What would happen if I checked in for inpatient mental health?
That’s a good question, and I’m glad you had the presence of mind to ask in advance.
First, let me tell you what won’t happen. You will not be put to bed with a telephone beside you and a television in front of you and meals served to you.
You will be admitted to a two-bed room with regular beds, not hospital beds (unless you have a convincing medical condition that requires it). You will be awakened every morning, except Sunday, around 8:30. You will be required to get up, get dressed, and go out to the “day room,” a communal space of tables, chairs and a television set.
Your meals will be tray service, served in the day room with specific times for breakfast, lunch, dinner and an evening snack. Around breakfast time your vital signs will be checked and you will be medicated for the first time. If you are in a state hospital, your room will be locked while you are at breakfast and you will not be allowed to return to it.
You will be required to attend groups. Groups mostly meet in the morning and afternoon on weekdays. A staff person will tell you which groups you are to attend. They may include psychotherapy and a lot of other stuff that I can’t remember. Despite spending years going to these groups, none of them were memorable. With the exception of psychotherapy, which is run by a good social worker or a psychologist or an inexperienced resident, groups are run by aides who may or may not have graduated college.
There are imagining groups and positive thinking groups and art groups and discharge planning groups. Some aides are talented and you may occasionally learn something useful, but don’t count on it. You cannot turn the day room television on while groups are meeting. There are no radios or other music machines nor are you allowed to bring your own. You’d better like to read.
There is no smoking on inpatient psychiatry. After three days, your psychiatrist may write an order for you to have smoking passes. This means that everybody who has such a pass will gather by the locked door and wait for two aides who will take you outside for a few minutes, watch you, then take you back behind the locked doors. You cannot go out for walk, have lunch in the cafeteria, or visit the gift shop. The cart from the gift shop may or may not visit your unit, depending on how squeamish the little old lady volunteers are.
Your psychiatrist will usually see you for ten minutes, Monday through Friday, unless you are in a state psychiatric center, in which case your psychiatrist will only see you once every week or two.
Visitors typically are allowed from around 10:00 a.m. to 9:00 p.m. Everything they try to bring you will be searched. There is a long list of things you are not allowed to have but neither you nor your visitor will be notified in advance of what those things are. All your personal belongings will be taken away from you and searched, then some things will be returned to you, e.g., clothes without belts or drawstrings, shoes, underwear. Among the myriad things you cannot have will be cigarettes, lighters, shaving equipment, anything glass (perfume, deodorant), spiral-bound notebooks, pierced earrings, any over-the-counter pills or potions (except hand cream) and so on at the whim of any 22-year-old who’s in charge of you. These things will be kept locked up and only given to you for a few minutes a day—if you behave yourself. Your room will be searched every night.
There will be a curfew. Sometime between ten and eleven o’clock the television, telephone and most of the lights will be shut off and you will be told to go to your room. You will probably not be able to see out the windows or have any significant sunshine. At Upstate Medical Center, the windows are plastic, not glass, and an uninformed worker washed them with a normal abrasive, thus causing them to become opaque. Upstate, which has recently spent a million dollars on changing its name and posting new signs, has not seen fit to replace the windows so the patients can see the world in which they are supposed to live. St. Joseph’s Hospital has venetian blinds locked between plastic and glass. Most of the adjustment mechanisms are broken, consequently there is a greater than fifty percent level of darkness in the rooms, day and night.
The aides will spend very little time talking or listening to you. They are too busy (a) writing chart notes about you or filling out forms; (b) attending rounds or other meetings; (c) locking and unlocking things. Besides, why would you want to talk to a young person who has never birthed a baby, bought a house or buried a parent? What do they have to offer you in the way of insight, support or information? The nurses will not talk or listen to you either. Their job is pass pills, not establish a therapeutic relationship. You are free to speak at will to any of the other twenty to forty people locked up with you. However, your peers will be (a) too depressed to come out of their rooms (and you are not allowed to go into anyone else’s room); (b) too drugged to carry on a conversation; (c) too crazy to make sense; (d) too obnoxious to be tolerated.
If you have the presence of mind to ask in advance what would happen if you checked into inpatient psychiatry then you are in sufficiently healthy that you shouldn’t go. (To be continued)