psychiatric hospitals


The Upside Of Admission To The Psych Unit: A Doctor’s Inside View

By Helen M. Farrell, M.D.
Guest Contributor

I met J in the Emergency Department. Dark red blood was oozing out of self-inflicted deep lacerations to her forearms. The surgical team was consulted and the cuts were debrided, cleaned, stitched and neatly bandaged. J was patched up. But she was not healed. Her wounds ran deeper than a surgeon’s instruments could access.

Together, we had a thoughtful conversation that included a review of her suicidal thoughts, intermittent hallucinations and innermost feelings. These vacillated unpredictably between anger and worthlessness. I informed J that she was going to be admitted to the psychiatric unit for her safety and treatment.

“Locked up?!” These are typical words expressed by patients who learn that they are going to be admitted involuntarily to the psychiatric unit. When J heard this news, her own tear-stained face scrunched up in an expression of horror. After several minutes of pleading, she finally resigned herself to the plan.

A nurse came into the room and took J’s phone. She took her sweater, her belt and the laces from her shoes. J stripped down into a standard hospital gown. It is common for patients to make one last plea and many have told me that they fear the psychiatric unit is analogous to prison.

J is representative of the many patients whom I treat on a day-to-day basis. She is a composite of those actual people who suffer from serious mental illnesses ranging from psychotic and mood disorders to personality disorders that require hospital level care.

Not Your Mother’s Psych Ward
The days of psychiatrists wantonly locking up patients like J against their will are long gone. They have been replaced by a legal process called civil commitment that firmly puts patients’ rights first. Yes, J was being admitted against her will, but she would retain her power to make treatment decisions, summons legal counsel, and even have a hearing with a judge. These safeguards apply to patients like J who are mentally ill and at risk of harm to themselves or others as a direct result of mental illness.

We know about the extreme cases of mental illness — those who involuntarily get locked on a psychiatric unit. An estimated one-quarter of the United States population will suffer from mental illness. But what about those people whom we never hear about? Far too many people, victims of stigma, neglect treatment and suffer in the isolating silence of darkness. They are compelled to withdraw because of fear and shame.

Beyond Shock Therapy

Driving much of that stigma is the fantasy of what happens behind that infamous locked door. Images from “One Flew Over the Cuckoo’s Nest” fill people’s imaginations, as do fantasies of the “shock therapy” room, which many incorrectly think is a place of punishment and not treatment. Continue reading

More resources:

New $302M State Psych Hospital, Recovery Center Opens Today

Massachusetts officials are opening the $302-million Worcester Recovery Center and Hospital today, The Globe reports, a huge, controversial, state-of-the-art facility for the most seriously ill psychiatric patients. With bucolic landscaping, treadmills and pool tables in the rec-rooms and careful consideration of how best to enhance the healing process for folks with very tough disorders, the new facility is the largest non-transportation project in state history,

The Globe reports:

Yet within this $302 million structure, there is clearly a sober ness of purpose. The ceiling light fixtures lack any parts that could be used to help residents hang themselves. The lights’ on-off switches are partly covered to avoid deliberate electrocution. The walls are made of a high-impact material to absorb fist-pounding and kicking…

The 320-bed hospital will take in the patients displaced from a Worcester facility that is being closed and a partially shuttered Taunton hospital. The new complex will treat nearly half of 670 psychiatric patients across the state needing long-term hospitalization. In the mid-1950s, the state’s network of about a dozen psychiatric hospitals housed nearly 23,000 patients.

The complex, with its private rooms and its airy communal spaces, represents a stark departure from state mental hospitals of old, where patients fought delusions and depressions in locked wards, with little focus on privacy and choice.

While state authorities remain deeply committed to the concept of community-based care, they said they had to construct a more modern structure in line with current therapeutic practices for those who cannot yet live safely in the general population. Many of the patients who will be treated there have been diagnosed with schizophrenia, severe bipolar disorder, and other profound mental conditions.

Back in March, Carey got a tour of the facility while it was still under construction. Here’s a bit of what she saw:

The hospital space flows much as the space does in a typical life outside, from private space in a patient’s room, to a small unit, to a “neighborhood,” to the broad interaction of downtown.

“The intent is to create as much autonomy as we possibly can, to engage the patient in their recovery in a way that is not controlling,” said Anthony Riccitelli, the hospital’s chief of operations. Continue reading

Advocate On Taunton Hospital Closing: Trouble Isn’t Beds, It’s Help Outside Walls

The state announced yesterday that it would be closing Taunton State Hospital and relocating patients and staff to other state-run psychiatric hospitals, including a new state-of-the-art Worcester facility scheduled to open this summer. The Massachusetts Nurses Association decried the move as bad for both staff and patients.

‘The problem is not a lack of hospital beds, the problem is a lack of investment in local community prevention efforts.’

I asked Deborah Delman, executive director of The Transformation Center and a leading Massachusetts advocate on behalf of people with mental illness, for her reaction. Her reply:

“The state is systematically draining local community-based support for people with mental health conditions and pretending that services driven by medical providers will include mental health. The problem is not a lack of hospital beds, the problem is a lack of investment in local community prevention efforts.

We would support the state in full if it involved us in a locally based plan to:
•Open 6 regional peer-run respite centers which have been shown – using claims data tied to social security numbers – to dramatically reduce hospitalizations and costs while improving services (a single pilot is about to be implemented in Western Massachusetts.)
• Open locally based specialty medical homes focused on mental health recovery services (such as the grant funded pilot at Community Healthlink in Worcester.) Continue reading