Conditions in mental hospitals

Psychiatric hospitals | Your Health in Mind

Private psychiatric hospitals admit a really broad range of people.

They range from adolescents, through to adults through to elderly people, with a whole range of mental health problems.

Common problems like depression and anxiety, drug and alcohol problems.

Even less common things like schizophrenia.

One of the reasons people come into hospital is things like suicidal ideas where there's a real risk and danger.

And clearly in hospital we can observe people and support them during those difficult times.

The treatment of a person is tailored to what they need and will usually involve a close discussion between them and their psychiatrist.

Almost all patients will be involved in therapy, both group and individual.

There'll be other group activities involving things like art therapy, yoga or exercise - all of which we know can be beneficial to the treatment of mental health problems.

There's also some treatments like ECT that we utilise for some of the most serious conditions. They also have lots of opportunities to have one-on-one discussions with their nurse.

In hospital you will be greeted at a reception desk.

They'll help you get to the ward and find your way around.

Usually a nurse will greet you, take some admission details and show you around the place - so you know where to go for various things.

Your psychiatrist is responsible for leading your care. That means your psychiatrist will meet with you most days, review how things are going and what you need to work on next.

Your psychiatrist will also meet regularly with the rest of the team. That means nurses, psychologists, occupational therapists or whoever else in hospital is there to help you.

The average length of stay in a psychiatric hospital now, is about two to three weeks. Many people worry about - what's it going to be like with the other people in hospital.

For many people, having a mental health problem can be quite isolating. Remember that these people are more likely to understand what it's like than most people you meet every day.

People get better in hospital.

They usually need ongoing support afterwards, and your psychiatrist is likely to continue to be part of that care team.

How long will I be in hospital?

The length of time you’ll be in hospital really depends on why you’re there, the treatments you need and how you’re responding.

Some people only stay a day or two. Others may stay for 2–3 weeks or longer.

People who haven’t been in a psychiatric ward before sometimes worry they may never be able to leave. That never happens these days.

What happens after I leave hospital?

Being in hospital is just one part of your recovery.

Before and after you’re in hospital you might have home visits, telephone or internet case-management and appointments for psychological and medical treatment.

A social worker can help if you're worried about accommodation after you leave hospital.

Can I be treated without my consent?

Sometimes a mental illness can become so severe that the person with the illness may not even realise they are unwell.

If someone is so sick they don’t understand they need treatment, and if not having the treatment would put them (or others) in danger, the law allows that person to be treated involuntarily.

This means they can be kept in hospital (if necessary) and treated, even though they say they don’t agree to it.

To make sure this only happens when it’s absolutely necessary, the law requires that doctors present a case for this in front of a tribunal (or, in New Zealand, a judge).

The law also protects your rights. You have the right to legal representation and in some cases this is provided for free. (In New Zealand all cases under mental health compulsory treatment orders receive free legal representation.)

You have the right to be seen regularly by your psychiatrist and to have contact with family/whānau.

Each Australian state and territory and New Zealand have their own mental health acts, which set out these rights and the other rules that doctors must obey.

Seclusion and restraint

Seclusion or restraint may be used when a person is acting violently and the person, other patients or staff members are at risk.

Seclusion is where a person is kept alone in a room or area where they are unable to leave.

Restraint is where a person is physically restricted from moving around, for example by someone holding them, through medication, or by being strapped down.

Seclusion and restraint are a last resort where all other options to keep people safe have been tried or considered. Both should be very rare.

The RANZCP’s position is that the use of seclusion and restraint should be reduced and where possible removed entirely.

RANZCP Position statement on seclusion and restraint [PDF; 305 KB]

Your rights in hospital

Tell hospital staff if you are uncomfortable with any part of your treatment or are unsure of anything.

While in hospital, you have the right to:

privacy
safety

respect for your cultural identity
ask questions about your treatments and medications and their side effects
know your diagnosis, and disagree with it
get a second opinion (this could be at your own cost)
refuse treatment (though if you are under an involuntary order your doctors may end up insisting on some medications)
make a complaint
have a family/whānau member, friend, family consultant or anyone you choose to help you ask questions.

Help for families/whānau

If you have a family member or friend who is in hospital, you can be involved in the person’s treatment, with their permission.

Most hospitals will have workers whose main job is to help families learn about the person’s illness, find community supports and work out how to best use the health-care system.

What Are Mental Hospitals Like?

You know the feeling when you walk through a doorway and you’ve forgotten why you’re there? That’s how it felt to walk through the hospital door and enter the psychiatric ward for the first time. A little bit surreal.

