Inside Mental Hospitals and Behavioral Units: A Bipolar Patient’s Point-Of-View

Popular media portrayals of mental institutions often depict unflattering prison-like facilities staffed by stern attendants trying to manage patients as if they were small children in constant need of severe whippings and isolation. Except for government-run facilities for the indigent and criminally insane, today’s hospital settings are much more benign and peaceful. This fact is not due to the oft-portrayed result of overmedication needed to keep patients from being too active and unmanageable as found in nursing homes; rather, it stems from today’s empirical knowledge that a serene and comfortable environment is key to a patient’s mental and emotional healing.

When an individual experiencing a mental disorder episode is either violent or not determines whether he or she is taken to either an emergency room (ER), a private mental hospital, or public hospital behavioral unit for assessment. The out-of-control ER patient typically receives a sedative medication upon admission to prepare him or her for transport to a mental health facility. Both they and non-violent individuals who enter a psychiatric unit are first assessed in order to discover their underlying condition(s). With the patient safely inside a secure facility, a psychiatrist prescribes an initial mix of psychotropic drugs to arrest and stabilize the patient’s presenting condition and immediate symptoms’ presentations. A lengthy hospital stay is often required because most psychiatric drugs require 2 to 4 weeks administration before behaviorally affecting the patient.

A violent or unruly patient is sometimes taken to a locked and padded isolation room for observation before his or her initial dosing of meds wears off. A psychiatrist, psychotherapist and case manager are assigned to the patient. The “in-control” patient in either a private hospital or general hospital behavioral unit is quickly assessed to determine the nature of the current episode. A patient history is also cobbled together. He or she is asked a battery of questions concerning moods, thoughts, actions and beliefs by a psychologist or trained psychiatric nurse, caseworker or licensed social worker (LSW). However, the patient is primarily scrutinized according to his or her “body language,” as 65% of all human communication is non-verbal.

Medical care is often limited, constrained by government regulations, sub-standard facilities and medical professionals’ unions found in state and federal (e.g., veteran) hospitals. There is even a lack of basic janitorial services at some of these locales. Additionally, “drug lists” used within these institutions are narrow and limit the physicians’ use of the latest, most-efficacious and commonly prescribed psychotropic medications available in the marketplace.

Complicating adequate patient care in many of these facilities is the fact they are mandatory repositories for both criminally insane and indigent patients. As with prison facilities, dangerous contraband including drugs and sharp objects often find their way into the patient population and constitute an existential threat to all in-house staff and patients. Basic equipment, as can be found in most hospitals, is either non-existent or broken. A padded crutch or fully functional wheelchair may be non-existent or broken. A lone wheelchair may exhibit an undersized seat, loose armrest, pinch-points, missing footrests or broken brake lever. Group and individual counseling are pedestrian at best and absent at worst. Occupational and physical therapies often do not exist. Food is often substandard.

Standard procedure in all hospitals is having all items except for the textile portions of patients’ clothing bagged and safely stowed to prevent theft and injury to the patient by items like pocket knives, belt-buckles and other items known as “sharps.” Disposable slippers or cotton socks with non-slip rubber soles are issued in lieu of the patient’s original footwear. Meal service is either smooth-edged metal spoons or plastic flatware accompanied by either unbreakable smooth-rimmed melamine or non-injurious paper or styrofoam plates. Styrofoam drink-ware is also used. Meals are of above-average quality and quantity. This stems from patient dietary needs due to disorder-caused eating issues that have deprived most patients of both nutritious and adequate amounts of food. Meals are served in either buffet lines or catered-style metal food warmers. The latter usually contain meals selected by patients the previous day from menus offering a choice of entrees, beverages and desserts. Much light-hearted trading of food takes place around the tables during mealtimes.

More women than men occupy a psychiatric unit at all times. Although an equal number of men and women are bipolar, women suffer depression twice as much as men do. Hence the patient census typically exhibits 15%-25% more women than men on any given day. With the wide variation of patients, their personalities, and manifold states of their drug therapies, arguments between and among them are not uncommon, as are physical confrontations. Psychiatric technicians and nurses are always on guard to immediately quash these encounters.

