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

And the only thing I would add to that is that the laws on commitment can vary greatly from state to state. In my own state of New York, the sole criteria is danger - is the person a danger to himself or to others?

 

That's true but oversimplified. One is limited in how one defines 'poses a danger' with respect to the law in this case.

 

"Not understanding" historically leads to fear of the unknown and the perception of danger. Are they really a danger, or do we just perceive them to be dangerous because we fear what we don't understand?

 

I am a nurse who worked in a psychiatric hospital (within the last ten years). Substance abusers were indeed admitted with the patients who were depressed, psychotic AND confused. There were also patients with dementia. So Puchthedamnkeys, your characters are perfect for your story. I would look for a copy of the most recent DSM ( Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ) at your local library and get info on signs and symptoms that fit the criteria of psychiatric disorders. Good Luck!

 

In my state, thinking they may be a danger is not grounds for commitment. They must have acted in a way that actually poses a danger to themselves or others. Ignorance or fear are not legal grounds.

 

I posted an online link to a DSM-IV source that's easy to read. And 5 isn't officially out yet, or if it is it shouldn't matter to a writer if they have DSM-4 or 5.

While there is a detox unit at the facility I work for, there's no hard fast rule detox patients don't mix. As for dementia, though, that's a mix I don't see often. But it makes sense to me there are a wide variety of facilities out there. I do consulting work for a nursing home that has the occasional psych patient, and I worked in the past with a nursing home that had a unit for the developmentally disabled, all ages.

 

Which is why it has to be ordered by a judge.

 

But how do we define behavior that "actually" poses danger to themselves or others? There is an excellent scene in the movie "Crash" where a white police officer is giving a young black male a ride. The young black male reaches into his pocket, and the police officer believes he is pulling out a gun, so he shoots him. The point is, sometimes we see dangerous behavior when it is actually innocuous.

Let's clarify: Who is being ordered by judges to mental institutions? Homeless people?

 

In the US, it's not easy to get a person committed.

For someone who is suicidal, you have to tell someone you are going to kill yourself or make a failed attempt. Then you are only committed for a very limited time.

A danger to yourself, but not suicidal, you'd probably need to be so psychotic you didn't recognize reality or so ill you just stopped eating or something like that.

A danger to others, unless the person actually commits an assault, it's also very difficult. The court has a much higher standard than a cop making an instantaneous decision.

We get a few people committed just for being psychotic, believe me, there is no question the person is not functioning in the real world. The process is, they get arrested for doing something really bizarre like running down the street naked screaming at Jesus. Then they get a mental health eval. and then the judge hears the case. If the person is coherent in the courtroom they are not likely to be committed.

You are not committed simply for being homeless, or an addict or even for just being mentally ill. You can see evidence of this in any urban center, just look at who is sleeping in doorways and on park benches.

 

Psych wards are very, very quiet and boring. Everything is regulated to the nth degree. A person can only leave their room at certain times, need to lay down at certain times. The nurses and orderlies run it pretty tight.

It's definitely not a pleasant place for people to visit. I've gone to see a friend before and had to take my shoes and belt off before entering as do the patients.

 

@funky:
You seem to have a few misconceptions about treatment of mental illness. Severe mental illness causes physical brain damage, especially chronic psychosis, but also others. All severe mental illnesses also share one symptom in common -poor insight. In other words, the sicker the patient is, the less able he or she is to believe they are ill. That's why treatment is mandatory, to prevent long term cognitive damage (or to lessen it). And despite the fact that to a lay person, a psychiatrist's job seems vague, I assure you it is based on thorough scientific research and it is very methodical in its approach. Schizophrenia is incurable. A small percentage of patients (10-15%) do well, about 30% do well as long s they stay on meds and about 50% have limitation of function and some have very poorly controlled illness. Whoever finds an actual cure will no doubt get a Nobel Prize.
I can only speak for the UK and Australia, but only doctors, approved social workers and the police have the right to detain a person under the Mental Health Act, and it has to be revised within 48-72 hours, and paperwork filled out by 2 psychiatrists. Every 14 days, the patient has the right to appeal if they are committed, and then they get a hearing in front of a lawyer, an independent psychiatrist and a lay person ( so called Mental Health Review Board).

 

Well, again, that depends on the facility, and even the ward within the facility. The hospital I was at, one had severe restrictions only for the first 24 hours; after that it depended on how well one 'acclimated'. Once in the main hospital, one could come and go as they pleased, even on the grounds. You were only restricted if your illness (or just bad behavior) put you or others at risk. No visitors had to remove belts or shoes, but there were some reasonable restrictions as to what they could bring for the clients. The facility itself had a large grounds, very park like.

