Podcast: Inpatient Psychiatric Stays From a Doctor’s Perspective
We’ve all heard scary inpatient stories from the psychiatric hospital. Perhaps you have a personal experience that you’d rather forget. In today’s podcast, Gabe asks a psychologist with 25 years of hospital experience the tough questions surrounding psych wards: Why do so many psychiatric inpatients seem to have such unpleasant — or even traumatizing — experiences while there? Are these stories the norm or the exception? For those who have had bad experiences, how can we change things?
Tune in to hear the unique perspective of Dr. David Susman, a licensed clinical psychologist who offers a deeper, behind-the-scenes perspective.
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Guest information for ‘Dr. Susman- Advocacy’ Podcast Episode
David Susman, Ph.D. is a licensed clinical psychologist. He is an Assistant Professor in Psychology at the University of Kentucky (UK), where he serves as Director of the Harris Psychological Services Center and the UK Psychology Internship Consortium. He worked for over 24 years at a public psychiatric hospital and was the founding director of the hospital’s award-winning Recovery Mall rehabilitation program, which provides services to adults with serious mental illness and substance use disorders. He has been active in mental health advocacy initiatives at the state and Federal levels. He is an active member and supporter of NAMI (National Alliance on Mental Illness), and serves as faculty advisor for the NAMI Campus chapter at UK. He is a member of the leadership team for the American Psychological Association’s Council of Representatives. Check out his mental health and advocacy blog at davidsusman.com, or connect with him on Twitter, Facebook, Instagram or LinkedIn.
About The Psych Central Podcast Host
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.
Computer Generated Transcript for ‘Dr. Susman- Advocacy’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.
Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast, calling into the show today, we have David Susman, PhD. David is a licensed clinical psychologist. He’s also an assistant professor in psychology at the University of Kentucky, where he serves as director of the Harris Psychological Services Center and the UK Psychology Internship Consortium. David, welcome to the show.
David Susman, PhD: Well, thanks, Gabe. It’s great to be here with you.
Gabe Howard: David, I’m really excited to have you here. Obviously, your credentials are exceptional, you’ve done a lot of really, really good work. But the primary reason that I wanted to have you on the show is because you worked for over 25 years at a public psychiatric hospital. And there is just a lot of debate out there about public psychiatric hospitals and the role of psychiatry and psychology in those establishments. You know, we have the whole. They should be shut down and then we have the whole they should open up more. And you’ve had a front row seat on the medical side. And a lot of the information that’s out there is a front row seat on the patient side. And that made me want to give you an opportunity to discuss all of this, because a lot of doctors aren’t speaking up. They’re kind of staying out of the fray.
David Susman, PhD: Yeah, I think that’s an accurate description.
Gabe Howard: Obviously, the reason they’re staying out of the fray is because they’re at work. There’s probably nothing that they can add. And I think just to kind of be fair, the reason that patients are jumping into the fray is because they feel that they have been wronged. Their experience has traumatized them in some way. Now, we’ve talked on the show before that just because something is traumatic doesn’t necessarily mean that it’s bad. But from your point of view, as a medical practitioner, why do you think the patients feel that this is such a bad thing that happened to them?
David Susman, PhD: I think it’s for a couple of reasons. One is that as I have a lot of friends who are firefighters and police and they always say their job involves helping people on one of the worst days in their life. And so that’s also the case for most of the people who we would see who would come into our psychiatric hospital. It was because most of them would come in not willingly. They would come in because some crisis had arisen and they had reached that level where friends or family felt that they presented some threat of harm to themselves or others. And they would go through some court process and usually they would come in on a 72 hour court order for evaluation and so forth. And so, you know, you have people who don’t want to be there by and large. The environment, as you know, can be quite I don’t want to say threatening, but it’s certainly unpleasant because most of the units have locked doors and a lot of these things are safety precautions. But so people are taken out of their lives. They’re brought into this hospital, they’re put on a locked unit.
David Susman, PhD: They’re subject to a lot of questions and evaluation and so forth and so on. Many of them really don’t want to be there in the first place and feel, in fact, no need to be there. It is a difficult environment. And so people think as a result of that, they do feel like the experience, rightly so, is very unpleasant. And they feel like it was a very difficult thing for them. And, you know, quite frankly, nobody wants to stay in a psychiatric hospital. I mean, I think that’s common sense. And so the challenge for us as health care professionals is that we’re in a situation where people are not eager to be there and they’re not eager to see us. But we have to try to establish some rapport and some relationship with them and also try to get some information from them so that we can figure out kind of what’s going on. And then also to begin to suggest a plan of care. And so that is a little bit easier said than done, as you might imagine.
