Sunday, March 15, 2015

How Was Your Stay in a Psychiatric Hospital? -- Please Take My Survey: 5 quick questions

I'd like to tell you something.  The comments we get on this blog, especially lately,  talk about how horrible it is to be treated in a psych unit.  People say they would rather die then go back, they're infantilized, demeaned, and sometimes people describe frank abuse. They deem it comparable to rape and torture.  In my all-voluntary outpatient practice, I treat patients who sometimes get hospitalized and I make a point of asking people about their experiences.  People end up in psych hospitals during miserable periods in their lives, so it's never a happy issue, but unlike our blog commenters, my patients often say the  hospitalization was helpful, that people were kind to them, and that they left in a better state.  I don't work in the hospital and I generally have open and warm relationships with my outpatients -- who know I don't have anything to do with inpatient units -- so I'm thinking that perhaps they aren't lying out of fear of retribution if they are readmitted.

Let me add something else, the two biggest psych units near me are rated in the top ten in the country.  This may well be a skewed sample.  Few people go to state hospitals in Maryland for routine psych care-- the state hospitals are mostly for forensic patients and the state leases out short-term beds in community hospitals for the uninsured.  There are still a few long-term patients in the state hospitals, but not a lot.  And the chairman of my residency program made a point of asking every patient he interviewed if they were being treated well; The patient might be afraid to say they were treated meanly by a nurse, but the nurse would be even more afraid.  And please don't think that means that no one ever muttered an insensitive word to a patient or did the wrong thing, but I do think most patients there thought it fell short of torture.  In urban areas, many are looking for "three hots and a cot" and the hospital often fills that roll.  And some of the units attracted patients from all over the country who really, really wanted to be there for relief of their torment.

I'd like to know about your experience if you've ever been treated as an inpatient on a psych unit.  Will you take a quick survey for me?  And please -- this isn't science,  it's not validated -- but please just answer one time and one time only. And thank you so much!


George Dawson, MD, DFAPA said...

Good survey.

I think that a critical question is whether a person was asked to leave too soon. That is a major problem in most of the managed care environments that I have observed.

Another issue is whether the mix of other people on the ward seemed right. Did the person leave because they felt like they did not fit in?

EastCoaster said...

Just curious, as a technical question, how does voluntary hospitalization work in Maryland?

I ask, because it seems to me like there are very few "voluntary" admissions. Many people sign themselves in, but they were pretty much on the cusp of having someone else say that they had to go.

If you actually wanted to go, they'd probably think that you could be diverted to intensive outpatient treatment and weren't actually sick enough to take up the bed.

Hopkins is probably not representative of most places--especially the for-profit ones.

Anonymous said...


As one of the anonymous commenters in your entry "Are There Ways To Lessen The Violation That People Feel After Psychiatric Hospitalizations?" I commend you for your follow up. I provided my answers to your questionnaire for whatever it is worth.

I think that you are beginning to see the light. You seemed particularly impacted by one of the commenters in Mad In America (not me, I can assure you) calling your entry "pure evil".

Several people have pointed out this to you in the past in this blog to no avail. I don't know what in the response to "Are There Ways To Lessen The Violation That People Feel After Psychiatric Hospitalizations?" made you react in ways previous comments in this blog didn't, but whatever it was I welcome it.

You can do now a retrospective exercise and read the testimony if psychiatric survivors in your own blog and at Mad In America with a different perspective. I am sure you'll learn a lot from listening to their voices.

I describe my own experience to friends and family as having gone to hell and then coming back.

It is very difficult to convey to people the sense of utter violation that a psychiatric survivor feels. Even though at times comparisons have been made to rape, where the analogy fails is that in the case of rape, there is societal agreement that rape is pure evil. What you usually see on TV are victims of rape describing their suffering and getting the public's empathy.

In the case of psychiatric survivors, in addition to having to live with a very traumatic experience what you see on TV are unapologetic defenders of the abuse you just endured, such as congressman Tim Murphy or Pete Earley. If you manage to recover from the sense of loss of humanity and humiliation that follows an involuntary psychiatric incarceration, you become stronger in ways no other experience can make you stronger.

I put emphasis on "if" because, sadly, the average survivor never recovers and becomes a victim of the system through repeated hospitalizations, repeated humiliations and repeated forced drugging.

