1. punchthedamnkeys
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    punchthedamnkeys Member

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    is this fictional situation believable?what do you guys know about mental hospitals?

    Discussion in 'General Writing' started by punchthedamnkeys, Mar 5, 2013.

    a really odd question, i know, but hear me out...

    i'm new here and all, but as some of you guys know i'm on my first attempt at trying to write a novel. to put it simply, my novel is about a homeless man with a trouble past who wakes one day in a mental hospital... and that is why i have these questions about mental hospitals.

    can mental hospitals be co-ed? what about age differences? and in terms of severity of mental illnesses, how does it effect what kind of mental hospital you would be put in? if i have to change these characters up a bit so it's believable that they could all be together inside a mental hospital, how would i do it?

    tell me if these people could in fact be possibly found together inside a mental hospital:

    - homeless man (25-30 years old, depression, suffering from hallucinations, very slight schizo, can't remember his childhood, doesn't know his own name)
    - man (20-25 years old, not really depressed, more like "thinks different", acts wild, not really crazy though, does hard drugs)
    - woman (20-25 years old, hippie-like, pot smoker, confused mostly more than actually depressed)
    - woman (20-25 years old, depressed, trauma from sexual abuse earlier in life)
    - woman (30-35 years old, extreme depression, out of it mostly just staring into space)
    - man (35-38 years old, depression)
    - old man (60+ years old, senile)

    this is probably one of the weirdest question asked here before, and it may sound really stupid... i'm kinda laughing just looking at what i just asked, but i am serious.
     
  2. GhostWolfe
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    GhostWolfe Member

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    Based on your descriptions, unless this story is set a couple of decades ago, most of those people wouldn't be in a facility. The idea of institutionalising people is really nothing like the asylums you see in movies & on TV. A psychiatric hospital is more like an aged care facility, it provides around-the-clock living assistance to those who cannot care for themselves and controlled, supportive environments for people who cannot live in a normal setting.

    Psychiatric hospitals are more likely to be a wing of a general hospital. Ultimately, their goal is rehabilitation of a patient's condition where possible. Yes, a hospital would be co-ed, but it is very unlikely for a depressed patient to find themselves in hospital care. If they attempted to harm themselves, they would be placed under emergency care until such time as they were deemed to no longer be a threat to themselves, but they would be isolated from any long-term care, as they have different care needs.

    A "senile" patient may be in long term care, if their dementia is caused by mental illness, but it is more likely that you would find them in an aged-care assisted-living home.

    The male youth on drugs would never be placed with long-term psychiatric care in a modern setting, they would be placed in drug rehabilitation.

    However, all of that being said, a large hospital may house many facilities & these characters may meet even though they're not supposed to.
     
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  3. iolair
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    iolair Active Member

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    I lack much experience of the inside of a mental hospital (I went for an interview in one once, but it was for an IT job).

    Outside the local one here (UK), I have seen both M and F inpatients sat outside having a smoke together, so they're clearly not "locked away". I think the vast vast majority of people who spend time as inpatients have agreed to do so.
     
  4. matwoolf
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    matwoolf Contributing Member Contributor

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    Do some research to spark you off a little more.

    Your characters don't sound very sick 'depressed, pot smoker' - more like family members. Roughen them up with some ghastly tales from the backbrain. 'He was just sitting there on the bus, breathing. Well I soon put a stop to that,' she said, her eyes sparkled, met mine and I knew, knew one day this woman, one day she would be my wife.

    Or write it silly and polish up to sincerity with the research and drafting laters. Hardest part is words on the page. First draft 'ECT queue' and 'juicy fruit' - by draft 4 you'll have more empathy and background knowledge.
     
  5. GhostWolfe
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    GhostWolfe Member

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    Expanding on that, a patient wouldn't be "locked up" unless it was essential to their treatment (drug rehabilitation, suicide watch, extreme cases where a patient may 'break down' or act out if their environment is not strictly controlled [think along the lines of how violently an autistic patient can be when they're being forced to do something they don't want to], the mobility impaired).
     
