Whenever I hear someone use the term “psycho ward”, it’s often part of a *joke*.

Well, trust me, there’s nothing funny about it.

The image I assume people get in their heads is from the book One Flew Over the Cuckoo’s Nest by Ken Kesey, or the subsequent movie, starring Jack Nicholson and a number of recognizable-but-not-yet-famous actors (including Scatman Crothers, Danny DeVito, and Christopher Lloyd).

(Damn that Nurse Ratched! She is EVIL! She’s so good, actress Louise Fletcher won an Oscar for her portrayal of the cold, heartless tyrant.)

Hollywood aside, there are probably some things you don’t know about psych units (aka “psych wards”) if you’ve never been in one. And I mean as a patient, not a visitor.

THE LAST RESORT

For those of us who’ve been admitted (or committed) to psych units, we know it mostly as a last resort. And no, I don’t mean the kind of resort where you get to lie back with your feet up, read a good book, have people wait on you, and get a tan. (Although those might exist in places like Beverly Hills.)

I have a lot of experience with this, for better or for worse. I’ve been hospitalized fifteen times in seven different hospitals in three states. Fourteen of these admissions have been since 2003.

Not that I’m counting.

But I know of what I speak.

A psych unit is not someplace you go to relax, to take a break from your stressful life and responsibilities and go back home refreshed. In fact, release from a unit does not mean everything is hunky-dory now. Substance abuse disorders, medication noncompliance (maybe because the person feels better and thinks “Well, I don’t need these anymore”…), and suicide are not uncommon after discharge. (Read more here.)

No, a psych unit is where you go either when your mental illness is out of control (or getting there) or when you don’t feel safe – ie., suicidal or homicidal.

Unfortunately, you can’t just walk into an emergency room, tell them how terribly depressed you are, and expect to receive treatment (unless you’re psychotic or violent).

If you’re not a danger to yourself or others or having a psychotic break, they will do the triage thing. The on-call psychiatrist could make a small adjustment to one of your psych meds, but more than likely, they’ll tell you to go home and call your shrink (or go find one). Psychiatric units at hospitals are for stabilization purposes only, not for intensive treatment.

If you are suicidal (or homicidal), you will be admitted eventually, but you’ll have to wait for them to find a bed for you. You may get lucky and only have to wait a couple hours in the “holding tank”, as I call it (the psych ER, aka “rubber room”). More likely, you’ll have to wait an unknown amount of time, alone, in a room with virtually nothing in it (so you can’t hurt yourself) with no meds (possibly), no one to talk to, and no updates.

In my experience, when you’re in the holding tank, it feels like no one gives a shit. They just make sure you don’t hurt yourself. (Thus the lack of privacy, the cameras in the room, and the complete and utter lack of sharp objects/edges, phone cords, etc. Trust me – I’ve inspected many of them!)

And if you have to pee, you need to be escorted to the bathroom by a security guard. (No, they don’t go in with you). Of course, the door to the holding tank area is locked to protect the unsuspecting “normies” in the regular ER from us “crazies”, and at some hospitals, the nurses and other staff sit behind plexiglass for their “protection”. (*She said with a sneer and more than a little sarcasm.*)

I once had to wait thirty hours in a psych ER room until a bed at a nearby facility opened up. That’s almost a day and a half, while I was having a meltdown! I was in a really bad place in my head, and in all honesty, I was more agitated and more suicidal after being left alone in that room for so long than I had been when I got there! And I’ve heard from other patients that they’ve had to wait up to 48 hours for a bed!

Another time, I was in the psych holding tank in a Minneapolis hospital, waited several hours for a bed to open up, and was then transported (by ambulance, of course) to the hospital in Cambridge, MN – 55 miles away! Why so far? Because that was the nearest open bed. So much for family and friends visiting, eh?

And this is just one little part of the system. The state of mental health care in America is a travesty, believe me.

But that’s another post for another time.

*shivers at the thought*

ONE SIZE FITS ALL?

