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Psych Ward Survival Tips

So You've Been Hospitalized

By IsyanPublished 2 years ago 12 min read
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Image Source https://i.ytimg.com/vi/moQz6AO8nYg/maxresdefault.jpg

As a person with 8 emergency psychiatric hospitalizations under my belt, due to experiences ranging from severe psychosis, attempted suicide, and the overall agitation that can come from being a traumatized person without housing, I find myself to be qualified to address this topic. Experiencing a mental health crisis can be a traumatizing ordeal in itself, without having to endure barbaric and coercive treatment practices. If you or someone you know is experiencing a mental health emergency there may be little option for care outside of inpatient hospitalization. In this writing I synthesize past personal experiences to help you or your loved ones navigate involuntary treatment.

Since no one really plans on their hospitalization, at least probably not the first go ‘round, this article, unfortunately, will not be of much actual use to someone in a psych ward without internet or data access. However, it could be a helpful read for family and friends of the hospitalized person to share information through phone calls and visitation. I write from experiences which occurred in Florida roughly a decade ago. I am also a person with white skin privilege and was living as a queer woman, in my late twenties at the time. I was also treatment resistant and not compliant with medication with a diagnosis of Bipolar I Disorder. My experiences, therefore. may not translate directly to another’s, but may help map out expectations.

It is important to understand that the line is often blurred between psychiatric treatment and carceral punishment. Inpatient treatment is usually extremely restrictive and, at times, feels down right punitive. Having been in county jails as well, I refer to psychiatric facilities as “prison lite.” And jails and prisons all too often serve as alternative psychiatric treatment centers, given the majority of inmates are receiving psychiatric care and many are arrested instead of hospitalized during a crisis involving criminalized conduct.

To be clear, psych wards do not only feel carceral - they are often intimately intertwined with the criminal justice system. Hospitalization is often initiated by law enforcement, with patients handcuffed while in crisis for “safety.” There are legal statutes keeping patients interred in psychiatric facilities and patients can address their rights within facilities using legal tactics like writs of habeas corpus, which I will address below. Courts may also rely on Mental Health Diversion programs and court ordered psychiatric treatments to deal with mentally ill defendants.

How Did You Get Here?

Your first point of contact may matter in how you are regarded by intake staff in a psychiatric facility. Were you brought in screaming in handcuffs or did you soberly bring yourself to an emergency room and ask for help? Were you accompanied by caring friends speaking for you, a dysfunctional relative projecting all of their shame onto you, or law enforcement complaining that you urinated in the cruiser? Although these circumstances and behaviors may be beyond your control, they will be documented by intake staff and considered in your treatment plan.

Most likely you will be held involuntarily for 72 hours for treatment and observation. If you are perceived as violent, aggressive, non-compliant, combative, suicidal, homicidal or otherwise a threat to yourself and/or others you will be extending your stay. If you are hospitalized before or during the weekend it is likely that you will not be released until a weekday when mental health clinicians are back on site and able to sign off on your stability. I have yet to witness a psychiatrist working weekends.

Additionally, if you are determined to lack housing you may be held for a longer period for your “protection.” Doctors have argued to hold me longer due to my vulnerability as a homeless person. For some that shelter is a welcome relief, for others it feels like another wretched day without freedom. You may also just be dumped right back out on the street without much care, all at the discretion of staff. Most likely the facility will coordinate your release with friends, family, halfway houses or residential programs.

How do you get out?

Accept the things you cannot change. The quickest way to get out of a psych ward is compliance. Accept whatever diagnosis you are “charged” with. Outpatient psychiatrists may claim that they need time to ethically assess a person’s mental health to make a diagnosis. This is not the case in a facility where you will be diagnosed and treated essentially on arrival. The diagnosis you receive may not match your relationship with your mind, but keep that to yourself. Psychiatrists are a particularly egotistical bunch, in my experience, and your willful assertions about your mental health may simply be pathologized or may lock you into a power struggle with someone signing off on when you get to see daylight. I’ve had ward staff lean in to warn me they’ve seen what happened to Randle McMurphy in “One Flew Over the Cuckoo’s Nest” happen in real life.

Remember you are not in power here. You can save your mad pride diatribes and anti-psychiatry beliefs for when you are back outside, that shit will not help you here. The best thing to do is to lean in, make the doctors and staff feel like you want their help and you just want to get better. Take the medications willingly - even if every swallow feels like a trespass on your autonomous being, and it is, your non-compliance will be noted and used as a reason to keep you on the ward. Ideally patients would have the right to refuse treatment, but your rights have been nullified by your beautiful mind. Take the pills, go to the groups, participate in activities, socialize, groom yourself, do whatever you need to do to show you are choosing life and wellness. You will only be here for a few days, you can choose what goes into your body afterwards.

Also consider that if you do not willingly swallow pills you may be forcibly injected as an alternative. Injections usually deliver a higher dose of the meds you are trying to avoid and that injection site can stay sore for days, even weeks. I have been forcibly injected multiple times. There is nothing pleasant about waking up after being doped in this manner, to find your clothing has been changed because you urinated on yourself after the drugging. Injections are a violation on your body, but they are prescribed "medical restraints" for patients who are otherwise non-compliant and agitated. You’ll want to avoid them, along with physical restraints, if at all possible.