  6. matwoolf
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    matwoolf Contributing Member Contributor

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    Iolair. Exeter's hospital used to be legendary. 'Digby' was synonymous like 'Joey Deacon' in crueller times
     
  7. punchthedamnkeys
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    punchthedamnkeys Member

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    hmmm.... based on your description of what warrants people to be locked in mental hospital, i'm thinking it may be a far stretch but i could probably still make it work and put them all in there together.

    - the old man with the dementia, part of the premise of the story is his family just don't care about him anymore and just threw him in the mental hospital instead of the old folk's home because it was cheaper.

    - the hippie-like woman who's a pothead, i'm thinking someone like sylvia plath (not sure if you know her), again she's an aspiring author, but not as depressive.. kind of like winona ryder from girl interrupted, she wasn't as bad but they threw her in there anyway

    - the other 20-25yr old man, he's a FORMER drug addict and that really took a big hit on his mental state... think john frusciante from the red hot chili peppers circa 1990-1995

    - the 35-40yr old man, he actually admits himself into the hospital, he basically pays them to stay in there

    i can probably throw in a few past histories of suicide attempt for a few of them lol. these are the four that are probably the less believable to be in a mental hospital but i wanna really make it work what you think? the reason why they're so different from each other is because i really want to show variety, how mental illness affects everyone and it does so in different ways... can i pull it off or what?

    sorry for the random references to people, but that's how i came up with those characters..
     
  8. EdFromNY
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    EdFromNY Hope to improve with age Supporter Contributor

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    Mental hospitals are used now only for acute psychiatric emergencies. The model used is short term acute in-patient care, followed by out-patient maintenance (which is almost always pharmacological, and since mose psychotropic medications have heavy and unpleasant side effects, many outpatients do not stay on their meds, which is a large part of most city's homeless problems). None of your characters would be in a mental hospital, and would not have been since the early 1980s. The old man with dementia would be in a nursing home or assisted-living facility (for a solid fictional treatment of one, see James Michener's "Recessional"). Even before deinstitutionalization, many of your characters would not have been there. Homeless people, if they go anywhere, go to shelters (and most avoid them out of fear - in New York, city workers have to comb the streets to pick them up when the weather gets extremely cold).

    If you want to show the effects of mental illness, you will need to do a lot more research. At one time, the scandal of mental illness was that patients were "warehoused" in huge facilities that kept them in dehumanizing conditions. Now, it's that they are largely ignored and left on the street.
     
  9. iolair
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    iolair Active Member

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    Yes, I believe Digby hospital closed down in 1987 (though I'm relatively new to the south-west) - I live a minute's walk from the buildings which are now apartments. Lovely architecture too. The current one is Wonford House, and it's on the same campus as the main hospital.
     
  10. iolair
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    iolair Active Member

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    It sounds like you could get round many of your "problems" with your characters not being suitable for a modern mental institution in the English-speaking world by moving the setting either back in time (say, to the 70's or earlier) or to another country where they still have a more isolationist view to these conditions - that could be a very strong approach, but unless you have first-hand experience will up your hours of research to do somewhat.
     
  11. chicagoliz
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    chicagoliz Contributing Member Contributor

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    It is extremely difficult to find long-term in-patient psychiatric care, and even if it can be found, it would be extremely expensive, and insurance companies don't want to cover it. Where does your man get the money to pay for it?
     
  12. jazzabel
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    jazzabel Contributing Member Contributor

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    (ps. all this applies only to countries with free medical care such as UK, Australia, France etc. The organisation will be the same in the US but a lot less patients will have access to appropriate medical care because they are expected to pay and the sickest people usually have the least money).