 

Like Shadowwalker says, there is a great variety of institutions. I should clarify here I'm the infection control practitioner at the facility I do work for. I don't do a lot of psychiatric nursing though I do see patients for infection issues from time to time. Patients have to take their shoes off when admitted but they get them back depending on a number of issues. Visitors don't take off shoes. And people have a lot of free time, there is a therapy schedule, and a bed time patients have to be in their rooms, but even that isn't strict. I see patients at all hours coming to the nurses station for various needs. There's a day room, and an outdoors for smoke breaks.

At OR State there was a large day room the patients hung out in.

 

All the studies that show patients with chronic psychosis and brain damage do not have an effective control group. All of the subjects with psychosis are all taking psychotropic drugs, and so we cannot conclude that it is the psychosis causing the trauma, when it could just as easily be the drugs.

According to both of the major WHO studies, only 1/3 of people with schizophrenia recover, while 2/3 of people with schizophrenia recover in third world countries. Why the difference? The biggest difference is that, in first world countries, patients are treated with medicine, and in third world countries they are not.

Let's look at the history of the diagnosis, because we must review the past in order to prevent making the same mistakes. In the 18th century, people with schizophrenia were called and viewed as "brutes." They were kept in gloomy cells & whipped. They were chained to rings of iron. They were restrained with hand-cuffs and ankle-irons. Treatment was even more brutal. They were subject to blood-letting and emetics. There was the "Swinging chair," which essentially swung patients around so much that they would feel nauseous for hours. These treatments did nothing but shock the patient's mind and body so much that it created the illusion that the psychosis was mitigated, and thus it was being treated. They also found that drowning worked particularly well when the patient went unconscious, and thought of it as a "brain reboot." But sure enough, the treatments were a failure, and the patients' psychosis returned as soon as they recovered. The treatments would continue on indefinitely, and commitment to an institution at this time was equivalent to a life sentence.

Naturally, the patients responded to this trauma with fear and aggression. This would confirm the hypothesis to the doctors that these people were indeed subhuman "brutes," more animal than human. The doctors would respond with further "treatments" until the patients were reduced to a pitiful, whimpering state.

Now let's move forward to the early 1800's, when we had a brief success with "moral treatment." In response to the brutality of previous treatments, a new wave of mental health practitioners went in the opposite direction. The patients (still people with psychosis) were treated morally - No punishments, no blood-letting, no swinging chair, no drowning, etc. Their living conditions were much nicer, with comfortable rooms, beautiful gardens, and the freedom to roam campus. They instead taught the patients the belief that they could control their thoughts. That they were not hopelessly ill, and in fact had a potential for future betterment. More than 80% of patients receiving such treatment recovered (that's 47% more than today).

However, the Moral Treatment Centers began to fall into decline by the late 19th century, and in 1900 came the darkest age for mental health in modern history: Eugenics. People with psychosis were viewed as having bad genes and were thus subhuman by both society and the medical field. They were viewed as "social wastage," "malignant biological growths," and "poisonous slime." They were "unfit to breed," and were sterilized. Sterilization was spun as therapeutic, and doctors were able to convince patients that they wanted to be sterilized. The patients asked for it.

Moving on to 1935-60, we have the era of lobotomy. It hit a big headline in the New York Times, "New operation... will go down in history as another shining example of therapeutic courage." Lobotomies were believed to relieve tension, apprehension, crying, melancholia, anxiety, depression, panic states, disorientation, nervous indigestion, insomnia, suicidal ideation, delusions, & hallucinations. Pretty cool, huh? Of course, we know why they relieved all of these symptoms - because they turn you into a potato. Removing the frontal lobe removes most of what makes you human. In just the years 1950-51 alone, approximately 10,000 lobotomies were performed. Again, just as with sterilization, lobotomies were spun as therapeutic. Doctors were able to convince their patients with psychosis that they wanted to be lobotomized. The patients asked for it.

In 1954 we have the first modern psychotropic drug come into treatment plans: Thorazine. It was originally viewed as sedating brain function, as an anesthetic for surgery. One surgeon, Henri Laborit, noted that the drug seemed to create an "artificial hibernation," describing it as, "sedation without narcosis." That is, it sedated the patient without putting them to sleep. It was widely believed to be "the pharmaceutical substitute to lobotomy." As expected, patients with psychosis did not want to take thorazine. They rebelled by cheeking and hiding tablets. Hospital staff responded to this by turning thorazine into a colorless, odorless solution, and adding it to their drinks. Over time, doctors were able to convince their patients with psychosis that they wanted to take thorazine (the "pharmaceutical substitute to lobotomy"). The patients asked for it.