Gabe Howard: I can imagine. And in the interest of full disclosure, I live with bipolar disorder and I’ve been one of the patients in the locked psychiatric ward. And when I was inpatient, I did not realize on day one that those doors were locked. I don’t know why it could be because I had severe bipolar disorder. I was not. I was not in my right mind. But when I did realize they were locked, I immediately jumped to the conclusion that it was because I was incarcerated and it was because
David Susman, PhD: Mm hmm.
Gabe Howard: I was bad
David Susman, PhD: Mm hmm.
Gabe Howard: And it was because society was discriminating against me. They were afraid of me. And I carried this belief for a decade. Now, the easy thing to say is that that’s not true. That’s not why it’s locked. We have to control the unit. You were suicidal. We can’t just let you wander around because we have to make sure that you can’t hurt yourself or others. And that’s a very, very fair and reasonable thing to say. But the question that I want to pose to you is how come nobody explained that to me? Why did I not understand that? Why did I carry around for a decade? That the reason the door was locked is because people hate psychiatric patients. And I know that’s a big question. But from your perspective, why do you think that myth sort of persists, that it’s just this desire to lock up people with mental illness?
David Susman, PhD: Well, it’s a great question and it opens up just so many thoughts for me. There’s so many different ways to respond to that. But one is that I think it reflects just our society’s view of inpatient psychiatric hospitals and how that has been shaped over many, many, many, many years, if not decades, by a lot of just stigma associated with that which has been perpetuated by stereotypes and the way things are portrayed in the media. You do have these images that if you’re in one of these hospitals, you’re just locked up and left in some sort of barren cell with a bunch of burly guys wearing white jackets. You know, I mean, you know, we all have kind of that image that I can’t speak to what happened to you specifically, but I can’t speak to our you know, our job when we would get new patients in our psychiatric unit is that we would take great care to sit down with them and to try to explain to them very carefully this is why you are here. These are the circumstances that brought you here. This is a hospital.
David Susman, PhD: This is a treatment facility. These are health care professionals. You know, we would have people who maybe assume they were in jail or some some other kind of thing. And so we would try very hard to just sort of really clarify. We’re here to provide you care and treatment. This is a health care facility. The reason the door’s locked is a safety issue. It has nothing to do with anything. Reflecting on you or your character or anything bad you’ve done. And so I think really some of what you’re talking about comes down to the responsibility of those professionals to really explain what’s going on and to help people feel as supported as they can in this really difficult situation. And I’ve heard many stories like yours. I mean, obviously not the first person that I’ve heard that kind of story where you felt like you were incarcerated or jailed or locked up or that kind of thing. And so that’s unfortunately, I think, been all too common an experience. But it’s one of these things that we’re certainly working hard and working actively to change that.
Gabe Howard: One of the things that I love about my life is that I reached recovery. Obviously, that’s number one. But number two, I got to be an advocate. And as my role as the host of this show and in other podcasts that I do and in public speaking, I get to meet a lot of people. And some of those people that I meet are doctors, doctors like you. And one time a doctor said to me, are you sure that it wasn’t explained to you? Are you sure that nobody sat you down and explained it to you? And that gave me quite a bit of pause for a moment, because I am sure that nobody explained it to me. But let’s think about that for a second. I was delusional. I was suicidal. I was depressed. And I am 100% positive that going to the hospital saved my life. But I’m also sure that I had full control of my faculties to remember those four days accurately. Like, that’s a bit of a stretch, right? I sort of want to put that out there when some of this information gets out. We are hearing it from people who are in crisis. And I certainly don’t want to take away from patients. But what role do you think that plays? Like you said, you’re helping people on the worst day of your life. Is that going to impact how they recount the story of their time there? Because it is scary. You agree that it is a traumatizing experience.
David Susman, PhD: My first reaction to that is, as you describe your experience and that someone would question you. Are you sure that nothing was explained to you? To me, that comes across as you are being discounted or invalidated, actually, in some way. So, you know, that’s I think, unfortunate that someone would would really kind of doubt your memory or your account of the events. So that concerns me. I do think people are under incredible stress when they’re in these situations. And also, people may be severely depressed. They may be super anxious. They may be having some traumatic flashbacks or nightmares. They may be actively hallucinating or hearing voices, seeing things, whatever. And so you can certainly have a lot of these sometimes temporary symptomatic issues that impact what’s going on and how someone experiences that time that they’re in the treatment setting. So, you know, everybody’s experience may be a little bit different, but I do think it’s interesting because you would see people go from that sort of state of mental chaos. And then over a few days, most of the people that we would see would feel a lot better because they would have time to rest and sleep and perhaps begin receiving counseling or medication or other activities or whatever. And so we would see incredible change over a very short period of time. And we would see people sort of coming back to themselves, if you will. And so that’s always terrifically gratifying to see that. But I think what you’re describing so much of it is just impacted by just that stress and chaos that people are going through.