The first time I entered those doors was 17 years ago—I was just 16 and hiding under a very thin white blanket while seated in a wheelchair. My parents nervously escorted me through the industrial-looking doors.

I'm not exactly sure why I was under a blanket but my mind had been playing tricks on me and I was frightened. I've since learned I was having symptoms of paranoia that are fairly common in many people with bipolar disorder. Only a few nights earlier I had heard demons chanting the name of my savior in my head: “Jesus Christ! Jesus Christ!”

On the day I was admitted, I remember waiting in the ER for what seemed like hours, beforehand. When I arrived, there was a whole new team of medical personnel wanting to see the young girl hiding behind a blanket. My mom prompted me and I shyly stood up, trying really hard to be brave. Thank goodness the first person to greet me was a friendly aide. A friendly aide.

“Hi, I’m Kim. You must be Katie. ” She was the first face of hope I met there. After taking me to the nurse’s office to get my vitals, I met Holly, another aide, with a sparkling personality that also helped put me at ease for the remainder of my three weeks there.

The seriousness of the experience didn't hit me until my parents left. It felt surreal and lonely but on some level, I knew I needed help. This was one way to get it.

I didn't know what to expect and it would have been less scary if I knew what would happen in advance.

Why Do People Go to Psych Wards

Inpatient psychiatric care can be very helpful for people struggling with mental health challenges. The intensive care available in mental hospitals can provide the break you need to receive treatment and focus on getting well.

That has certainly been my experience. I'm not saying it's a vacation—therapy is hard work—but most people leave feeling better than they did prior to arriving there in the first place.

In the United States efforts to reduce hospital stays and save money have led to overcrowded emergency rooms and people with serious psychological distress not receiving the treatment they need. Experts define serious psychological distress (SPD) as feelings of sadness, worthlessness, and restlessness that are hazardous enough to impair physical well-being.

According to the National Alliance on Mental Illness, more than 20% of American adults experienced mental illness in 2019. That's one in five adults. Inpatient, 24-hour care comes in a variety of forms. It can exist in a dedicated wing of a hospital, a private hospital, or a public/state hospital. Care is usually provided by psychiatrists, nurses, and therapists.

Mental hospitals can be an effective way to receive treatment but some evidence suggests that intensive outpatient programs (IPOs) can also be helpful.

What's most important is to reach out for help and support if you are struggling because treatment works. I'm living proof! You can get better and you will.

How Is The Day Structured in A Psychiatric Ward?

There is a schedule that isn't necessarily the same every day. But you can be sure the staff will keep you on schedule. You are expected to go to bed at a reasonable hour, and sleep for at least 8 hours. There is order to the day.

Mine often looked like this: time to prepare for the day (I got an hour in the morning), breakfast, quiet time, recess/physical activity, TV time, study time (for school-aged patients), recreation time, and group therapy. After lunch, more of the same activities follow until a break for dinner which is often followed by visitor hours, movie time, and lights out.

The activities don't necessarily occur in that order but the schedule is typically posted in a visible place.

When can I see my doctor?

At least once a week I would see the doctor. Maybe not as often as I wanted, but at least as often as he could see me. I recommend being as honest and transparent as possible with the doctor. They want to know how you’re doing, so tell them if you’re having a cruddy day, or if your symptoms are bothering you. They are there to help you.

Wait a minute, can I change my mind?

Depending on the laws that govern the state where the facility is located, in the adult ward, may be able to petition your case, provided you voluntarily admitted yourself, and fill out the proper paperwork during the first 72 hours (3 days). In the adult ward I went to, the state of Florida had a law that allowed the patients who had voluntarily admitted themselves to petition the hospital administration in a court of law within the hospital to review and possibly repeal their case for earlier release.

I recommend visiting the Treatment Advocacy Center website for more information on laws concerning admission and release. They monitor the 46 United States that abide by a common set of laws for the treatment of patients and score them in their efficiency to abide by those laws. Also, if you were involuntarily committed, there are laws to keep you monitored and unable to be discharged for the first 72 hours (three days).

I can't say there weren't times when patients got out of control and the staff had to intervene but if you follow the rules and avoid confrontation with others, you should have no problem. Try to keep your distance physically and emotionally from people who you think may have the potential to be violent. Also, remember that many people in the psych ward may just like you and you may even find a friend or two during your time there. I created a lifelong friendship at the psychiatric ward.

What kind of testing is performed?

They draw your blood upon admission. They also take your vitals regularly, usually morning and evening, but at least once a day.

What does the facility look like?