Thorazine is still used today as a treatment for psychosis. Now, you said that the psychiatric methods are today are "based on thorough scientific research and it is very methodical in its approach." Well, that is exactly what they said about lobotomies, sterilization, emetics, the swinging chair, and blood-letting. In the past, they assumed they were on the cutting-edge of medicine, and now we know they were far from it. With such terrible prognosis for psychosis today, why should we assume the same?

Psychotropic drugs have a number of side-effects. Sedation, tardive dyskinesia (involuntary, repetitive movements that are perpetual and incurable), akinesia (inability to initiate movement), akathesia (inability to remain motionless), a decrease in bone density leading to osteoporosis, and a suppression of gonadal hormones that leads to inhibited libido and sexual functioning. Whose to say that they don't cause brain damage?

Karl Jung stated that true suffering comes from avoiding pain. Psychotropic drugs remove the patient's ability to fully experience their pain. At the Western Lapland Open Dialogue Project, they allow the patients to experience their psychosis fully, and by accepting and embracing it they are able to move through it. They do use meds, but only in extreme cases, only a small dosage, and only for a few days. And they have amazing success. 83% of their patients are able to hold down a job, and 77% show no signs of resurgence.

And I'm not a lay person. I'm in grad school for psychology.

EDIT: Sources:
Mad In America by Eric Whitaker
ISPS-US 13th anual meeting
Open Dialogue, a film by Daniel Mackler

 

I don't see much in the way of citations in your belief rant there, Funky. Have you ever taken an introspective look at why you've drawn these conclusions over other conclusions?

 

I didn't make these conclusions. Whitaker did in his widely aclaimed book, Mad In America.

 

So he's gotten honors for his writing, but he's a medical journalist. And some might call his book 'acclaimed', others... not so much. I think I'd rather see studies supporting your conclusions, rather than re-phrasing one journalist's conclusions. Obviously you're taken with this fellow and his book - but after you've finished your graduate work and been in the field for a while, you may feel differently. At least as far as putting all your eggs (enthusiasm) in one basket.

 

Yes, yes, be critical of the criticism. But in doing so don't forget to also be critical of the original subject.

And it's not just Robert Whitaker. It's at least half a dozen of my professors at school. It's all of the practitioners I met at the ISPS-US conference last year. The mentality is not that Open Dialogue is the answer, but more like searching for more treatments, and not assuming medicine is the one and only answer. Speaking of putting eggs all in one basket, by the way, there are no controlled studies that compare medical treatments to other treatments...

 

I don't see any science there, just opinion. In particular, the kind of opinion that sells a lot of books because people like to fit conclusions they read to their pre-existing beliefs about the world.

As a person whose pre-existing beliefs center around a scientific evidence base, I'm not impressed. Meanwhile, back to the thread topic.

 

wow, when i made this thread i was afraid i wouldn't get much reply, especially it being such a random question. you guys have definitely proved to be very helpful with all these information you guys have posted about. "Iamfenian", i'm glad to hear from you... i guess i can make it work after all.

i have a few questions regarding these hospitals.

how are treatment for the patients given?
i don't plan to go too much into detail in the story explaining how the hospital works. i was thinking of having one head doctor, a psychiatrist, she basically "cares" for everyone. aside from daily medication, i was thinking of having her provide group therapy where everyone would participate and talk about themselves. as well as individual therapy, patients having one on one time with the therapy. all the characters i've listed are all under this psychiatrist's care, so they kind of form a somewhat tight-knit group as the story goes along. again, the story is more the relationships the characters form, and what they learn from each other...

can mental hospitals have something like sentence terms?
where some patients are sentenced to be in there for a certain amount of time?... kind of like a prison term i guess...

i will also check out the DSM manual you guys talked about... it could prove to be resourceful...

 

Oh how I love to be useful.

With the variety of facilities, I can only speak for the one I do work for. There are a number of attending doctors, (psychiatrists), and a patient is generally assigned to one of them for treatment. The nurse practitioners manage the patients' non-psych medical issues. I manage the facility's infection control issues and see patients and advise the nurse practitioners re antibiotic choices and advise the NPs and nursing staff on related followup. The nurses and counselors play key roles in patient care. I.e, it's teamwork.

The psychiatrists don't run any of the group therapy, the therapists do. The docs for the most part manage the psychiatric medications and overall care plan. Iamfenian likely knows more about the day to day stuff than I do.