As I was saying, psych units are for episodes of acute distress. I’ve been in enough of them to know that they are all basically the same. Well, okay, I’ve never been in a private one, but at a plain old hospital, this is generally what they’re like:

• They are understaffed, sometimes severely.
• The well-meaning staff is overworked and underpaid. Some have become quite jaded.
• Not only are the units locked, but most of them have a sally port so it’s harder (impossible?) to slip out unnoticed.
• There is little, if any, décor. Most of them look and feel like the institutions they are, which only serves to remind us that we’re in a locked hospital ward – so we must be pretty sick (maybe even dangerous!) I have been in one that was remodeled to look much less institutional, though, and let me tell you – a little human touch makes a big difference. It helped me feel like I was “less sick,” if that makes any sense.
• Patients get very little (if any) individual attention. In my experience, it is simply not available in the vast majority of psych units, due to the large amount of work the small staff has to do.
• You probably will not see the psychiatrist every day.
• All of them have groups available, such as informational and educational groups, occupational therapy (or “OT”, where you can color, do crossword puzzles, or make something crafty), possibly an exercise or movement group, and daily community (“check-in”) groups.
• Groups are normally totally optional, although they do give you something to do for a while, and staff does notice whether or not you participate.
• Most of the patients are normal, everyday folks, just like you and me, although there always seems to be one or two who may stir things up a bit (bothering people, being loud and disrespectful, not following policies, taking someone else’s lunch tray from the cart, experiencing a psychotic break, etc.). Staff is always able and prepared to handle such patients.
• My experience has been that there are approximately 12-16 patients on a unit at any given time, both men and women.
• The median stay on a psych unit is 15 days. Please note that this is not the average length of stay; half stay longer, half stay a shorter number of days. There is also some question about the category/severity of the illness, according to this source – but I’m having difficulty finding a solid answer. I would have guessed maybe 5-7 days, based on my experience with dozens and dozens of patients.
• The goal of a psych unit is to keep you alive and safe, not give you specialized treatment for your illness. For a variety of reasons (mostly political and financial), the amount of time a patient stays in a psych unit has decreased drastically since about the 1980’s, giving them little time to do anything much with you.

I don’t consider spending 3-7 days in a psych unit (my average) as being “in treatment” for my mental illnesses. Therapy, DBT, seeing my psychiatrist, and taking my meds are treatment.

I consider it the place to go when my depression is so deep that I’m afraid I might actually try to kill myself. Psych units – generally speaking – are very safe places. Once my suicidal ideation goes away, which usually happens within a couple days, I convince the staff that I’ll be safe and I get discharged.

And life goes on, as it always does.

AFTERCARE

During a typical stay in a psych unit, and despite their lack of support staff and resources, they do try to help you as much as possible.

For instance, every unit has a social worker (or two or three) that helps you find resources in the community, like a chemical dependency treatment program (the relationship between mental illness and drug abuse/addiction is ridiculously high), or a halfway house so you have somewhere to live, or a pdoc, or a list of AA or NA meetings, or help with a legal issue. They try to set up appointments for you before you leave their care.

I must say, though, that’s one thing I’ve noticed that sometimes doesn’t actually happen. I know the social workers have big, very important jobs (a matter of life and death in many cases), but they may just be the most understaffed category there is.

Or they run into someone like me, who says, “I have a therapist. I’ll call and make an appointment when I get out tomorrow.” (Yeah, right! My fear and anxiety surrounding phone calls borders on phobic!) So there’s another appointment that doesn’t get made.

But taking care of yourself after you leave the safety and security of a psych unit is incredibly important. Otherwise, you’ll just end up there again within a month or six.

There is no cure for mental illness (not that I can think of, anyway), so you have to learn how to live with it (not fight it), manage your symptoms, and maintain whatever stability you can work out.

When I’m really into self-care and feel like I’m capable of finding some balance, here are some of the things I do (or *should* do) to avoid another crisis and help me stay out of the hospital:

• Play tennis (weather permitting)
• Write
• Look at my DBT book and practice my skills
• Share my thoughts and feelings with my wife on an ongoing basis
• Go to therapy, pdoc, and other appointments
• Take my meds (finances permitting)
• Photography
• Listen to music
• Bake
• Meditate
• Do yoga

There are actually lots of other things you could do to help find your balance. These include:

• Coloring
• Doing a puzzle
• Playing an instrument
• Playing a sport/going to the gym/doing something physically challenging
• Writing a song or a poem or a screenplay or a personal manifesto or a love letter or a homemade card…
• Cooking
• Taking a walk
• Praying or some other kind of spiritual practice

Whatever blows your skirt up – there are so many possibilities!! The keys are to not spread yourself too thin and to make sure you spend some time with yourself as often as possible, doing something you genuinely enjoy.

In the last few years, I’ve noticed that the more I do these things, the less often I end up in the hospital – and my stays are shorter, too.

So hang in there. Take care of you. Do what you can with what you’ve got.

I’ll see you next time.

Keep it Real!