You could be a force changing that and I hope you join those of us who are fighting to correct the abuses that coercive psychiatry perpetrates every day in the United States.

Dinah said...

George, I should have thought of that! I was too focused on whether people find the hospital helpful to even think about too-early discharge.

EastCoaster: I will do a blog post on this for you at some point.

Anon: a year+ into the research for a book on involuntary treatment and I am well aware of how violated some people feel and how oblivious others are to this sense of violation. What I'm becoming very aware of is that the voices of those who felt such violation are blocking the voices of those who felt helped. And there's a lot of inbetween. I am going to start moderating out these comments because I have allowed them to be part of the discussion for 9 years, and they've chased away some the psychiatrists who'd like to talk, as well as the patient who just want to say that they've had good experiences. It's time for the other side to have a turn.
Thank you for taking my survey and for adding your voice to the mix.

Liz said...

these questions are hard to answer, dinah-- i was often better after discharge because psychiatric hospitalization was a temporary "reset" button for me.... but the care still sucked, kwim? some of the time, a mini-vacation might have been better, with immediate daily access to both a psychiatrist and intensive outpatient treatment.... in addition, while i may have been better at discharge and was not physically abused much of the time, there were still times when i felt tremendously degraded. and, within the same hospitalization, times when i felt so validated i could have cried with relief. a question- why are visitors so limited on inpatient psych units? i'd love to hear more about that. there is so much that could be done to improve psychiatric hospitalizations... for one, make hospitalization as non-miserable/helpful as possible, and let people check themselves in when they need to. two of my od's were attempts to get hospitalized because i felt out of control and didn't know what to do. also, i love your new magical "i'm not a robot" button.


Anonymous said...

I'm having a hard time answering these questions because there are very few things I could point to as "helpful" in my hospital stays -- sometimes, but
not usually, the med changes, not the doctors, seldomly the nurses, definitely not the groups, not the other patients.

Yet they were helpful in that they defined a point of, like, surrender for me, a point at which I had to admit somewhat publically my thoughts and behaviors were not under my control anymore. I fought the hospitalizations because *that* was what was traumatic (being out of control). The hospital stays themselves were mostly just holding places until things settled down a bit. Symptoms I had been fighting --usually obsessive SI -- always got worse at the beginning of the hospital stay, I guess because it was a 'safe' place to release them.

So the stays were terribly traumatic, in that mental illness is hellaciously traumatic. Others, where I was involuntarily committed without being as sick, were just dumb. Not helpful, but not that traumatic either.

Jen said...

I am going to answer this survey three times, one for each of my (voluntary...but I didn't really have a choice) psych hospitalizations. All were for severe depression and suicidality. All were at the 2nd highest rated university hospital system in the country. All three were very different experiences. One was helpful. The other two were tremendously damaging and traumatizing, in different ways.

Jen said...

Dinah - I've been thinking about this for a while, and I'm not really sure how to say it, but like your commentators, you are also seeing the issue in black and white. When you talk about all the commentators who called you evil and compared their hospitalizations to torture and rape, you're ignoring the negative experiences of many others. I've seen ALOT of comments that didn't compare hospitalization to torture or rape, but did find it invalidating, humiliating, abusive, including my own. I understand that your patients found the hospitalizations helpful and I think that's great. Personally, I have been hospitalized voluntarily, for depression and sucidality, three times. One time was helpful; the other two were traumatizing to the point where I was unable to go within a 5 block radius of the hospital for a good three years, and qualified for a PTSD diagnosis for a while. So of course I am not everyone in the world, but if you take my experience as a microcosm, that means 2/3 of voluntary hospitalizations are severely traumatizing. Which means that it's completely reasonable for your patients, who clearly fit into the 1/3, to have had helpful hospitalizations (particularly living close to such great hospitals, though my hospitalizations were at the #2 ranked psych programs so I'm not really buying into that as a criterion) AND it's ALSO completely reasonable for 2/3 of the rest of the people hosptialized to have had humiliating, traumatizing, deeply damaging experiences.
When you continually reference those who call you evil and compare to rape and torture, you are discounting a huge percentage of people who WERE deeply traumatized by psych hospitalization -- but not claiming that comparison.