Gabe Howard: I think that you’re right. And I think that we do need to take into account that there’s all different levels of psychiatric hospitals, there’s all different levels of psychiatric care. It’s every psychiatric hospital doesn’t have the same types of services, the same doctors or the same budget. So I also sometimes think that the cautionary tales that are out there aren’t for psychiatric hospitals or psychiatric wards in general. Therefore, a specific psychiatric hospital or psychiatric ward. And it just sort of gets put on to all of them. I know that there’s a lot of bad press and stigma associated with psychiatric hospitals. So this next question is a bit loaded. And I’m counting on you, to be honest, David, but
David Susman, PhD: Ok.
Gabe Howard: How much of the bad press and stigma is just true?
David Susman, PhD: A lot of it is true. So, you know, in my almost 25 years working in a inpatient psychiatric setting, I felt like I was very fortunate because our facility was a full psychiatric hospital. The only thing we did was mental health care. Our whole staff was comprised of mental health professionals and we had hundreds of staff and we had a couple hundred beds in the facility. And we were sort of the Cadillac of facilities in some way. So we were quite fortunate and quite blessed. But I also interacted with a number of other smaller facilities and more rural facilities and where you would have small psychiatric units and maybe a rural general hospital. So I felt like in some ways we were kind of a Cadillac type facility where we had a lot of resources. But some of the other smaller units that we would find in rural hospitals or in smaller general hospitals, they were very short staffed. They would be lucky sometimes to even have one full time psychiatrist on staff. They would have very limited kinds of treatment services available to patients. And so in some ways, we kind of felt like we were the NFL and some of these were like, you know, eighth grade kids’ football league or something. The comparison was just so striking. And I do think that sometimes in the facilities where they have less services and less staffing, that’s where you hear kind of more of more of the difficult stories or where more of that stigma kind of persisted. So I think that’s probably also where some of the true stigma comes from, because the level of care was just different in some of these other kinds of units.
Gabe Howard: It is one of the things that I try to preach to people. I really feel like it’s important to mention it again here. We tend to take the worst of something and apply it to everything. And the analogy that I always like to use is if you’ve ever gone on one bad date, then you have to assume that all dating is bad. There’s no reason to get married. Never fall in love. And we all have a single bad date story. Well, most of us anyway. But we try to improve it and we get better. I’d like to see advocacy do a better job of separating that out. And here’s honestly why. I think that by tabling all psychiatric hospitals and all psychiatric wards as bad, you give cover to the bad ones. They don’t have to change. Is that how you see it from your vantage point?
David Susman, PhD: Yeah, I think that’s true, and I think, you know, our mental health system, one of our biggest challenges still is that we don’t. Many areas we still don’t have adequate funding. And without adequate funding, you’re limited in how you can improve your level of care. And so you still find a lot of these agencies and facilities that are really struggling. And they just they’re not getting the infusion of money that they need to really bring their services up to a more current and more acceptable level. And so that’s still vital legislative change, that battle we’re still fighting through our policymakers and our state and federal governments and trying to get more funding because honestly, some of this stuff, it’s going to be very difficult to change unless our advocacy continues to say we need more funding for mental health services. And it’s incredible. I mean, in my state, we’ve had somewhat flat mental health funding for going on 20 years. And so, I mean, it’s just caught up, Gabe, in so many different issues that we are still a long way from solving. I think you and I are on the same page. We’re very passionate about continuing to work toward free services and increased funding and increased access to care. And that’s ultimately what’s going to do away with some of the less than adequate care and some of the persisting stigma that we still face. But until some of these larger issues are really tackled head on, we’re going to still struggle in some of these ways.
Gabe Howard: David, one of the things that fascinates me is that I live in Ohio. You live in Kentucky. Our states, they border each other. The amount of money and resources that Ohio has. And what Kentucky has is very different, starting with Ohio has Medicaid expansion. So this allowed a lot of poor people who have mental illness, who are disabled, to have health care. And because they have health care, they have more access to mental health treatment than the people in Kentucky who don’t have Medicaid expansion. And we’re literally, I am three hours from the border, so people three hours away have just a vastly different landscape to manage their mental health. And this is true for every state. This is true for municipalities. If you live in Columbus, Ohio, the capital of Ohio, you’re doing better than if you live in one of the rural areas of Ohio. You’ve done legislative advocacy for a long time. David, how do we fix it? How do we? Because three hours, David, three hours. And it’s completely different.