    I don't see anything stupid, or weird about your question. It's good that you asked and that you are interested in making your story more authentic.
    Mental hospitals are usually co-ed. Forensic mental health institutions tend to be segregated though. Ages 17 - 65 are admitted to Adult Acute psychiatric units. You also have Psychogeriatrics which are usually divided into dementia ward and "other (because dementia patients have special needs). There are Child and Adolescent, Mother-Baby (for post-natal psychiatric conditions), Learning Disability (people with autism and intellectual disability who need psychiatric care), then you might have specialised Eating Disorders, Also Chronic and Rehabilitation and then you have outpatient clinics for everything. It depends on a patient as well as the system in that country or county, where a patient might end up. Oh and Drug and Rehabilitation units, which are self-explanatory.

    All Adult Acute wards (this is what is usually represented as "mental hospital" in literature and film) will have a secure areas where patients can be locked up for their safety. This is usually used for patients who required sedation, but also patients who are violent or otherwise at risk of harm. The rest is divided into rooms with beds (the nurses usually try to keep women with women, men with men, but sex on the ward still happens, it's impossible to avoid especially when people are disinhibited) and other activities rooms and spaces. Lots of patients chain smoke so there's a smoking rom and a locked courtyard. The wards are usually locked and only staff with keys can come and go as they please.
    Everyone who isn't a part of a forensic system, and isn't learning disabled, and is 17-65 goes to these wards and here you'll see everything, from psychotic and bipolar illnesses, to depression, personality disorders etc. So all you need to do is make it an Adult Acute ward, and you can have all different kinds of patients there.

    Whether someone is "put into mental hospital" depends on one thing - are they at risk of harming themselves or others? Risk assessment forms are most important part of psychiatric assessment in hospital. As soon as the patient is no longer at risk (there are risk indicators in several categories and these assessments are completed daily in the hospital, as well as on admission), they get discharged into community care. This goes for both voluntary and involuntary patients.

    As for your characters, I can give you a kind of scenario that might land them into hospital"

    1. homeless man - psychotic break, chronic alcohol abuse, probable onset of schizophrenia (mutism, thought withdrawal, paranoia)
    2. man who does hard drugs - without severe mood or thought disorder or a suicide attempt (psychotic depression, mania) he would not be admitted to hospital the way you described him. He might have antisocial personality disorder and fake his way into hospital in context of impending court case (classic presentation).
    3. confused 25 yo female pot smoker - she would have to be significantly cognitively impaired, in which case she is probably suffering delirium but cannabis wouldn't produce this. She would either have some early onset dementia or psychiatrists might suspect solvent abuse or some long term hallucinogenic drugs, or she has undiagnosed schizophrenia or some such.
    4. 35 y.o woman with catatonic depression - your first fully plausible patient, she will most likely be receiving ECT and will suffer episodes of confusion and partial amnesia after her treatments, and some memory loss for the next 6 months, but her mood will be dramatically improving from week to week and you can show her personality emerging from illness really well in the book.
    5. 35 yo man with depression - must be a high suicide risk (recent or previous serious attempt) to be in hospital (or as per patient 4.)
    6. old man might be having early dementia and the ward might be in process of trying to transfer him to psychogeriatrics, because even though he is not 65, expert nursing care he needs he can only get there. Or he could be depressed and present with pseudodementia (when depression slows cognition so much, and the patient is elderly, the assumption is they are senile but with some antidepressants and other therapy, they can recover completely, which is not the case with senility of the old age aka Alzheimer's type dementia).

    The most important prognostic factor for seriously ill psych patients is the quality of support in the community. Do they have loving families, friends, a partner, who can look after them until they recover (or indefinitely if that's what they need) or are they struggling to cope on their own.
     
  13. punchthedamnkeys
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    jazzzabel thanks for that, you actually hit my main character almost spot on ^, chronic alcoholic for sure..

    i thought about all the things you guys described on the requirements to be a patient in a mental hospital, and i realized the movies i've watched in fact really don't depict mental hospitals all too well. i'm thinking of going the same route and just writing it in anyway... would it be that big of a deal? i mean the story itself isn't just about mental illness, it's mostly about the relationships he forms with these people...
     