Psychiatric facilities focus on both mental (including emotional) and physical health for patients. Spiritual needs are not addressed except for an occasional, optional 15-minute non-denominational session on a Sunday morning, for example. The goal of a restored circadian rhythm in patients explains the strict observance of scheduled morning wake-up calls, meals, group therapy sessions, physical and occupational therapies, other activities and bedtimes. Occupational therapy consisting of small construction and art projects provide for patient relaxation, sense of accomplishment and success in meeting small goals. Sometimes batteries of mental and physical tests are administered to gauge the overall status or health of the patient. An Intelligence Quotient (IQ) test is but one of these exams.

Mood patient anxiety, mania and depression slowly subside in response to a varying drug “cocktail” in an attempt to discover the best course for the patient. Also, a physical, emotional and social activity regimen is instituted to achieve a patient’s overall goal of mental stability. “Level” or “stable” moods, not joy or happiness, are the goal, as is commonly misunderstood by the layman, for achieving mental recovery. Outpatient therapies and counseling may be administered before ultimate patient release. When a lack progress is evidenced after treatment with various pharmaceutical therapies, bipolar I and severe cases of clinically depressed patients may undergo Electro-Convulsive-Therapy (ECT or “electroshock therapy”) to relieve the pain and damage done during episodes of mania, deep depression and catatonia. Although these procedures produce tremendous restoration of patient moods, they are performed at the expense of varying degrees of either or both temporary and permanent loss of patient memory.

As in-patients, a holistic approach to healing takes place due to the coordinated efforts of psychiatrists, psychologists, psychiatric nurses, psychiatric technicians, physical therapists, occupational therapists, dieticians, case managers and social workers. This advantage to the patient is abruptly interrupted upon release and can cause varying levels of anxiety and perhaps a relapse. There may be only psychiatric visits after leaving hospital and perhaps some psychological counseling. Sadly, these two professionals, psychiatrist and psychologist, are usually not in communication with one another and the resultant disconnect results in a patient’s issues being poorly addressed. While the psychiatrist is primarily concerned with drug therapies, the psychologist is more concerned with talk, thought, emotional, and behavioral therapies. This scenario often, when combined with the patient’s continuing poor domestic environment and poor responses to life challenges, will often require another visit to his or her hospital alma mater, or result in injury or death.

Once stabilized to the satisfaction of one’s psychiatrist and other staff, the patient is readied for release. A strange feeling creeps into the patient’s psyche as his or her release date and time draw near. He or she has been “ready to leave” for days on end and cannot wait for release. Nonetheless, immediately prior to walking out the door, anxiety strikes the patient with full force. The realization of having been in a peaceful, nurturing environment contrasts with having to confront the stigma of having mental illness, their home environments, and former (sometimes toxic) relationships with others and having no outside help. Fortunately, for most patients, they are usually referred to a counselor or licensed social worker with whom they can continue their recovery back in the “real world.” Either an out-patient program or support group meetings can provide other avenues for recovery and maintenance of their mental health.

Because mental healthcare is a specialization and therefore more costly than general medicine, medical insurance usually covers a relatively small portion of both in-patient and out-patient mental health expenses or none at all. Lifetime total in-patient hours are often limited despite high premiums. And, as with any medical hospitalization, the mental hospital facility and doctors each bill the patient separately.

Perhaps I have raised more questions than I have answered. Further information on the topic of mental health facilities and my battle with Bipolar Disorder are discussed in my autobiography, BOY, INTERRUPTED: My Magical Misery Tour:

http://www.amazon.com/dp/1475136935

Additionally, I have created a website with essential mental health resources, and with emphasis on resources addressing my and others’ battles with Bipolar Disorder.

[http://www.writeonhome.com]

Thanks for stopping by,

– Jeff

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