Tuesday, April 07, 2015

Responses to a Short Survey on Inpatient Psychiatry

147 responses


Was being treated on a psychiatric unit helpful to you?

Yes, I was better at discharge5738.8%
No, I was the same or worse at discharge9061.2%

Were you admitted as a voluntary or involuntary patient?

I entered as a voluntary patient and my stay was helpful3121.1%
I entered as a voluntary patient and my stay was NOT helpful4127.9%
I entered as an involuntary patient and my stay was helpful2919.7%
I entered as an involuntary patient and my stay was not helpful4631.3%

Was your treatment abusive in any way?

My treatment was kind and respectful to a degree I found reasonable and acceptable5336.1%
I felt I was physically abused by the staff1610.9%
I was verbally threatened by the staff4127.9%
I was treated by staff in a demeaning manner without an obvious reason8457.1%
I was assaulted by another patient96.1%
I was threatened by another patient2416.3%
I was physically uncomfortable because I was denied access to food or restroom facilities in a timely manner2114.3%
I was uncomfortable because I was not permitted to smoke.96.1%


When I left, it was clear where I would go for follow up and when7853.1%
I left with no clear follow up appointment or plan4329.3%
Upon discharge, I was given prescriptions for medications I was able to obtain5336.1%
When I left I was given prescriptions for medications I could not afford117.5%
My prescriptions lasted until I had an outpatient appointment3221.8%
My prescriptions ran out before my outpatient appointment1610.9%
I never went to any followup1711.6%
I never filled my prescriptions138.8%
i've been discharged to a safe house
I was released with the drugs
It's been 5 months since my hospitalization and I still haven't been able to meet with a case manager. It took 2 months for them to call me and they have rescheduled twice at the last minute.
price of prescriptions almost $400
Due to holidays and no case worker I didn't see anyone until about 6 weeks after discharge.
The meds were so costly, my entire prescription benefit for the year was used up for ONE month's handout, plus I had a $200 copay when I was told it was free (I told the discharge nurse these brand name antipsychotics were too costly, and she said no copay, but I was billed $200 later, and had to pay it)
The diagnosis was inconsistent with diagnosis of therapist and was based on false information from abusive spouse
they didn't set up where I was going of medication changes my regular out patient providers did
that made me worse than before I went in
I was very over medicated, against my instincts, and those instincts were correct once I got a second opinion. I was misdiagnosed with bipolar because I went manic on copious amounts of energy drinks- not because of a biological disorder. The drugs brought me down, but time/sleep during treatment would have done the same!
I only obtained a proper plan after a subsequent episode
I left when my own doc was appalled the treatment
Voluntary, private hospital, late 80s ( was 16), doubt I would have the same positive experience now.
I was already taking meds at the time.
Follow-up plan was poorly devised and seemed just to check boxes.
got out - tapered myself off all drugs - it took some time
One follow up told them was suicidal last I heard of them. Last attempt may of been successful. Hopefully yes but only time will tell and not going to the doctor to find out if I'm dying.
The Psychiatrist changed my perscirptions with disarterious results.
I was order to take oral and injection meds
I was asked to do an exit review but felt it would not be wise to honestly comment as i was worried i would be re-admitted at some point and they would have more ammunition against me.
Became an antipsychaitry activist
so my answer is irrelevant
Like whatever. Fix the damn system tired of losing friends to suicide. I love Billy btw. Loved your book too.
No one explained diagnosis.
I had no choice or options. I was violated.
They actually had me sign papers saying I was safe to leave the hospital when I told them I was no different if not worse ( signed papers with statement that I didn't agree but that I had seen the paper)
the drugs tranquilized for 14 hours straight when taken as prescribed; no information about tapering safely to a lower dose that I could function at was provided
followup prescribed inconsistent with their own diagnosis

What aspect of care was most helpful to you?

The medications1610.9%
The interactions I had with the psychiatrist117.5%
The interactions I had with the nurses42.7%
The interactions I had with other staff32%
The activities provided00%
The food00%
The physical environment42.7%
The interactions I had with other patients2517%
Group therapy and educational groups21.4%
The interactions I had with my family00%
The time I spent in a seclusion room21.4%
The time I spent in physical restraints00%
The opportunity to escape the stresses of my outside life (work, etc)2013.6%
Yoga, tai chi, massage, general healing00%
The coping skills I learned00%
Family visits64.1%
Support animals on the unit00%
Nothing at all was helpful3624.5%


Anonymous said...

I wonder though, that if you asked people who had been hospitalised more than once if they have had both positive and negative experiences.
I have had both and I feel that the negative experience has left me with much stronger feelings towards the experience. The positive was good, and helped me along and I continued on with my life, but the negative set up a large barrier that I had to break through to continue on with my life.
People may have had both positive and negative experiences, but it is the negative expereinces that have stayed with them and possibly have left a greater mark?

I would also like to ask how the responses tally with your personal experience and the experience of psychiatrists in general? (But you answer very few of my incessant questions!)


Dinah said...

BecB -- I think you may be right that the negative experiences resonate more, at least among our blog commenters.