  14. shadowwalker
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    shadowwalker Contributing Member Contributor

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    The hospital I was in had everybody and their uncle in regard to illnesses. There was a separate building for the elderly who suffered from dementia and Alzheimer's, and the prison ward was a couple miles from the main campus, so they really weren't 'included' with the general population. It was not part of a medical hospital, but then it was a regional treatment center - mainly for those who couldn't afford a private hospital. The dorms were co-ed, but of course roommates were same sex. Children weren't there at all - late teens, early twenties were the youngest. People stayed there anywhere from a couple of weeks to several months. I myself was there for just over three months.
     
  15. jazzabel
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    jazzabel Contributing Member Contributor

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    I'm glad if it was helpful. I think it is important for you to know how psychiatric hospitals work. Also, it is important to fully understand each illness you want to incorporate. It is true that writers shouldn't get bogged down in too much detail, but if you want to make any illness a part of your plot, you probably don't want to disrespect people who suffer from it, by writing stuff that is inauthentic and irrelevant.
     
  16. Bimber
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    Bimber Contributing Member

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    Right on the spot, will just add stuff like this needs some heavy research while you may not write about all those illnesses you need to know more about them so you get a better picture how to write it, plus agree with everyone you need to up the "crazy" in them a little all i got is they depressed than most of us would be in there too...
     
  17. funkybassmannick
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    funkybassmannick Contributing Member

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    Here's a brainstorming idea: Make them a family! Since you already seem to have some strong characters in mind, you probably don't want to change them too much, so change the premise. You can still keep most of the elements of the hospital, like they feel "trapped" in the family, they could even joke their house is a mental hospital.

    As a side note, I would argue that the real problem is our society's culture of pushing unwanted prescriptions/doses on people. Psychiatric patients typically have little say in their medicine, ESPECIALLY minors. They would be more likely to take helpful medicine if they had a say in how much medicine they want, but the doctor's word is law.

    Also, there is a lot of research to support the idea that various kinds of acceptance is the greatest treatment for mental illness. The way we view mental illness is, "These people are dangerous if they don't take their meds," but this kind of mentality is not accepting them for who they are (we're trying to change them) and may actually be exacerbating their condition. Check out the Western Lapland Open Dialogue Project if you're interested to learn more. They prescribe little to no meds to schizophrenic patients, and they can actually CURE schizophrenia. Because of this program, schizophrenia is not a life-long disorder there as it is in America.
     
  18. shadowwalker
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    shadowwalker Contributing Member Contributor

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    That's a little misleading. They work with people in the very earliest stages of psychosis, and it's so far shown to be more effective treatment than waiting until the illness has progressed. I don't think I would call that a cure. But it's certainly promising. However, this treatment program hasn't been tried on other kinds of mental illness, and, as you noted, is not widely used - I couldn't find where it was widely used anywhere except Finland.

    At any rate, one should work with the research and treatments in use wherever the story takes place, mainly because there are all kinds of so-called 'cures' out there, with varying levels of effectiveness.
     
  19. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    I do consulting work for a small private psychiatric hospital and I've had some clinical experience years ago in the same state hospital that One Flew Over the Cuckoo's Nest was filmed in.

    Yes, they are co-ed in the day rooms, only a few people are locked up in a single cell and even then, it may only be some of the time.

    You do find all sorts of disorders on a single unit.

    Adults are segregated from kids, but beyond that you find all ages together.

    You are not going to find senility or dementia patients unless the person was mentally ill first and committed years earlier. Patients with dementia are cared for in nursing homes, including some that have whole Alzheimer's units.

    Detox patients are frequently on separate units or in different facilities, mostly because the nursing and medical care differs.


