A little more about the psychiatric hospital

People have asked me why I hate my psych rotation so much. It's not because I'm not interested in psychiatry, or because I don't get to be involved in patient care, although those would be reasons enough. It's because I come home angry and depressed every single day. So, here's a quick summary of the things that I have seen that make me so angry. I honestly hope it makes you angry too, because unless a whole lot of people get very upset about it, nothing is going to change.

First, there is one nurse for every 30 patients. That is simply not enough. The nurse spends his/her day filling out paperwork, not even giving medications (an LPN does that). Zero patient contact, unless a patient becomes disruptive or dangerous.

Second, the unit feels like a prison. There are locks on all the doors, and I understand that is out of necessity and cannot be changed. What could be changed are the institutional rooms, fluorescent lights, warnings posted on the walls, and complete lack of individualization of patient rooms. Several patients have said that they feel much happier and more stable when they're at the regular hospital or doing outpatient treatment, just because that place makes them depressed. Honestly, I would probably become suicidal after being locked in that unit for a month.

Third, there is nothing for the patients to do. The nurse is too busy to interact with them. The mental health techs don't seem to give a damn. The LPN just does medications. Who's left? Other patients. And they do okay together, but any time you put a group of 30 people together with no available form of distraction besides the one television there will be problems. Then do it with 30 mentally ill people, many of whom have impulse control problems or histories of violence, and you've just got a ticking bomb.

Fourth, the patients get medication, not treatment. Medication is not the same as treatment. The doctors don't seem to realize this, and the nurse and social workers are either too busy or too jaded to do anything about it. Medications help. They calm symptoms, like command hallucinations and extreme depression or mania, and make it possible for various types of therapy to be successful. There are several kinds of therapies available, and many of them are effective. But, they need to be implemented with consistency and expertise. One group therapy session each week is not going to make a difference in these patients' lives. So, instead of getting treatment, they get medicated to the point where they are "safe" (read: unable to feel or think straight) and then medicated some more to deal with the side effects of the original meds.

Fifth, the patients believe that nobody cares about them, with the possible exception of the social workers. And who can blame them, I've seen very little evidence to prove the patients wrong. Almost all of the staff are unapproachable and impatient. I don't blame them either, they are overworked, underpaid, and buried in paperwork.

So, who's to blame? Everybody. Why? Because none of us care enough to fix these problems. What's the fix, you ask? Easy, money. Mental health funding has been cut significantly in the past 10 years. They are now so broke at this place that they don't even have snacks or drinks other than water available between meal times. They have a full kitchen and used to bake cookies with patients. Now they can't afford the ingredients, so the appliances have been disconnected and the kitchen is locked. They used to get $200/month for the entire hospital (less than $1 per patient) for recreational therapy. That is going to disappear by the end of this year. They won't even be allowed to buy a deck of cards or a soccer ball, unless it comes out of the pocket of a staff member. This isn't a unique situation, this is standard for psychiatric hospitals around the country.

Where does the small amount of money that they do get end up? Paying staff to do paperwork. The amount of paperwork they have to do is beyond belief. Double, if not triple, anything I've seen at a regular hospital. That's why the nurses can't spend time with their patients, and the therapists don't have time to do more than one session per week. The intense overregulation of mental health care is preventing any actual care from being given.

So that's why I hate psych, because it's a broken system and there is nothing I can do about it, except be angry and try to care.