Tuesday, August 01, 2017

Inpatient Psychiatry: Not All Bad


I'm going to send you over to the Washington Post for an article that was published last week, written by Stanford psychiatry resident Dr. Nathanial Morris:  please check out 'Psych Wards' aren't what you think

Morris makes the point that the inpatient psychiatry units is portrayed something out of a horror show,  when really it is a place of healing.  He writes:

These are places where patients put their lives back together, picking up the pieces torn apart by such illnesses as depression, bipolar disorder and schizophrenia. Caregivers from doctors and nurses, to social workers and psychologists work to heal the sick, to guide patients out of the abyss. Families often reconcile with loved ones. Patients may find hope in one another, opening up in groups, sharing meals, discovering the comfort of shared experiences.

Morris is right. People go in to hospitals in miserable states and they come out better.  They don't, however, necessarily appreciate the care they've received.  As we note in our book, Committed, some people come out feeling terribly traumatized.  If they feel better, they may attribute it to reasons other than the psychiatric treatment they received.  Perhaps they healed from time, or being away from their problems,  or the kindness of a nurse or their fellow patients.   Ah, yes, moments of healing.

Morris points out that part of destigmatizing inpatient care involves acknowledging psychiatry's dark past.  Again, he's right.  What he doesn't say is that psychiatry continues to be dark in many ways related to inpatient care.  Psychiatry is not a money maker -- the resources are not always there for the luxury rooms and pleasant surroundings that might be found perhaps on the orthopedic floor.  And beds are reserved for the sickest of the sick: those who are both ill and dangerous.  We remain the only specialty where pre-authorization for inpatient care demands a life-threatening level of acuity-- if you're not suicidal, you go home.  It means the inpatient units are full very sick people and sometimes there are dangerous, patients may hurt each other or the staff or themselves; it's the sad reality.  And treatment is sometimes dictated by doing what needs to be done in an understaffed environment to keep people safe, even if it means the care is not what is ideal in the long run for the individual patient.  This is not to ruin such a lovely article because Dr. Morris is right (once again)-- psych units are full of tender moments, they are about healing, and they aren't about torture.  Often, they are about pressing the 're-set' button after the power has gone out.

 We're short on beds and negotiating the system is difficult.  It should be easy.  If more people could or would get the care they need, we'd have fewer suicides, less suffering, and fewer people in jails. 

Morris goes on to say: 


Overcoming the stigma against psychiatric units won’t be easy. But I think it’s possible.

Familiarizing the public with psychiatric care is a first step. Stereotypes against psychiatric units endure when these places remain unknown and out of sight. By opening up about the realities of mental-health treatment, providers and patients can address the pervading views of the “psych ward” as a place of torture and imprisonment. This kind of transparency can illuminate psychiatric care’s potential for healing rather than horror.
Bravo!

9 comments:

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Catlover said...

I don't come here very much anymore, but I'm recovering from surgery and have a lot of time on my hands so here I am. After a major surgery with complications, and a minor surgery a few years ago, I can say with confidence that care in the regular part of the hospital is nearly always nurturing and respectful. The wound care (packing) is incredibly painful. But the nurse works with me in a caring manner.

When I took care of my husband for his knee replacement at a different hospital, there was lots of teamwork with all the patients recovering together. The nurses were incredibly kind and professional and there was no boss/subordinate nature to it. Not with the doctors either. Teamwork! Not the useless, no information groups and staff talking down to patients in the mental ward of that same hospital. (There are always some very good nurses on a mental unit but the terrible nurses do get around with their patient hate).

I get treated like a real human being by my regular medical providers. I'm grateful for that. I just want people to treat me like I treat them. Be nice!

I had to move to another psychiatry office because my long term favorite pdoc moved, and I feel like a lab specimen in the new place. It's a totally different vibe. Like I'm a sub human. The differences in care are disturbing. I wish very much that I could just drop out of mental health care altogether. I can't, because I need disability paperwork filled out and I do need a doctor following me because I am on the severe end for bipolar. The mental health providers in the new office have such low expectations for me. My old pdoc and I could have good conversations and he cared what I thought. Now I'm like the cute drooling idiot who can do clever tricks. It's hard to explain. I'm bringing my husband along next time so he can "normalize me" in the eyes of these new providers. It's so BS that I have to do these things. I only ever have this trouble in mental health. EVER. I dread going there for days ahead of time. I might try switching to another place, but this one is much more convenient in location.

Catlover said...

Another thing is at the new outpatient providers, all the staff wear hospital scrubs (color coded, even) and that is incredibly triggering (I hate that word) for a person who's been inpatient and mistreated several times. No thought given to patients with serious mental illness at all. Tone deaf. They are not getting vomited upon. Not doing needle sticks. No wound cleaning. Why can't they just wear regular clothes like it used to be in outpatient psychiatry? Oooo, it's got to be all medical looking, I guess.

I'm still low functioning (too chronic) but I'm glad I'm not going inpatient anymore. Off the drugs several years now, I'm back to thinking sharp and having high functioning friends to socialize with. They give me zero trouble over me being a mental patient on disability and I'm not their little pet. These are equal, healthy relationships.

Truthfully, my doctors, family and friends are protecting me from the system. That is very sad, isn't it? I no longer suggest people go for help with their troubles. It breaks my heart. The system is a steamroller and it will crush you. A false hope.

I think a lot of people caught up in the system do not even realize that they are gradually being demoralized with the curse of low expectations. They accept their new lot in life and lead needlessly diminished lives. That's what I saw when I was in the system a lot more heavily than I am now.

I will add that it is probable that at least some of the better treatment I get now is due to my moving into middle age. It seems like people are less judgmental because everyone has scars from life by 50, pretty much. And yet, something is really off at the new pdoc office. I don't have the best social skills and haven't put my finger on it, but my husband will figure it out next time. My pdoc is nice, and has terrific credentials, but somehow I'm not treated in a normal manner. It's just off in a way I can't define.

When we get it all figured out, I'll do my thing and write a nice note to try to make some culture changes for the better, without blaming anyone. Honey, not vinegar. It worked last time. I don't want to be a token mental patient. Oh, *this* lady, she's all right. I want providers to see that we are all people first. The mental label comes way down the list after mother, father, sister, brother, goofy fun guy, animal lover etc. I really hate doing this stuff so much. I like to do my nerdy things. But I can't stand by and watch this train wreck and do nothing. I met a lot of really nice people in the mental hospital with me, with their string of tragedies, and I don't forget that.

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