I work exclusively in an outpatient setting, so I don't have personal experience with inpatient settings. But knowing this, when I see someone who has been hospitalized, I ask if it was traumatic or upsetting. I ask people if they were mistreated in any way. Sometimes people look at me as though I'm nuts. No one I've seen in clinical practice has spent much time talking about how awful their inpatient stay was, at the worst maybe some eye rolls. Vast majority were voluntary hospitalizations. I do think you are right that if it was a a helpful experience, people leave and move on with resuming their lives.

I don't know the experience of psychiatrists in general.

Anonymous said...

I don't know if I've ever actually told my psychiatrist about my bad experience in hospital. It was before I started seeing him and it took a lot of pressure from my psychologist to re-engage and see a doctor again. And even more to be admitted to hospital again (although I was not presented with much of a choice at that time).

I think my psychiatrist guessed about my past bad experiences when I kept having anxiety attacks, and whilst I saw a psychologist to treat the anxiety I was suffering as a result of this hospitalisation, I presume she kept my privacy and did not disclose the reasons for my visits.
I think my reticence to discuss my experiences is probably not common, but it does happen.

I'm also a bit cynical and wonder if there has ever been a study into psych-hospital-induced ptsd? I know of at least a sample of 1.


J said...

I was diagnosed with PTSD following a traumatic and voluntary hospitalization. It was that bad. Thank you Columbia University Medical Center, which was at the time rated the #2 psych department in the country.

Sunny CA said...

I appreciated reading the survery results, because it made me feel I am not alone in feeling as I do. I have long suspected I have PTSD from being shut in isolation wiithout the lights or fan cor fresh air turned on. I ended up on the floor trying to suck air from the small opening between the bottom of the door and floor. I still, after 10 years get panicked if I get in a stuffy, hot car, and the driver sits and does not turn on the car so I have no way to open my window and get more air. When I am the driver, I open the door, turn on the air, lower the windows, before closing the door. I never had this issue before I felt I nearly suffocated in isolation. I agreed with many of the written comments, wnich mirrored my own experience. Some staff are caring, and others cruel.

Anonymous said...

I have been on both sides of the locked doors. As a social worker in a residential program I did intake and was involved in the discharge of people coming out of the biggest community hospital and our local state hospital (one of the oldest in the country).
As an individual with bipolar disorder, I has been involuntarily admitted for suicidal thoughts and activities. Between my multiple patient experiences and my professional experience (which I am taking a break from right now), I have seen four of the five hospitals in my region.

I think there are some simple, inexpensive things that can have great impact on a patient's stay.

Basic Needs: The need for hygiene supplies, linens, and clothing should be immediately accessed and arrangements should be made to ensure those needs are met. Ensure that someone coming into the ward has had a meal if they were waiting a long time to get to the floor. Ensure someone does not have a dietary restriction or food allergy, or food preference. Ensure someone can get an extra blanket.

Treatment: Ensure treatment team is qualified and using evidence based or at least best practices. Ensure there is a diversity of clinical expertise in the team. I have been to inpatient wards where there are no therapists or counselors employed. Even though individual counseling is not feasible in a community inpatient setting, having a psychologist, clinical social worker or similar profession can be useful when making treatment decisions. I have been to hospitals where there were just psychiatrists and nurses and the aides were the only people who talked to the patients. Having multiple disciplines on a team can be helpful to drive discharge plan and determine care.

Activities: I think most patients understand the limits involving safety and restricting visitor times. However, a psych ward can be dreary. The only things people are allowed to do is color, read, or watch TV, or go to a group. If the hospital's only activity is to allow people to color, at least spend $50 and make sure there are copies of crossword puzzles, coloring pages and what not. Supply paper so people can journal (even if it is with a crayon). Stock books and magazines. Have a TV with appropriate content. Actually run therapeutic groups. I was in a hospital for a week and there was no therapeutic groups of any sort

Staff Management: There is nothing more disempowering than being in a locked facility with Mean, rude, and disrespecting staff. Having staff training in crisis intervention techniques makes a big difference. It is really upsetting to have someone at a desk ignore you because they are playing a game on a computer, or staff watching TV (and not letting patients change the station!), or taking naps while they are working. Having simple customer service skills would be nice. Ensuring abusive staff are fired. I had seen male staff watch young attractive patient undress. Not cool. Staff not respecting religious practices. Staff pushing religion onto patients. There are a lot of really awful things that can happen on a psych ward.

Restraints: I have seen excessive and inappropriate restraints. NYS initiated some strict policies on it recently...

Anyone who works on a psych ward should understand that a patient has been stripped of their clothes, their privacy, most of their basic human rights. A psych ward feels like Jail. Actually, some places are worse than jails. If staff can try to imagine how powerless and dehumanized being a patient can be, and just treated patients with dignity and respect, the system can continue to improve.


Anonymous said...