And, no you don't get a 'sentence' because mental health care improvements aren't predictable.

 

I've seen two, one to visit a friend and the other for reasons dealing with my CJ bachelor's. Both were private run hospitals, with the wards on one floor and the regular hospital units on the other. Both were very similar experiences. Although the second trip didn't require giving up as many items. Both are run by the same company, just on opposite sides of town.

I can't speak for everyone, just for what I've seen. Now companies, and hospitals, are different in how they handle things. What they do here might not be what's done elsewhere.

Just my .02

 

My experience with psychiatrists tends towards them being pretty poor at therapy, you'd be better served by having a properly qualified psychologist on the staff as well.

No. In theory, if you were unwell enough to be committed by court order, then you stay there until you're well enough that you don't fall under the standards/requirements that got you committed in the first place.

This is a serious, offensive oversimplification of the situation.

 

@funky: Yes, I know that you are in grade school. However, you demonstrate a poor understanding for psychiatric clinical practice, which is what we are discussing here. Sadly, some psychologists would even make people believe that psychiatry is unnecessary and that psychology can treat all mental illnesses much better. However, results psychology has been able to achieve do not support this claim.
I worked as a psychiatrist in Australia and the UK so I have a good understanding of treating patients. I disagree with ostricization of psychologists from medical establishment, however, psychologists who teach kids like you this kind of caustic reasoning, make it difficult for clinicians (both psychiatrists and psychologists) to actually do their job.

I won't reply to your entire comment because it is excessively long, and repetitive in it's erroneous interpretations. I'll give you one example to illustrate the type of mistake you are making in your conclusions. You raised an issue of cross-cultural psychiatry. You mentioned that it's been found that "people in the Third world recover faster/more from schizophrenia than people in First world" and you extrapolate from that that it is the medicine which is available in first world that is somehow "impeding" the recovery". Although this conclusion is obvious, it's also wrong. There are many factors which contribute to this, and medication making people more schizophrenic isn't among them.

2 main ones:
1. Clozepine. It's been developed in China, and it's been used since 1950 to treat patients with psychosis. This practice has spread to Chinese influence zones, mainly Africa. Clozepine is extremely effective, compared to other antipsychotics, however, it has nasty side-effects including agranulocytosis. It is very rare, but when it happens it can kill. Also it has other more common but damaging side effects, for which blood tests and ECGs have to be done at regular intervals, in other words, what's the trade off? Psychosis goes away but at what cost? In the West, around 10% of schizophrenics take it, and not often long term, whereas in china it's more like 50%.
Perhaps in the West, we take a more liberal approach to treatment, taking whole health in consideration, while in some third world countries treatment is much more regimented and enforced, such as in China (not now so much but up until 10 years or so).

2. Threshold for diagnosis and threshold for recovery. A chronic schizophrenic male in Australia, who started university but can not finish it, and continues to suffer mild paranoia and delusions, negative symptoms etc, will be recognised as ill, whereas somewhere else he would be able to carry out simple tasks in a communal living situation and be considered a bit odd but "cured". In some places, only the active episodes (relapses) are recognised as illness, not the negative symptoms in between. What is clinical depression here in the UK, in Serbia it would be "someone who is miserable". That person would be repeatedly told to pick themselves up, deemed annoying and "negative" and nobody would think they are "bad enough" to actually take antidepressants. Only if they try to commit suicide would they be recognised as depressed. In psychiatry we consider that too late, and endeavour to offer help and support to people much earlier. Depressed patient in General Practice has 80% recovery rate on simple antidepressants. For this a correct diagnosis has to be made and it "ruins the stats" for us but the bottom line is patient's quality of life. This is why the stats do not reflect what you think they reflect.

I hope you understand this, but it's up to you. I won't reply to any more of your comments because it is very time consuming for me, and you will no doubt gain deeper understanding of these issues as your education advances. All the best!

 

The hospital I was at had two psychiatrists, but they weren't 'on hand' - ie, they had appointments with clients and were available for consult. One psychologist and, if I recall correctly, two psychiatric nurses dealt with the various group therapy sessions; the psychologist handled individual sessions but those were typically on a weekly basis.

The only "sentence" would be the mandatory hold period, that time during which it's decided whether or not there should be an involuntary commitment (typically 48-72 hours). Otherwise, the time one stays depends on the illness. There is the one exception (at least in my state and I believe several others) where sex offenders get "diagnosed" as incurable and shoved into secure mental institutions after serving jail time, but that probably isn't relevant to your story.