The psych wards I’ve been in had the basics. I would describe them as pretty plain on the inside. Unfortunately, they don’t seem to make interior design a priority.

The first one had no pictures on the walls, and the second had about three abstract paintings and two illustrations that reminded me of the Silence Of The Lambs movie poster (eerie, I know). Another adult ward I stayed in had vaulted ceilings with large photos of beautiful locations around the world. There are usually minimal decorations and “homey” items. It’s easy to understand that it would be a risk to keep any home-like furnishings in the rooms, so it was pretty bare, needless to say.

Are The Beds in Mental Hospital Rooms Comfortable?

Honestly, all of the beds I had slept on were pretty stiff. They had plywood frames and no headboards, with a couple inches of mattress padding. But the sheets and linens were cleaned regularly, thankfully.

I do know that some people were out the next day. And some people stay longer. I was there for 3 weeks. Some people stay a few months. Doctors and staff regularly review the patients’ behaviors. Their input in part dictates the length of treatment at the facility. The staff wants to ensure you’re safe and not a harm to yourself or others before you are discharged.

What do you wear?

When I was in the juvenile ward, we wore scrubs. In the adult ward, we wore casual, comfortable everyday clothing. They confiscate any belts, hoodie strings, shoestrings, and the like so as to take away anything that may pose a safety risk.

Is there any physical activity?

This may vary from place to place, but there was always a recreation time to either interact with others in a gym or outside in the enclosed courtyard. Take advantage of the physical activities, your brain needs it as much as your body. And you may end up passing on it during times you want to be alone to think or relax.

How can I avoid sensory overload?

It may be best that once in a while, during times that the patients congregate in a group, you may want to go to your room to rest, away from the noise and commotion. There were days it was hard for me to handle the day-to-day activities in my mental illness, and an even greater a struggle to deal with a blaring movie on TV or a crowd of people talking loudly waiting for their meds in the dayroom. Permit yourself to take breaks from the anxiety-inducing activities, know and identify your triggers, and learn coping skills.

A final note: be sure to make the most of it. Your time in the psych ward may be the darkest night of the soul, or a welcome reprieve from the lifestyle you lead that could help you get your bearings while you’re away. In either case, know there is a light at the end of the tunnel. It may seem like the moments are going on forever, but just remember, “This too shall pass.” So, while you’re waiting for discharge, cooperate, and work on you.

Being isolated within a hospital psychiatric unit may seem contrary to what you need when you’re not in a stable frame of mind. You’re not surrounded by friends or family inside those walls, though they should be more than welcome to come visit you. I would encourage you to seek professional help when deciphering whether or not you should be admitted to a psychiatric unit. I know I received the help I could not have gotten elsewhere had I not been committed. In the end, my mental health benefitted greatly from it.

For a wider breadth of understanding about hospitalizations and what questions to ask, I recommend reading the information on psychiatric hospitalization on the Mental Health America website. Visit The Depression and Bipolar Support Alliance (DBSA) website for more information about recovery and support after you leave the hospital.

Notes: This article was originally published July 7, 2021 and most recently updated July 15, 2021.

Katie Dale

Katie Dale is a 30-year old writer and blogger living with bipolar disorder. After having her first bipolar episode at 16, the experience of entering the juvenile unit of a psychiatric hospital in a wheelchair wrapped head-to-toe in a thin blanket is seared into her memory. Katie has recounted her story in a soon-to-be-released memoir. For more information on the book and other tips on dealing with bipolar disorder in yourself or loved ones, visit Katie's blog, BipolarBrave.com.

Sanitary zone: what's going on inside mental hospitals | Articles

When orderlies become involved in news chronicles, it is most often about beatings, bullying, violation of the rights of patients. Workers are fired, put on trial, but the abuses continue. Why this is happening and what is included in the duties of orderlies, Izvestia found out.

Teaching is light

Orderlies, according to the Unified Qualification Handbook approved by the Ministry of Health and Social Development, can perform various work: from cleaning the premises to bathing seriously ill patients. Therefore, they are often confused with cleaners, then with nurses. But unlike the first, the orderlies are included in the group of junior medical personnel. This allows them to qualify for a reduced work week and additional vacations on an equal footing with other medical staff. At the same time, unlike nurses, orderlies bear much less responsibility for their work and may not have knowledge in medicine. Formally, only a secondary general education is enough to enter this position.