The treatment I received in my first hospitalization was helpful. The treatment I received in my last hospitalization was so traumatizing and damaging that yes, I would rather complete suicide and die then live through that experience again. I recognize that I could get to a healthy, happy point in life, but I would still prefer to die then go through it again. It was that bad. It took years to work through and get past that experience, and I still have nightmares about it, many years later. Had I not wound up with an excellent shrink, albeit two years later, I perhaps would still be stuck in the middle of that trauma. And since the hospital gave me no discharge plan at all ("Patient will follow up with her family [who lives on the other side of the country and has no connection to psychiatry, psychology, social work, or medicine] about finding a day program [except when you aren't referred directly from an inpatient unit, insurance won't cover it.]") the chances of winding up with a great shrink are pretty darn low.

But I still wouldn't compare it to torture or rape. And when you only reference those somewhat extreme comments, you aren't acknowledging the rest of us who had deeply traumatizing hospitalizations - you're throwing out the baby with the bathwater. Please think about it.

Jen said...

Please check your lost messages. I posted twice, neither was offensive, so I don't understand why they are being disapproved.

Milo said...

Thank you for even asking this question.For me personally, it would mean the world if someone ever asked. I feel so humbled, privileged and blessed for ever knowing someone on the other side counted me as an equal human being.

Anonymous said...

I've been planning a longer post to your orignal comment Dinah, but I've been a very busy and a bit low on energy so it's taking a while.
I just wanted to say quickly that whilst I have had a 2 (out of 4) hospital stays that were traumatic- so much so that I had symptoms of ptsd from one of them. But one thing I have discovered in therapy for this ptsd, 5 years after the event, is that it was in part being so sick that I found traumatic, not just the treatment I experienced. The treatment was still horrifying, but it wasn't the whole story. And being able to talk about the experience has been very healing. So being asked for feedback may help this healing process.
Also my last hospital stay was actually quite positive. I felt safe, I was treated with respect for the most part. (I was in partly due to lack of compliance with meds and having to 'prove' that I'd swallowed my meds was denigrating. Particularly as I know I have the freedom to refuse them if I wish and if I did, I would just say so, and not be so underhanded as to lie about it!)
My doctor listened to me and tried in several ways to help, the nurses were fairly reasonable, although their ideas about appropriate times t the day for meals, showers and exercise were strange. When I was well enough, I was given the freedom to go for a walk once a day. And I was able to 'smuggle' food out of the kitchen to eat after my meds, as when you take anti-psychotics they make you damn hungry after you take them.
But I have to say I was at a private hospital and I was a voluntary patient. I was not given a choice about being hospitalised, but I was not under an involuntary order, so that may have made a difference. Also most of the patients were there for depression and anxiety and to be a snob, whilst the patients were ill, there wasn’t any inappropriate, violent or abusive behaviour. So I guess there was no reciprocal behaviour on behalf of the staff to be aggressive, or condescending. The patients all seemed to be pretty normal people who were feeling ill, which was one thing I found so healing, I liked these people and they were mentally ill, so maybe I wasn’t such a bad person after all.
So, I think positive hospital experiences are possible, but I wonder how much of the bad treatment is a response to the behaviour of someone who is mentally ill. Not saying that the mentally ill person is responsible, but if you’re a nurse and you’re understaffed and trying to deal with a group of people with challenging behaviours I can see how after a while you might start acting inappropriately. It doesn’t make it right, but I can see how it might happen.

Anonymous said...

Further from what I said earlier, I think the most important part of the positive hospitalisation was that I was treated like an adult and given adequate treatment for my illness.
Hospitals are there to treat ill people and I think in a lot of mental health cases the hospitalisations are too short and don't provide adequate care.
My hospitalisations have been in the duration of several weeks and I was given time for meds to work and therapy to help.

Anonymous said...

I was hospitalized involuntary once in my life, about 15 years ago. I was 20 years old, in my final year of college, and dealing with depression, PTSD, and dissociation (although I did not know any of that back then). I made a miscalculation while self-harming, and ended up injuring myself badly. I was taken to the ER, and from there I was put in the “locked ward” of the behavioral health center.