David Susman, PhD: Yeah, I think a lot about advocacy as you do in different ways to try to be more effective. You know, I always say get informed and get involved. Are kind of the two key things for effective advocates. And the first part of that is a really key thing because we need to make sure we’re well informed about these issues. And I see a lot of people in the advocacy space who perhaps are not as well informed as they should be. But you really have to delve in and learn about some of these things, about funding and about the way laws are made and changed and the way that different kinds of political forces shape the funding and how that impacts people on such a larger level. You know, once you’re informed, that’s when you begin to take action and you begin to craft your message and you begin to develop your platform of issues. You begin to work with your legislators to introduce bills and things that can begin to change things. And it’s tiring, exhausting work. And as you well know, it takes sometimes years, if not decades to bring about some of these changes. But that’s the other thing about good advocates is they tend to be very tenacious and they don’t give up. You have to just keep coming back year after year after year, because a lot of these bills that we try to get passed, they’ll take years and years and years to really get them through.
Gabe Howard: We’ll be right back after these messages.
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Gabe Howard: We’re back discussing the state of mental health advocacy with Dr. David Susman. David, we talked about advocacy, we’ve talked about public hospitals. We’ve talked about the wide gap between how patients see things and how the medical establishment sees things. Let’s just talk about recovery. One of the coolest things you did in your 25 years of the public psychiatric hospital is that you started a recovery based rehabilitation program. Can you tell us about that?
David Susman, PhD: Yeah. So the hospital I worked out is the second oldest psychiatric hospital in the country. It was established in 1824, so it’s been open almost 200 years, which is pretty incredible. Never closed its doors. For about 185 years of that, it was a very antiquated facility. But then they actually built a brand new state of the art replacement hospital about six years ago, which was very exciting for us. You know, here locally. But even before we moved into the new hospital around 2005, we decided to start a new hospital wide recovery based program. So we did a lot of research and we spent a little bit over a year and we unveiled what we came to call the recovery model. And that was based entirely on kind of modern recovery based approaches to treatment. And it ended up being kind of like our patients, our college, if you will, because every patient that would come to our hospital would have an individualized schedule of classes and groups and activities. And we had a gymnasium and a library and a computer lab and we had pottery and we had art therapy and music therapy and all kinds of cool skill building classes. And we had peer support specialists and we had trained mental health professionals and we had this just tremendous kind of synergy. And so we were able to put that into place in 2006. And that program is still operating today. It really in many ways, I think, kind of revolutionized the care that we provided and brought us firmly into the 21st century in terms of using kind of modern philosophies of recovery and of rehabilitation. And we weren’t the first actually hospitals to develop such a program, but we were one of the first. And it’s actually spread to a lot of other psychiatric facilities around the country, which is really gratifying.
Gabe Howard: I think that’s incredible. And I like the idea of bringing in peer support specialists and understanding that there’s multiple pathways to recovery. Because I think that really is what’s needed, because the way that Gabe Howard got well and the way that Jane Doe got well, especially living in different states, being different ages, being different genders, having different family supports or just having a different personality. And I think that maybe people don’t understand that I’m often surprised at how often I get. Well, you have bipolar disorder and my son has bipolar disorder. So what’s that? I’m like, well, here’s the definition of bipolar disorder. But beyond that, we’re two very different people.
David Susman, PhD: Yeah.
Gabe Howard: And they’re like, no, I don’t think so. You both have bipolar. On one hand, I want to get angry and be like, how could you be so stigmatizing? But on the other hand, I think, wow, that’s the level of understanding and education that my fellow Americans have about mental health issues. I don’t think they’re trying to be malicious. I don’t think they understand the concept of mental health. Which leads me to my next question. I don’t think that most people understand the concept of recovery. I know that out there in the mental health space, it means something different to different people. I’d like to hear what your thoughts are.
David Susman, PhD: Well, you hit the nail on the head. I mean, your experience is different than everyone else’s because you’re a unique individual and you’re not the same person as anyone else. Coming up on 30 years, I’ve talked to thousands of people who’ve been in all stages of recovery. And I can firmly say that that journey of recovery is different for every single person. And you’re totally correct that many of the general public, they don’t really appreciate a lot of the basic things about mental health, about recovery. And that I think then speaks to our job to continue to educate people. You know, it’s often said people don’t know what they don’t know. And I think that’s very true. When I’m training graduate students in clinical psychology, I often say to them, you have to assume that people don’t know anything when you’re working with them and when you’re providing them care and treatment. So that means that a lot of basic education is needed. But we get hung up, as you know, Gabe on language around mental health and language
Gabe Howard: Yep.
