grim as that may seem, a dose of reality can save your life when it comes to mental health. It’s easy to get sucked into a haze or a state of denial or indifference to your own well being. But things can always be worse. Being that close to rock bottom is sometimes the thing that changes a person’s life. You might be afraid to visit there but it might also encourage you to make that visit temporary and turn your life around.
If you need help and you feel like the situation is falling through your fingers, consider getting the help you need. There is a huge stigma on things like psychiatric hospitalization but no person should feel shame for trying to improve their life. Get rid of the misconceptions,ignore the media portrayal, and appreciate that you have a right to being happy. If you feel like you’re in danger of hurting yourself or feel an urgent need to speak to a health professional than care about yourself enough to do that and do what’s best for you above outside perception.
Thousands of people are suffering in silence right now and sometimes give up on life completely because of the stigma that the media and social myths have put on psychiatric hospitals as a treatment option. It’s time for us to take real steps to end the stigma and understand that it’s okay to need help. If you feel like you need to step away from your life and regroup or know someone who could benefit from that, let’s talk about it!
Encouraging people to take a new look at the benefits being missed by fearing psychiatric hospitals is a conversation people need to have because giving it a chance could literally save a life. I know I would be in casket right now if I hadn’t taken that step to invest in my mental health and all the avenues of treatment available to me. It can be scary but it can also be the missing piece to reclaiming your quality of life.