After reading other people’s accounts of their hospitalizations, I can appreciate just how well-treated I was at my hospital. The nurses and techs were kind and respectful, medications were not forced on me (they were strongly recommended, but I was allowed to refuse them), I was not strip-searched or restrained in any way, and the facility itself was comfortable and well-funded (there was even a swimming pool- I couldn’t go in because of my stitches, but I could sit on the side and dangle my legs in.)

And it was still one of the most traumatic experiences of my life. Even though I wasn’t mistreated, I was still locked up against my will. It was terrifying to suddenly have no voice, to be transformed from normal college student into someone who was “mentally ill” and therefore unable to determine what was best for myself. I knew that I didn’t belong in the hospital, but my thoughts and feelings meant nothing. It’s hard to describe just how scary it is to be treated as if you are crazy, and know that there is nothing you can do to prove to the other person that you are not.

After my 72-hour hold was up, I thought I would be released, but they told me they had filed papers to keep me indefinitely. I had been easy-going and pleasant up to that point (even though I knew I didn’t belong in the hospital, I could understand why they put me there), but hearing them say that was totally surreal and awful, and I stopped cooperating. I requested a lawyer, saw him the next day, and a few hours after our meeting I was released. Any sort of party or celebration of my leaving would have felt patronizing and insincere.

Once I got out, I had nightmares for years about being back in the hospital. I tried not to think about what had happened, but the knowledge that my agency and voice could be taken from me at any time dominated my thoughts for years afterwards. I still managed to finish college, go to graduate school, and become successful in my career. I think the worst consequence of the hospitalization was that it scared me away from any contact with mental health professionals for a long time afterwards. It is only in the last few years that I have started seeing a therapist again, and I feel sad that I went so many years of my life without help because of my experience at the hospital.

Even though my hospitalization was so traumatic for me, and I don’t think it was necessary, I do think that there are times when it is necessary. I have discussed with my therapist certain situations in which I would want him to hospitalize me, even knowing how traumatic it would be.

Anonymous said...

I've been wondering about this all weekend...
Dinah, can you write a post about what exactly is therapeutic about a hospital stay?

Is it mainly about keeping people safe?
Maybe getting people on meds?
From what other people write, giving people a break and some respite also seems to be a big factor.
I know for me, little things like being fed have a big impact. You feel a lot better when you eat every day. How much is it the 'little things' and how much the 'bigger things'?

And how effective is it actually?
What are the outcomes?

How much of the process of hospitalisation is doctors covering themselves when someone threatens suicide? Does hospitalisation prevent suicide?

Do the therapy 'groups' in hospital serve any purpose? Well, by that I mean any psychological purpose, not just filling in time? Most seem like a waste of time, but at my most recent hospitalisation they were really good. They went into the details of what all the different mental illnesses were, and what the different treatments were and how they helped, and even went into the science if it which made me happy. It was really good.
Plus they taught mindfulness (which I hate), meditation, stress reduction, coping techniques and even had question and answer sessions with a doctor.

Do all the restrictions they place serve any purpose? Does access to soap and toothpaste really pose that big a risk? Does it really matter what time of the day I have a shower? Is it really that big a deal if I have it after breakfast rather than before?

How do the nurses who work on psych wards feel about their job? Do they feel that they are helpful?
On the public wards I've been on they seemed to hate it. It would be a hard working environment, but it would suck to go to a job that you hate everyday. And if you hate your job, I don't see how you could provide the high level of care that psych patients require.

What would an ideal hospital stay comprise?

How long would an ideal hospital stay be?
Are there actual studies into what is the best care in a hospital situation?
I know in Australia mental health nurses need further training (masters) and study about different techniques and treatments. But I also know that most nurses on the ward have no further training. Mental health nurses in Australia seem to work mainly in outpatient services.

Sorry, most of these questions are not really appropriate for you to answer in your blog, but I really do wonder and pubmed/medline can only take you so far (particularly when you have no training in the field).


Jen said...

I have told myself not to continue engaging on this point, but I will just say one more thing.

Even your title of the original post says it all. How about instead of "Are There Ways To Lessen The Violation That People Feel After Psychiatric Hospitalizations?" -- Are there ways to lesson the violation that occurs during psychiatric hospitalizations?

I think by now we are all, even you, in agreement that these violations routinely occur in psych hospitalizations. Yet, even your title questions that premise....