David Susman, PhD: About re-cut recovery. And, you know, are you recovering or are you recovered or are you in recovery? And, you know, we have all these debates about this. But I think the important thing is that recovery is going to have a different meaning probably for each person. But there is some sense, I think, that recovery involves growth and it involves change and it involves support. It involves learning. Just, you know, it’s the journey. It’s not a destination. I think, you know, I have many people I know who who maybe have had severe eating disorder. And they quite confidently say they’ve recovered from their eating disorder. And I’m fine with that. Whereas you might have someone else has chronic schizophrenia and they might never feel like they are, quote unquote, recovered. They might feel like it’s still sort of a maintenance process for them because of their illness. And I’m fine with that, too. So I you know, I don’t think any of us need to be the word police. I think we just need to meet people where they are and we need to accept them for where they are and where they’re going on their journey. We need to provide them support. And however they want to view recovery, we need to help them find that potential to just have a better life. To me, that’s what it’s all about, quality of life.
Gabe Howard: I can’t agree more. David, the last thing that I want to talk about is your blog. You have a feature on your blog that I love where you help people share their mental health journeys. And the series is called Stories of Hope. I just think it’s really, really awesome to help people get their stories out there. And it’s atypical for a doctor to do. I want to say that as somebody who lives with bipolar disorder, we’re constantly hearing from websites, you know, about recovery or hope or being mighty. And patients are constantly sharing each other’s stories. But I want to give you kudos. You know, you’re a doctor and you’re helping patients share stories of hope. And that’s I’m sad that it’s unusual, but it’s unusual.
David Susman, PhD: Well, first of all, thank you. That means a lot to me. And I also want to mention in case people go there, that you are one of the people who is kind enough to go through the story of hope interview with me and we have your interview on there as well. So, you know, that was fantastic. But yeah, I just decided early on. I’ve been blogging for about five years now. But there are obviously things I can talk about from my experience and from being a health care professional. But as I learned many, many, many years ago, it’s the voice of the person in recovery that probably matters even more. And so I felt like I just wanted to showcase that. And so I started the stories of hope, which is this simple idea to let people talk about their journey, whatever that was. And I just provide kind of a very simple framework for them to do that. And they talk about kind of what they’ve been through and what their challenges have been and their successes and perhaps what sort of support or treatment they saw. And it’s been to me not only informative, but it’s been very inspirational. I’ve been able to connect with people in actually several countries around the world. I’m coming up close to 100 interviews. It’s just been tremendously fun and enjoyable and I’ve learned so much from them. And so I’m going to keep doing it. If anybody wants to do a Stories of Hope interview, send them my way. I’m happy to do that.
Gabe Howard: And how can they do that? What’s your Web site? E-mail address, what’s all of your info?
David Susman, PhD: Yeah, my sort of home base is my Web site, which is where my blog is. And it’s just DavidSusman.com and that’s S U S M A N. DavidSusman.com. And from there they can contact me. There’s also information about the Stories of Hope and they can read all the other interviews that are on there. You’ll also find all my mental health and advocacy blog posts. So I have other social media pages on Facebook and Instagram and Twitter. And if people want to connect through LinkedIn as well, you can find really everything on my Web site.
Gabe Howard: That is incredible, David. Thank you again for being on the show and for all you do with people living with mental illness and to help educate the public about everything that’s going on with mental health, mental illness, psychology. You’re doing a yeoman’s job, sir.
David Susman, PhD: Well, thanks so much, Gabe. You know, as are you. You’re one of the advocates I greatly admire. I’m very grateful and thankful to you for letting me spend some time with you today.
Gabe Howard: Thank you so much, I really, really appreciate that. And listen up, everybody, wherever you downloaded this podcast, we just need you to do a couple of things. Subscribe to the show. Rate the show. Use your words and tell people why you like the show and share us on social media. Once again, your words matter in the little social media description. Tell people why they should listen. If you are on Facebook all the time like us, you can go to PsychCentral.com/FBShow and join our private group. And finally, remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere simply by visiting BetterHelp.com/PsychCentral. We will see everybody next week.
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Central Podcast, T. (2020). Podcast: Inpatient Psychiatric Stays From a Doctor’s Perspective. Psych Central. Retrieved on October 25, 2020, from https://psychcentral.com/blog/podcast-inpatient-psychiatric-stays-from-a-doctors-perspective/