    I'll comment on one of my pet peeves, but ignore it if it doesn't apply to the premise in your story:

    If you are going for realism as opposed to using a bit of fictional license, you should know we don't just lock people up like they might have in the past. It bugs me about the movies/stories like Gothika and a whole lot of others that use the 'wrongly locked in a mental hospital' theme because it just doesn't happen like that. In the US, doctors don't lock people up, judges do. I'm guessing it's the same in other first world countries.

    As for needing the doctor to say you are OK to get out, that's really only in very limited cases. If you can talk coherently to a judge, you have to have done some really weird or bad stuff to get locked up involuntarily. There are a whole lot of mentally ill people who could benefit from mandatory treatment, but that option went out decades ago (with more benefit than loss, I should add).

    In the private hospital the majority of the patients are there voluntarily, a few are court ordered. Regardless, the doors are kept locked. Court ordered treatment usually follows threatening suicide, acute psychosis, or criminal behavior, including assault.

    If a patient were to attack staff (with some exceptions) they would be arrested and charged with assault just as they would outside of the hospital. Most of the patients are short term and come in either for detox or medication management. Only a few are in this facility more than a month, but there are private institutions that treat more long term inpatient care patients.

    In the state hospital I did a clinical rotation on a locked ward. These folks were more or less committed for long term and all were there by court order. They had very severe disease and couldn't function on their own, or, would pose a significant danger if released.


    You could get around this by either putting your story in a different era (before 1960) or ignoring reality, most people don't know how people end up in psychiatric hospitals.


    I strongly suggest you take a look at the diagnostic criteria in the DSM IV. (Don't worry about the DSM V scheduled to come out this year.) The descriptions you've listed for your characters could use some tweaking if you want realistic. You can still give them the qualities you listed, lots of people have what we call co-morbidities, such as a mental illness and a drug or alcohol problem. A schizophrenic could also have a major depression, and so on. But I think using the symptoms listed for a diagnosis in the DSM would really tighten up your characters.
     
  20. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    In the US, we do still have state psychiatric hospitals and in the rest of the civilized world, they have national health coverage.

    What everyone is saying is mostly true, even when people are committed, they are committed for very short term, usually to get them back on meds. But there are a small percentage of patients who really can't function in the world and they don't all have money or medical insurance.


    For example: OR State Hospital still exists.
     
  21. funkybassmannick
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    funkybassmannick Contributing Member

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    I redact my use of the word "Cure." But it is definitely the most effective treatment. One reason it's hasn't been done effectively in the US is because it receives a lot of resistance for going against the medical field. It was implemented, I forget where, but the hospitals didn't allow them to take patients in the early stages, only patients in late stages. The treatment doesn't work that way, and so it makes it look like the program is failing. Last I heard they were trying to get hospitals to give them early-stage patients, but the hospitals don't trust them enough because their program "doesn't work." A catch-22.
     
  22. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Fictional mental health hospitals are the norm in literature. There's no reason you can't do it too.

    But, as you can see from the comments in the thread, more and more people are aware of the fiction and readers may turn off of an unrealistic story. I agree with the suggestion you don't worry too much about it, write the story and then see which elements are critical to the story and which aren't. You could use reality and surprise the reader with a fresh story, or you could decide it's fiction so, meh, who cares? Readers will overlook a lot if the story is good.
     
  23. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    I think you're a bit out of date here. Only the very sickest patients get mandatory treatment, and the doctor's word is not law.

    Eeek, I'm sorry but this is fraudulent stuff.

    I'm assuming it is also off topic and not a discussion that belongs here so I'll say no more.
     
  24. GingerCoffee
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    This ^
     
  25. funkybassmannick
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    funkybassmannick Contributing Member

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    "Fraudulent stuff" I'm learning in grad school for psychology. Hmm... Also, there is a very recent study on minors in the health care system done by Dr. Robert Foltz that looks at their view of treatment, and the results are very surprising. Perhaps I'm the one up-to-date.

    If you'd like to talk more about it, we can PM.
     

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