Eleven Good Ideas for Inpatient Psychiatry

Inpatient psychiatry is dreadful, so here are my recommendations for changing it.

1.  Medicate the staff first.  Those people are way too edgy and jumpy.  They got major control issues.  Dummy them down with drugs.  They seriously need to relax and everybody knows that drugs help people calm down.  Calm down the staff first and the patients will follow suit without being drugged.
2. Make the minimum hiring age 37.  Right now the aides—with whom the patients have most direct contact—are kids right out of college.  They are 22-year-olds who have never bought a house, birthed a baby or buried a parent.  How the hell are they supposed to have the slightest idea of how to treat, for example, a 67-year-old man who has gone quite mad because his daughter was raped and murdered?  Hire older people who are seasoned by life and have acquired some skills for working with people who are upset.
3. Maintain a running audit of psychiatrists and drugs, and suspend the psychiatrists who are prescribing the most drugs.  Too many psychiatrists take the quick way out:  instead of taking the time to listen to their patients they just drug them.  Send a clear message that patients are to be treated as human beings, not as lab rats.
4. Replace tranquilizers with massages.  You want to tone down somebody’s anxiety?  There’s nothing better than a good massage.  After massage you experience something that therapists call “massage fog,” which is a totally benign state of bliss.  It has no negative side effects.
5. Give some patients the key to the locked door.  Under mental health law, the door to inpatient psychiatry does not have to be locked.  It may be locked if there are patients who need to be protected, for example, patients who are disoriented and wouldn’t know to come in out of the rain.  Also, there may be a legitimate reason to keep involuntary patients locked down, but as for the rest?  Give them a key.  Most of the humiliation and degradation that staff members visit upon patients would have to stop immediately if the staff knew that the patients could simply walk away.
6. Inpatient psychiatric staff training should start with the new staffer spending two weeks living as an inpatient.  Walk a mile in my moccasins and learn what it’s like; that’ll fix you.
7. Require inpatient staff to include as many spiritual counselors as it has psychiatrists.  The psyche is both mind and spirit:  psychological care should include treating the spiritual side of mental illness.  Give psychiatric patients access to spiritual guides who can help them work out their destiny.
8. Remove psychiatric units from hospitals.  It is a wholly unknown fact that, at least in New York State, inpatient psychiatry is not under the jurisdiction of the Dept. of Health; it is under the jurisdiction of the Office of Mental Health.  Mental illness is a disease of the mind, which is not the body.  The main reason why we aren’t curing anybody of mental illness is because we are treating it as a medical illness.  It isn’t.  Mental illness is a disease of human relationships.  Get it out of the medical institution and start treating it for what it is, not for what physicians want it to be.
9. Make it mandatory for psychiatric patients to have regular daily access to physical exercise.  Children in day care centers are required to have outdoor play areas; why are troubled adults not given the same access?  Exercise is really, really good for anxiety—why do you think guys play so much basketball?  People who sit on their butts all day are stewing in their own juices.  Give them the chance to get up and out—at the very least, let them use the exercise machines in the physical therapy department.
10. Criminalize electroconvulsive treatment, i.e., shock treatment.  The most effective way to stop psychiatrists from doing shock treatment is to make it a felony—his ass goes to jail if he violently abuses a patient.  You would not run a major jolt of electricity through your computer so why should it be done to your brain?  Doctors used to do lobotomies, too; ECT is equally as harmful and without demonstrable benefit.  ECT is one person violently attacking another person, and should be criminalized as such.
11. All people on inpatient psychiatry should have significant daily access to the natural world.  All patients should be allowed to go outside.  We are human beings.  We belong in the natural world.  We should feel air moving against our skin and be allowed to breath in the sunlight.  Even better, get down on your knees, work the soil and talk to the worms.  Worm therapy is some of the best therapy I’ve ever had.

These are eleven suggestions for the improvement of existing inpatient psychiatric units, however, inpatient psychiatric units should not exist at all.  These recommendations are for interim modifications.  Check back later for how acutely distressed people really should be treated.