Jen said...

And - "I am going to start moderating out these comments because I have allowed them to be part of the discussion for 9 years, and they've chased away some the psychiatrists who'd like to talk, as well as the patient who just want to say that they've had good experiences. It's time for the other side to have a turn."

You should make that clear in your posts and surveys that you are only looking for positive responses from those who have had psychiatric hospitalizations. Believe me, if you clarify that perspective, those of us who are up for an open dialogue with a shrink who appears to be up for it as well will understand that this is not the place for that and leave you alone to the fantasy that psychiatric hospitalization is all roses.

Anonymous said...

I think the differences in opinion may very well have to do with the vast differences in the quality of psych hospitals that patients and psychiatrists alike have been exposed to.

For example, I remember seeing on TV a patient painting on a canvas in front of large picture window in a nice sunny room in a psych unit (I think it was at Columbia), and I remember being absolutely amazed at how different her experience was from my own. You contrast that with a psych hospital in rural Texas where patients are even required to strip their own beds at discharge (I guess they could not afford housekeeping). The two experiences could not be any more different. The rural psych hospital is also much more limited in the ability to hire quality staff which is going to make a big difference.

So, I think the difference in the patients' experiences have everything to do with the huge variance in the quality of the facilities and staff we have been exposed to. If I had spent my afternoons leisurely painting in front of a picture window in a nice sunny room or doing yoga, surrounded by attentive, caring staff, I would probably have better memories about the whole thing. If you have to go through a psychiatric hospitalization, I'm thinking it might be better to opt for Johns Hopkins over rural Texas, LOL.


Joel Hassman, MD said...

Tip to Dinah: I am sure you know this, but would like to offer it in print anyway, I know you are not a polarizing nor extremist person, so, when you are called so, realize this is either projection by the commenter or just no ability to negotiate this issue of involuntary care.

Just trying to be supportive.

Anonymous said...

Jen, on a related note, when I ended up in an ER due to an adverse reaction to a med, I was given a survey to fill out 2 days later. They didn't ask for just positive opinions as they truly wanted my feedback. And with all the questions, unlike some surveys, there was plenty of room for me to comment on different situations which I did.

Anyway, as far as I know, hospitals don't stop sending out surveys if they don't like the answers they receive. Now how seriously they take the feedback is another question although a friend who works in one assures me that at least in her hospital, the feedback is.

Back to this issue - As one who has was never hospitalized voluntarily or involuntarily, I have to agree with Jen, Dinah, regarding the feedback issue. Just like that hospital I went to can't pick and choose the responses it gets, if you ask for feedback on people's experiences, it really isn't fair for you to do the same thing.

Anonymous said...

"What I'm becoming very aware of is that the voices of those who felt such violation are blocking the voices of those who felt helped."

So perhaps the issue is really a restatement of the iconic question -- is it better to punish one innocent person and so catch 100 guilty persons or to let 100 guilty go free to protect the one innocent?

Is it okay for abuse and violation to happen to so many because some are helped?

Personally, I'm not sure why the issue can't be reframed as how to STOP the violations and IMPROVE the level of care so that ALL patients can be helped, rather then choosing between and discounting those who are treated terribly to give space for those who are helped to speak about it? (and I mean come on, it was so bad that my insurance company filed a complaint with columbia! and to the person who thought "afternoons leisurely painting in front of a picture window in a nice sunny room or doing yoga, surrounded by attentive, caring staff" happens at Columbia, let me assure you that definitely doesn't happen!!)

@Joel Hassman - we're not only talking about involuntary hospitalization, which is a whole other can of worms and brings to bear many other issues. we are also discussing voluntary hospitalization.

Anonymous said...

Anon, thanks for clarifying. Honestly I can't really remember if it was Columbia or not. I remember it was a celebrity journalist who was interviewed (Jane Pauley, I think) so I don't doubt that no matter where she was her experience was a lot more cushy than the experience of the average joe. It wouldn't be very smart to mistreat a famous journalist.


Unknown said...

I've always likened my 5-day stay in one of the locked wards of a psych hospital to being on a cruise ship. I had my meals prepared for me, there were a bunch of silly activities to keep me entertained, and helpful staff to make sure I was doing OK.

When someone who had actually been on a cruise joined us, he said the food and beds in the hospital were better.