The Ministry of Education and Science of Russia proposed to change the situation and presented a draft order, according to which orderlies would have to receive professional education. The duration of training would be determined by the specific program. But neither the program nor the order saw the light of day, so for now, employers are independently sorting out the selection criteria. Previously, for convenience, they divided the vacancy into several components. For example, a cleaning orderly and a patient care orderly. Now the need for them is gradually disappearing. First, because hospitals prefer to turn to cleaning companies. Secondly, because the rate is divided among other employees. For example, the problem of transporting patients is now taken up by special companies for the transport of patients. They are on duty day and night in different departments of the medical facility. Patient care was given to nurses.

Photo: Depositphotos

Formally, it is impossible to say that the workload on the staff has exceeded the norm. If there is a sufficient number of personnel, employees will simply begin to fulfill the full list of those duties that are prescribed in the Unified Qualification Handbook approved by the Ministry of Health and Social Development. Most of the duties of orderlies, according to this document, overlap with the tasks of other employees or even duplicate them.

For example, the housewife provides the subdivision with the necessary household equipment, detergents, linen for the sick. Nurse - receives inventory and linen from her, "ensures their proper storage and use."
The younger nursing sister changes the bed and underwear of patients, transports seriously ill patients, and keeps the room clean. Nurse - cleans bedside tables after each meal, accompanies patients to the offices, helps them wash, cleans rooms and baths.
Nevertheless, in many hospitals where patients need constant care and attention, for example, neuropsychiatric hospitals, they are not yet ready to give up orderlies. Who gets into these positions?

Inside view

Artem turned out to be an orderly in one of the Moscow neuropsychiatric boarding schools immediately after graduating from Moscow State University, because he chose an alternative service. “In general, I imagined what it would be. I had some experience, I looked after my grandmother, who at the end of her life fell into dementia and was not aware of herself. But still, the change was simply cosmic. Recently I wrote articles, a diploma, and the next day I go to work where there are a lot of strangers and some sometimes try to strangle you, ”recalls Artem in a conversation with Izvestia.

There was no clear briefing before taking office. How to behave in a given situation, you had to learn by experience. “Of course, they don’t immediately send them to very difficult departments. I've been lucky in some ways and not in others. I ended up in the mercy department. There are severe, often bedridden patients who need constant care. There is a ward where there are those who have only a few days left to live. Physical strength is important here, because often they need to be literally carried on the hands.

Photo: Depositphotos

In total, there were 40–50 people in the mercy department at that time. They had six orderlies (two men and four women), two nurses and one doctor. The duties of the orderly included cleaning the premises, helping the sick in eating, bathing, changing clothes, walking with them, escorting them to procedures, and, if necessary, pacifying them.

The last one, in conditions when there are only two male orderlies in the department, seems to be the most difficult. But, according to Artem, the main thing here is not quantity, but quality. “If a person does not understand what to do, then either he injures the patient himself, or they injure him. Here it is important to know the patients themselves, they get used to you, react to your voice, you can often reach them. In this situation, I was most afraid of harming a person. He does not measure his strength, but I can get scared and do something bad. But after some time it is no longer possible to reflexively give change. You understand that the patients do not want to harm you specifically, it's just an attack.

It was more difficult to maintain self-control in cases where it turned out that the patient was not just a victim of the disease. So, those whom a mental disorder actually saved from prison also ended up in a boarding school. According to Artyom, there was also an alcoholic who tyrannized his family, and a man who beat and raped his disabled daughter for several months in a row. “It puts a lot of pressure on the psyche. At such moments, I tried to abstract. There is a duty - to make a bed, feed, change clothes. Done - gone. But all the same, every time I had to override myself, somehow prepare for this. Remember that yes, it’s unpleasant for me to interact with this person, but I have to.

Photo: TASS/Natalya Semyonova

There were no failures at all in such conditions. During the shift, which lasts from eight in the morning until eight in the evening, nervous tension sometimes reached a critical point. Emotions erupted in the form of swearing. “When someone puts pressure on the nerves for a long, long time, it’s hard not to break loose. To be honest, I had this too. But everything was done without physical impacts, at least I didn’t see anything serious. Although, perhaps, this is also because we do not have the most violent department, and the boarding school was considered one of the best.

Outside the Moscow Ring Road - darkness

Anton worked as an orderly in a psychiatric hospital in Veliky Novgorod in 2013, and recently ended up there as a patient. “Swearing on a mat, constant screaming, drunkenness to the point of unconsciousness, smoking at any point of the department, slapping patients in the face — that’s what the orderly was like in 2013,” says a former employee of the institution. “In five years, the head physician has changed, and, perhaps, the main thing that he has done is to eradicate drunkenness and drug trafficking. In the three weeks of my stay here as a patient, I have never seen drunken staff or smelled alcohol from anyone. The rest is all the same. The same stink, the same tattered linoleum and peeled walls, and the same relationship between nurses and patients.”

