Addressing Issues in Inpatient Psychiatric Hospitals
I’ve had less than favorable experiences in inpatient psychiatric hospitals, and I believe it’s crucial to address the systemic issues that persist within these facilities. In my opinion, the most glaringly offensive issue in inpatient psychiatric hospitals is that they are not patient-centered. Too often, my needs and preferences were disregarded, and communication resembled the tone of a corporate office memo, authoritative and forceful. This is a significant issue that needs attention. When I think of a place to heal mentally, I envision a serene environment where respect, patience, and understanding are the norm. I imagine an environment where the patient and their team work together to develop a treatment plan that respects the patient’s wishes and values while encouraging the help they seek. This is what it means for care to be person-centered, often used interchangeably with the term ‘patient-centered.’ Unfortunately, reality often paints a different picture, as I’ll recount while reflecting on my earliest experiences in an inpatient facility.
My Experience at an Inpatient Psychiatric Facility in New Jersey
First, I recall an inpatient psychiatric facility in New Jersey. Unfortunately, I do not remember the name or exact location of the hospital, or I would happily call them out on their bullshit. I believe I was 18 at the time because I was in a unit with other adults. Initially, I was open to treatment, but I staunchly refused to conform to their program by wearing anything other than my pajamas. I was determined to attend therapy in my sleepwear, and nothing could change my mind. However, for the most part, I complied with their requests. I even agreed to have my blood drawn, which was a huge fear of mine at the time – one that I began facing head-on during this stay and have continued to overcome since. I would socialize with people outside while we smoked and I was truly able to get comfortable there.
Abrupt Changes and Relocation
Then, one day, they dropped a bombshell on me – I was to be relocated to another wing within the facility. I couldn’t comprehend why. I felt safe and comfortable where I was. Why were they displacing me? Why did they need me to move? I didn’t know anyone in the next unit. What if I encountered hostility there? Why did I have to start all over again? In hindsight, I suspect that the unit I was initially placed in was primarily for diagnosis, while the wing they were moving me to was intended for treatment. However, no one bothered to explain this to me, and I couldn’t deduce it on my own at the time. Instead, a whirlwind of thoughts, questions, and worries engulfed me, and no one seemed capable of offering answers that made sense. Despite this, I maintained my composure – that is, until they finally tried to move me.
Resistance to Medication
At this point, I became a child all over again. I remember crying, vehemently expressing my reluctance to leave. The unknown future terrified me. I recollect being forcibly moved by several nurses as I struggled to resist. Eventually, they managed to get me through the doors, allowing me to collapse on the floor, still sobbing uncontrollably. Then, a nurse extended her hand, containing some pills, instructing me to take them. There was no explanation about what they were. I hesitated; I didn’t want to take them. What I truly yearned for was help. I needed to be treated with compassion and care. I wanted answers to my questions, help to alleviate my fears. So, while curled up in a ball on the floor of that inpatient psychiatric unit, tears streaming down my face, I refused their medication.
I thought that would be the end of it and I would be left alone. I thought that I had the right to say “No” to anything I did not want in my body. Little did I know, I had no say in what went into my own body. It was a naive assumption to think otherwise. My world came crashing down when the nurse informed me that if I didn’t take the pills, they would inject the medication into my butt (yes, she made sure to emphasize that lovely part). I am sure I lost my composure at this point. How could I accept that I was relinquishing all control and surrendering to their demands? It felt as if they were stripping away everything from me, dehumanizing me entirely. But I complied and took the pills; it seemed a preferable option to being assaulted by an unconsented needle to the ass.
A Visit from Dad
Dad tells me stories about how I behaved when he came to visit me later that night. He recalls that I would fall asleep mid-conversation. Then, I would wake up a few minutes later and continue the conversation like nothing had happened. Regrettably, I do not remember this, but being told that I was completely out of it when they came to visit me saddens me greatly. I despise that I could not advocate for myself to them or anyone else, both before and after being forcibly medicated. It wasn’t for lack of trying; my pleas simply fell on deaf ears. It also pains me to imagine how worried and scared Dad and my stepmom must have been when I could not engage in a simple conversation during their visiting hours. I’m in tears just thinking about it now. I did not want this. This is embarrassing, degrading, and infuriating. I still don’t even know what those pills were!
Strategy of Compliance
At that point, compliance became my goal. I played along with their treatment, doing everything that they said, but not truly believing or accepting any of it. I simply had to play along and act the way that they wanted me to so I could get out of there. What’s truly disgusting to me is that the doctors and nurses probably thought they were helping by forcing compliance rather than treating people like humans who need help.
The Outcome: A Misdiagnosis and Unrecognized Trauma
Ultimately, my strategy worked. I feigned cooperation well enough that they discharged me, but I gained very little from the experience that would help with my depression and anxiety. I did, however, have a diagnosis of Borderline Personality Disorder to show for it. Unfortunately, that was a terrible misdiagnosis that I believe hindered my access to appropriate care and led to years of misunderstanding myself.
Moreover, I had unwittingly endured trauma during that period, although neither I nor anyone else recognized it at the time. Their coercive measures and disregard for my well-being had traumatized me. I hadn’t realized it then, but my trust in psychiatric units had been shattered. I couldn’t trust them to treat me as a human being with rights, especially when I was at my most vulnerable. The doctor-patient alliance was severed at its most crucial moment: when the actual treatment was about to begin. It was impossible for treatment to have a positive impact when I no longer felt safe and respected there. Consequently, I am now extremely hesitant to go to the hospital voluntarily, and I advise those that I’m closest to not to do so for their protection as well. That’s not how treatment is supposed to work, especially in an environment designed for those in crisis.
The Need for Empathy and Active Listening
Instead of treating patients with authority, indifference, or impatience, psychiatric units should look at training their staff in empathy and active listening. I believe these are two of the most vital skills to have when working with patients in any mental health capacity. In my experience, if anyone had made even a modest attempt to de-escalate the situation just a tiny bit by hearing my needs and responding with empathy, I likely would have found a way to calm down on my own. Thus, I would have been able to maintain my dignity and truly build trust in my treatment team to help me and respect my preferences.
Embracing Patient-Centered Care
Psychiatrists recognize the necessity of adopting person-centered care in their practices. In “Psychiatry Embraces Patient-Centered Care,” an article by Lisa Dixon, M.D., M.P.H., and Jeffrey Lieberman, M.D., published in 2014, Dixon and Lieberman assert that the field of psychology is increasingly embracing patient-centered care. The patient-centered care approach involves forging a doctor-patient alliance to develop a treatment plan that takes into account the patient’s needs, preferences, and values. It proves to be a powerful method for building trust with patients, a critical element in the realm of mental health. Additionally, research indicates that patients who receive patient-centered care are more likely to actively engage in their treatment and continue it even after their stay in an inpatient facility ends. However, it’s evident that inpatient psychiatric hospitals have room for improvement in implementing this concept.
Advocating for Mental Health Reform
In sharing my first experience in an inpatient psychiatric unit, I hope to shed light on the need for reform in the mental health care system. This experience highlights the critical role of empathy and person-centered care in healing and recovery. It’s crucial that we work towards a system where patients are treated with dignity, respect, and understanding, where their voices are heard, and their rights are upheld. I’m not quite sure how, as I feel like such a small voice, but I would like to advocate for change and create a more compassionate and effective approach to mental health treatment, ensuring that no one has to endure what I went through.
Resources:
https://www.sharp.com/health-news/applying-patient-centered-care-to-mental-health-treatment
https://blogs.ohsu.edu/brain/2022/09/29/importance-of-person-centered-care-suicide-prevention/
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