Anonymous said...

Hi Dinah!

This is Ladyk73 (Ladyak47). Despite my years of "stability," my ability to get my MSW and do some great social work and peer work... The black cloud returned to me recently, and I am still struggling. I was involuntary admitted after an OD. I went to the ICU this time. There are things I don't remember (from the OD). It was interesting, in that I ended up in the same hospital I was in 10 years ago. There was a lot of really good changes. I know NYS had a huge initiative to eliminate/ reduce restraints. I was happy to report that there was none while I was there. The doctor was great. Most of the nurses were awesome. Some of the staff were annoying, from a professional prospective, it was a decent place. But.....

I had nothing from home. I only had the clothes on my back. After 72 hours of being in the same dirty underwear I was emotionally beaten. They had gowns and scrubs but the scrubs did not fit.

The food was awful (Near the end of my stay, the nurse admitted that they did that to reduce the 3 Hots and a cot). But after the fourth day of being served eggs (which I am intolerant) and being served toast that I could wring out like a sponge.... I felt like I was in prison. You only were giving beverages at meals. They had a water fountain of warm nasty water. You were forced to be the aides for a cup and an ice cube.

I realize that this is more information then most wanted to know.....But I might mention that I had a catheter while in icu. And some other woman issues that having clean underwear would be important.

After my friends were finally able to get me some clothes, and the nurse wrote a few dietary changes... things were tolerable.

It goes back to the very basic hierarchy of needs. I really need a pair of clean underwear and water to drink. Even though I may have not died from it, it was so humiliating and degrading not to have something as insignificant as a hairbrush.

I wish I could say a month later that the hospitalization was helpful. I am alive. But my life is in ruins. I got fired from my job, had to go on foodstamps, my new doc (I finally fired the old one) is still figuring out my meds. I am still having horrible symptoms. It was bad enough to get depression. It is awful to lose so much afterwards. I am still struggling to make it thru the day

Dinah said...

Ladyk73: Oh my, what a horrible ordeal. I am so sorry to hear, and so glad to hear that you've survived all this. Keep swimming, one day you will be in a much better place and look back and say, "That was a really awful period in my life!" But you're not there yet, it takes time to resurface and get your footing after such a miserable time. I'm glad they were kind to you in an overall way in the hospital, even if the food was awful. I'm hoping it just took a little while for your friends to get clean clothes to you and that it wasn't that the psych unit refused to allow someone to drop off clean stuff.
I hope you feel better soon. Hang in there.

Anonymous said...

Being in a psych hospital was the most traumatizing experience in my life. Why? First and foremost, because I DID NOT BELONG THERE. I was having an adverse reaction to one pill of an SSRI which CAUSED me akathisia and suicidal thoughts out of the blue and was sent to a psych ward from the ER because no one wanted to believe me. I was given the med for mild situational anxiety and had ZERO depression prior to taking the med. In fact, had plans for the rest of the week.
THAT is the first thing Psychiatry needs to change: BELIEVE THEIR PATIENTS because no one knows their bodies and minds more than a patient. THAT is the basis of RESPECT!
I was not believed and treated like subhuman at the psych hospital. Other patients advocated for me and told the staff that I clearly did not belong in there and that I was obviously having an adverse drug reaction. The result? I was drugged more and more...until I was made to HALLUCINATE! Me, who never did any drugs or alcohol hallucinating! Then you kept trying more drugs on me even though each and every one of them made me worse and worse and you failed to believe me...

That started 4 months of polydrugging with 14 different psych meds until YOU MADE ME PSYCHOTIC! From ZERO mental health problems in my life to PSYCHOTIC ON MEDS (never before)! 3.5 years later still recovering from the brain damage and the TRAUMA. Now you want to label me PTSD. Every time I hear the word "doctor" or "Psychiatry" or go near a doctor or hospital or pharmacy I have an immediate fight or flight response. PURE TERROR!

Thanks to Psychiatry I have lost it all. My career, my house, my education at a top university was a waste of time, but more than anything my sense of SELF and my ability to be a present mother for my children! Now THAT IS EVIL! Lack of insight and looking outside your bubble does not justify ignorance. Ignorance is NOT BLISS. Willful ignorance is EVIL!