After an involuntary 72 hour hold many patients are often either moved to a “voluntary” status or another involuntary hold may be invoked. Facilities get sneaky here, giving heavily medicated patients, with a loose grip on reality, documents regarding their treatment to sign. You may very well sign off that you are agreeing to remain in the facility without realizing it. You may also be brought before a judge or magistrate and assigned an “advocate” (from the facility!) who helps steer you into accepting their override of your rights.

If you feel that you are being held in a facility unfairly, you can request a writ of habeas corpus. Doing so will trigger a legal procedure where you will be assigned a public defender and have a hearing with a magistrate and state attorney. Your public defender can help make the case that you are well, that you are not a threat to yourself and others and that you deserve to be released. I have secured my release from 2 facilities in this manner.

How Do You Get Through?

If you are going to be on the ward for a minimum of three grueling days, you may as well make the most of things. It can be a good time to reflect on how you ended up here and how to create a safety plan that might prevent future visits. You will likely have a lot of time on your hands. The best facilities will have activity sessions, group therapy sessions and outdoor “rec” time as well. The worst will have none of this. Take advantage of every activity if possible. You are being watched. Show up and participate if you can.

Try to stick to your self care routines if possible. You may not be allowed to have dental floss, but don’t let that deter you from tending to your hygiene - your appearance is being monitored along with everything else. Unlike jail and prison, there is no commissary in a psychiatric facility - no way to purchase goods you may need. Friends and family may be able to bring articles of clothing (with draw strings removed and no long socks or shoelaces), books, notebooks and any prescription self care products but likely nothing else. Facility staff will go through whatever is brought into the facility and advise accordingly. Some facilities provide uniforms or gowns to patients, others rely on patients to supply their own clothing.

Sleep may be challenging as there will most likely be some form of 24 hour safety lighting on in your dorm and or hourly safety checks by ward staff. Try wrapping a shirt over your eyes. You will also likely be roused for a vitals check at some ungodly hour or otherwise made to get up unreasonably early against the grog of medication. I have not found much sympathy from staff for my inability to sleep in facilities.

If you have a special diet at home you will probably not be able to receive accommodation without a medical note. Nutrition plays a huge role in mental health, but psych ward dining often leaves much to be desired. Facilities that are in-patient wards in medical hospitals have, in my experience, the most optimistic menus - some even providing options patients can choose from. Some facilities just vary slightly from jails and dole out a miserable tray of "chow" 3 times a day. You may be able to grab seconds or trade food items with other patients, but you will not be allowed to save food items or store them in your room. There probably won’t be snacks, but many facilities have (decaf) coffee and tea stations which remain set up and there should be some sort of water dispenser on the ward.

You may be allowed to have a pencil and paper - make use of these. Document as much of your experience as possible, especially if you have experienced forced injections, restraints, negligence and harm by staff or other patients. Make note of your experiences, dates, times, names if possible. Many facilities have some sort of complaint procedure - request complaint or grievance forms if you are experiencing improper treatment. Take note of any numbers listed on bulletin boards, possibly near the public phone, if there is one. It was by calling nearly every listed number for support services that I learned I could file a writ of habeas corpus in the first place. I have also contacted outside social service agencies to come into a facility and document the abuse I was experiencing. Despite being interred in a facility you can still empower yourself and advocate for your rights.

Also be aware of other patients. I have experienced sexual and verbal harassment and sexual battery from other patients. A ward full of people is still isolating and lonely - doubly so when one is being harassed or abused. Staff may not believe that you are experiencing abuse from others or may not intervene if they see it. Do your part to document your experiences, find a safe person or buddy on the ward if possible, and find ways to avoid being alone with problematic patients. There is little way to avoid abusive people on the ward. Holing up in your room may be pathologized as well, so do what you can to balance socializing with safety.

Aftermath

After enduring the trauma of mental health crisis and the trauma of forced hospitalization, being billed for such sub par care may feel like a cruel joke. There has, in my experience, been a spectrum of facility approaches to billing patients. Psychiatric care in medical hospitals appears to be the costliest. I have been billed a staggering $30,000 for an emergency room visit and week-long inpatient stay, without health insurance. Most facilities bill insurance, some shockingly do not accept Medicaid although they serve low income populations.

Ideally no one struggling with a disabling mental health condition should be burdened by thousands in medical debt, with mounting prescription drug charges to boot - but here we are. Ask the treatment facility if they can reduce or cancel your charges due to financial hardship and mental health struggles. Many will at least dramatically lower your bill. If you are low income apply for Medicaid as soon as you can as it should retroactively cover recent medical bills. If you were ferried to the hospital in an ambulance, expect to be billed for EMS services as well.

Financial setbacks aside - you have survived. Being in a facility is a traumatic experience period. Your loved ones may not understand that you are recovering from both the experience of personal crisis and the experience of having your rights stripped away for days or weeks. You will likely need time to recover and rest. Double down on self care, sleep, spending time in nature, or engrossed in films.

If you choose to discontinue your medication, do so slowly and cautiously and keep some on hand. Abruptly stopping may lead to a relapse in the symptoms that will land you right back in the ward. Take this time to examine what led you to a psychiatric facility to begin with. Map out your experiences and resources. Connect with local and online support groups, work with outpatient mental health care, determine ways you can care for yourself and reduce harm in times of crisis.

Ultimately do not let experiences of hospitalization define or limit you. This is not the end of your life. Let it be the beginning.

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About the Creator

Isyan

lifelong writer and artist emerging from my lair

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