I am still amazed that there is surprise among the psychiatric community that *involuntary* hospitalizations resonate so negatively with people. One is jerked *involuntarily* from their life. The experience, although not involving hand-cuffs, may involve other forms of restraint (i.e. an isolation room while waiting ER clearance to go to the next unknown place.....). The in-patient"community" is a false construct and may be damaging for some (I was suffering major depression after being stalked in my graduate school; the "community" in my in-patient setting included a wife beater looking for "support."). When I was finally allowed to return to my previous life, I found that my life was now on hold because my school would not allow me to return without clearance. How could I tell the person who inflicted this involuntary hiatus, who now had control over my re-entry into my life, that it was not a good experience? Just because people see psychiatrists does not mean that we do not understand power-plays.

PHI-PTSD? (Psych-hospital induced PTSD). Yes. It is real.

When I was hospitalized, I was VERY depressed. Could I have been managed without that hospitalization? Yes, but not with that particular psychiatrist. (Because of that hospitalization and the distrust that it caused, I did switch). Now that I am years down the road, when I look at what happened, I am horrified. It seems surreal. At the time, I did not have enough self-respect to realize that what happened was not appropriate. It took years of therapy to generate enough self respect to realize how totally dehumanizing that process was. If you asked me after the hospitalization, I probably would have stared into my lap and told you in a a small voice "it was okay." I am embarrassed by what I did after being in an isolation room at the ER while waiting for clearance (so I would not tell you about the horror of that).

Psychiatrists treat a vulnerable population. Reading these blog posts and threads, I am surprised that there isn't a better understanding from "the other side" (i.e. the psychiatrists) that, in general, an involuntary in-patient stay isn't positive for many (if not most). Just think about it. Think about being ripped from your life, thrown into a community not of your choosing, isolated from your friends and family.....seems pretty rosy, eh?

Anonymous said...

I do have to say though, as someone who has been 'unwillingly' hospitalised (and that was the hospital experience I found helpful btw). I was at risk to myself. I agree with my psychiatrists assessment of the situation and I don't have a problem that if such a situation were to arise again that I should probably be hospitalised again.
But I do have a good doc, whom I trust.
I got the impression that involuntary hospitalisation only occurred if there was serious risk to a person, the patient or another person. Although, I can imagine as a doctor the 'risk' is viewed from a different perspective.
I wonder; if you have been involuntarily hospitalised if you've thought about why the doctor decided to make that decision in the first place?
I my first hospital experience made me vary wary about what I would say to health professionals, but it also drove me to find a doc I could connect with and who understood me and who would negotiate treatment with me.
I wonder if some of the trauma could be reduced by a better connection with one's doc and more open negotiation about treatment?
Just a thought.

tracy said...

Interesting. It is NOT a Physician who decides whether a person is involuntarily hospitalized. It is a Social Worker. They hold a huge amount of power.

Anonymous said...

I am a social worker and have worked as a mental health counselor in NYS and I have worked as a social worker in the hospital. I have spent many of nights worrying about my clients because I thought they were threat to themselves and others. I have no authority in an outpatient setting. I need to call 911 and the POLICE get to make the decision on who gets sent to the psych ER. Only the police or the county designated "crisis team." can send people to the hospital. Even psychiatrists in outpatient need to either 911 or the crisis team.
When the individual is taken to a hospital with a psych ER, they will still be accessed by a psychiatrist before being officially admitted to inpatient. If the police or crisis team sent them to the hospital, the psych ER will just hold them under observation status for the 72 hours if they don't meet inpatient criteria. There are other ways to get admitted (double doctor signature, etc...)

But the ONLY people that have the authority is the "crisis team," inpatient or ER psychiatrists and police officers....

As a social worker, as a therapist, my input is pretty insignificant.

I recently had to call the crisis team and 911 for a client that was decompensating. He had an extremely violent history while decompensated (multiple homicides). The crisis team would not even do an eval without the police presence...

When the police finally arrived, I took one of the officers aside and let them know the patient's history, while the team did their assessment (whom knew nothing about the person). Thankfully the police officer looked at my ID from the state hospital....
In this case the police were awesome....


Anonymous said...

ladyk73, it must depend on the state, but it was a social worker who had me put on a 72 hr old. A psychiatrist may have ultimately signed off on it, who knows, but a psychiatrist didn't interview me prior to the hold - it was all the social worker's doing. In fact, I was never interviewed by a psychiatrist until I got to the psych ward, and then I was only seen by a resident. I think in some places social workers hold a lot of power (too much in my opinion). If I had it to do over again I would refuse to speak to a social worker and request a psychiatrist. I think it would have gone differently.


Elisha said...

PK and LadyK, it depends on the individual. I have worked with amazing social workers and criminally negligent psychiatrists. In fact, the social worker I worked with in one of my hospitalizations was so wonderful that I referred private patients to her private practice afterwards. The psychiatrist in that hospitalization, on the other hand, was so cruel, disrespectful, and incompetent that I filed a formal complaint. Psychiatrists have FAR more power then social workers -- and cruel or incompetent psychiatrists can do far more damage then cruel or incompetent social workers when it comes to hospitalization and punitive measures then social workers ever will. Be careful what you wish for.

NB: This refers only to practices in the US. I am not familiar with the different designations in the UK or AUS.