The Complex Case for Inpatient Psychiatric Care
Amidst the cat pics and political memes, the images of my former elementary school classmates’ children, now elementary school students themselves, there will be a link to a mental health article smushed in there on my Facebook wall. Sometimes, usually against my better judgment, I click on it, because click-bait is just so deliciously clickable.
Today, I made the mistake of clicking on an article written by Noam Shpancer, PhD, a psychologist and professor at Otterbein University. The article detailed the experience of a psychotic loved one who spent a brief time in an inpatient psychiatric hospital.
In his piece, originally published by Psychology Today, Dr. Shpancer finds fault with just about everything about the psychiatric facility in question, including, but not limited to: the aesthetics of the inpatient milieu (“Every wall and piece of furniture screamed, ‘institution!’”), the psychiatric technicians (“poorly-trained”), the restrictive policies related to contraband, (“Not only were phones and other electronic devices not allowed for patients, visitors weren’t allowed to bring them in either. Our bags were searched as we entered. The safety (or therapeutic) rationale for this procedure was not clear.”), the lighting, “dim”… I could go on, but you can, and should, read Dr. Shpancer’s article for yourself.
I worked at an inpatient, crisis psychiatric hospital for five years, and my eyes were open. They saw things not wholly dissimilar to the things Dr. Shpancer’s loved one saw, and that he saw during his visiting time with her (he complains about visiting hours, too). I would never claim that many of Dr. Shpancer’s observations about this particular psychiatric hospital do not also accurately describe my own experiences at the hospital where I worked. My building was drab and impersonal, too. Some psych techs did not orient their patients properly onto the inpatient unit when they were admitted. Some groups were absurd, poorly-run, and childish. Some staff members should not be allowed to work with people, let alone people with mental health challenges. There is good and bad everywhere.
And this is precisely the issue I take with Dr. Shpancer: nowhere in his diatribe does he write one single mitigating sentence, not one word to offer a different perspective other than an irate family member. Not once does he say that many psychiatric technicians, nurses, therapists, and other frontline staff workers are doing their best given insurmountable difficulties, daily heartbreak, insidious, recurrent disease, poor funding, apathetic politicians, staffing shortages, burnout, trauma exposure, and on and on and on. Nowhere does he write that psychiatric hospitals, despite their faults, and there are faults, save lives — that, without them, individuals with SPMI (serious and persistent mental illness) would be arrested and be sent to jail and, in many parts of the country without inpatient psych facilities, that is exactly what happens.
Why is the furniture institutional? Because it’s inside an institution — because psych hospital furniture gets peed on, and thrown, and because patients will try to use it to harm themselves.
Why are cellphones not permitted? Because psychiatric patients call the police, and the FBI, and the White House, and threaten their family members, and it’s much easier for the ward clerk to flip a switch and shut the phones off when that happens. Oh, and cellphones also have these things called cameras and they’re connected to the internet, so maybe giving patients in a psychiatric hospital a tool with which they could commit HIPAA violations and violate people’s right to privacy isn’t such a hot idea.
Why are visitors searched? So that they can’t bring in items of contraband; items that a patient could use to hurt him or herself, or someone else. Because it isn’t a secure environment if it isn’t secured.
Why do private, non-profit psychiatric hospitals look “drab, impersonal, and ill-lit”? I wrote grants and did fundraising for a private, non-profit psychiatric hospital for two years. It’s not exactly the easiest sell to donors and foundations. I encourage Dr. Shpancer to try his hand at that and see how much money comes rolling in to support the mission and pay for charming enhancements to the corridors and rooms. And if Dr. Shpancer thinks that insurance companies and patients are paying out tons of money to private psych facilities; that’s not happening. Most of the money comes from Medicaid reimbursements and county funding, and they aren’t exactly swimming in that.
Why are visiting hours so short? Visitors tie up everyone at the hospital, from the crisis worker who has to sign them in, identify them, search them, store their belongings, to the psych tech who has to escort them onto the unit and keep track of them, to the roundsperson who has to watch to make sure the visit is proceeding appropriately and that nobody is getting escalated or heated, to the psychologist who has to try to meet with family members when they are present, to the staff member who has to escort them off the unit. There is only so much that can be done in such a setting, in the most restrictive setting, and that is what inpatient hospitalization is: it is the most restrictive setting and, plain and simple, that’s not going to be a super nice experience for anybody involved. It isn’t super nice for staff either.
But for Dr. Shpancer to make sweeping generalizations about inpatient psychiatric hospitalization on the basis of one experience that wasn’t even his, and to not make any statements that mitigate his ire in any way is irresponsible. His essay will dissuade individuals who need help from seeking it, and it will convince family members and friends of people who need help not to involuntarily commit their loved one or friend, and that is dangerous.
I will say it for anybody to hear it: inpatient psychiatric hospitalization should be the option of last resort. Inpatient hospitalization can be traumatizing, and it can be ugly. There are myriad ways to intervene with an individual who is in a mental decline; therapy, warm lines, support groups, interventions, clergy, employee assistance programs, mobile crisis, etc. But when a person is an immediate danger to himself or another person, or is bereft of their ability to care for themselves, inpatient hospitalization is necessary. I heard time and time again from patients, “Yeah, it sucked, but this place saved my life.” And that’s the bottom line.
Nathan, G. (2018). The Complex Case for Inpatient Psychiatric Care. Psych Central. Retrieved on April 5, 2020, from https://psychcentral.com/blog/the-complex-case-for-inpatient-psychiatric-care/