Photo: Depositphotos

The essence of the relationship, according to Anton, is quite simple. “This is a kind of cooperation. If you treat patients calmly and fairly, then they behave calmly and help.” According to most orderlies, the "help" of patients comes down to voluntarily doing part of the work of the orderlies themselves. For some, this is a way to keep themselves busy, while for others it is an opportunity to secure a good attitude, get an extra cigarette and tea.

Depending on the orderly, the degree of voluntariness may vary. “The problem is that anyone can be an orderly, as long as you don’t vomit from the smell in the department. These are former military men, and pensioners, and just lazy people who do not need anything from life, except for these 7 thousand per month. And they have no concept of ethics, patience, respect. Some explained that they came to oversee, "to drive cattle." Such people can kick and give a slap on the back of the head, but rudeness does not bother at all.

A patient of the regional clinical psychiatric hospital in the village of Vinzili, Tyumen Region, faced the same situation this winter. “I tried not to contact the nurses, because those who met me were boorish, habalka, bazaar aunts. And, to tell the truth, I was afraid of them. They were treated like animals, they talked like if you have mental problems, you are not worthy of communicating with people.

Photo: Depositphotos

According to the girl, she witnessed a scene where, instead of eating, an incapacitated elderly patient received only a portion of swearing. “Her jaw was shaking all the time, I don’t know what kind of deviation. The nurse covered her with obscenities, took the plate and left.

The incompetence of nurses once led to a fatal outcome. “The last time we were fed at five in the evening, so many, to whom relatives did not come, dragged bread from the canteen. And one of the patients choked while eating in the room. The nurses turned her over, shook her so that the bread flew out, but they could not save her.”

A similar situation could have happened in the Moscow boarding school where Artem worked. But there, the fact that the orderly knew the basics of first aid helped to save the patient's life. “We used the Heimlich maneuver, chest compressions. You can’t do this without skills, but it was necessary to help while the nurse or doctor was running.”

It turns out that so far the comfort, health, and sometimes even the life of patients largely depend on whether they are lucky with the orderly. Is it possible to hope for this while they are hired as cleaners, and returns are required, as from nurses, is an open question.

Treatment in a psychiatric hospital | SKKSPB №1

Hospitalization in a psychiatric hospital, contrary to popular stereotypes, is not always due to the fact that someone sees hallucinations or runs after people, brandishing an axe.

Placement in a psychiatric hospital indicates that the patient's mental state has deteriorated and it is impossible to help him at home. At the same time, a person can adequately perceive reality and give an account of his actions. Some forms of depression, for example, require hospital care. Sometimes a patient is admitted to the hospital to clarify his diagnosis or prescribe a more effective treatment. In any case, you should not be afraid of hospitalization. A stay in a psychiatric hospital is not much different from treatment in any other hospital.

Who makes the decision on admission to a psychiatric hospital?

It happens in different ways. For convenience, it is worth separating voluntary and involuntary hospitalization (a lot of social prejudices and fears are associated with it). First of all, consider situations where a person ends up in the hospital against their will. Indications for involuntary hospitalization are stipulated by the Russian law “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision”. The patient may be admitted to the hospital without his consent in the following cases:

When, due to his mental condition, he can harm (himself or another person) or tries to take his own life.
When he is helpless in front of daily household tasks (cook his own food, go to the grocery store, follow the basic rules of personal hygiene).
When not providing mental health care will lead to even more serious health problems.
When the decision on hospitalization is made by the court, this is the topic of a separate long conversation

Is it possible to go to a psychiatric hospital voluntarily?

Yes, if a person feels the need for inpatient care, he has the right to go to the hospital himself and ask to be hospitalized or tell the attending psychiatrist about his desire. The psychiatrist also, if he sees the need for this, suggests that his patient go to the hospital for a while, explains why this is necessary and how long the hospitalization will approximately last. But the decision on hospitalization still remains with the patient.

It is important to remember that the mere fact of being admitted to a psychiatric hospital does not mean negative social consequences or restrictions on rights for the patient. Some patients refuse to apply for a sick leave during their hospitalization, as they are afraid that they will find out at work in which hospital they were treated. These fears are also unfounded. The sick leave does not indicate the diagnosis, and besides, psychiatric hospitals and narcological clinics have separate stamps for disability certificates (the profile of the institution is not indicated on the stamp).

To sum up : it is not the fact of hospitalization that matters, but the state of your mental health. If it requires inpatient treatment, then you need to discard fears and follow the doctor's recommendations.

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